NRO: Why Not Medical Pricing Transparency?

[Winehole23]

I have also found that, if you ask doctors how much a service costs, they tend not to know. I once had an argument with my doctor, who did not want to give me a blood test for fear that my insurer would deny the claim for the expensive test. I later found out that this test costs all of $9.48 at my insurer’s negotiated rates, despite a list price of $169. When I got orthotics, my podiatrist told me they would cost nearly $600. But that was the list price; the actual ]insured (http://www.nationalreview.com/agenda/285019/why-not-medical-pricing-transparency-josh-barro#) price was less than $250.

The extreme opacity of medical pricing undermines the high-deductible plan model. High-deductible plans are supposed to help control medical costs, because consumers, with “skin in the game,” will make frugal medical choices. But how can we exercise (http://www.nationalreview.com/agenda/285019/why-not-medical-pricing-transparency-josh-barro#) frugality if we have to make the choice to buy medical services before we know what they cost? How can we comparison shop if we can’t easily find out competitors’ prices?http://www.nationalreview.com/agenda/285019/why-not-medical-pricing-transparency-josh-barro

[RandomGuy]

I am still pissed at my kids pediatrician, and the testing center she sent us to for something that happened a while ago.

"Go here, get this test"

Ok, being a bit concerned, we went there, and while signing new patient paperwork, we were informed

"$500, upfront copay"

FUCK.

"Ok, here you go, it is important and we are genuinely worried about our kid."

We do some tests to rule out something really really serious.

Two months later, we get ANOTHER bill for ANOTHER $500, as part of the coinsurance.

FUCKITY FUCK FUCK.

Nobody told us anything in the entire process about how much this was going to cost, or what the real options/risks were.

I am reasonably sure the pediatrician didn't know how much it was going to cost, and you can bet your ass I will have a rather pointed conversation with her at some point.

[101A]

I am still pissed at my kids pediatrician, and the testing center she sent us to for something that happened a while ago.

"Go here, get this test"

Ok, being a bit concerned, we went there, and while signing new patient paperwork, we were informed

"$500, upfront copay"

FUCK.

"Ok, here you go, it is important and we are genuinely worried about our kid."

We do some tests to rule out something really really serious.

Two months later, we get ANOTHER bill for ANOTHER $500, as part of the coinsurance.

FUCKITY FUCK FUCK.

Nobody told us anything in the entire process about how much this was going to cost, or what the real options/risks were.

I am reasonably sure the pediatrician didn't know how much it was going to cost, and you can bet your ass I will have a rather pointed conversation with her at some point.

I feel your pain; or at least completely understand it.

If I were a braggart (actually I am, but I am lazy), I would find the post years ago where I stated that the FIRST steps I would take to control healthcare costs, is make all providers (1) Charge every person or entity the same price for any service - not dictate the price, just make sure whatever they charge one person, that's what they charge another and (2) Make those prices public.

Don't be surprised, btw, if the Pediatrician doesn't have some ownership in that lab.

[Winehole23]

*cough* McAllen *cough*

[2centsworth]

http://www.nationalreview.com/agenda/285019/why-not-medical-pricing-transparency-josh-barro

Has been my biggest complaint about healthcare. The blank check system has got to stop if we ever plan on controlling cost.

[101A]

*cough* McAllen *cough*

Thanks, looked through that thread - it wasn't there (or I missed it). What WAS there was me being an A-hole to Nono.

Sorry Nono.

[Winehole23]

I couldn't find the link either -- anyway, I was pointing the sharp end at McAllen.

[101A]

I couldn't find the link either -- anyway, I was pointing the sharp end at McAllen.

Well aimed.

[Winehole23]

search terms, cost and control:

http://www.spurstalk.com/forums/showthread.php?p=3799985&highlight=cost+control#post3799985
http://www.spurstalk.com/forums/showthread.php?p=3760050&highlight=cost+control#post3760050
http://www.spurstalk.com/forums/showthread.php?p=3693048&highlight=cost+control#post3693048
http://www.spurstalk.com/forums/showthread.php?p=3626849&highlight=cost+control#post3626849
http://www.spurstalk.com/forums/showthread.php?p=3592822&highlight=cost+control#post3592822
http://www.spurstalk.com/forums/showthread.php?p=2399586&highlight=cost+control#post2399586
http://www.spurstalk.com/forums/showthread.php?p=2245233&highlight=cost+control#post2245233

[101A]

search terms, cost and control:

http://www.spurstalk.com/forums/showthread.php?p=3799985&highlight=cost+control#post3799985
http://www.spurstalk.com/forums/showthread.php?p=3760050&highlight=cost+control#post3760050
http://www.spurstalk.com/forums/showthread.php?p=3693048&highlight=cost+control#post3693048
http://www.spurstalk.com/forums/showthread.php?p=3626849&highlight=cost+control#post3626849
http://www.spurstalk.com/forums/showthread.php?p=3592822&highlight=cost+control#post3592822
http://www.spurstalk.com/forums/showthread.php?p=2399586&highlight=cost+control#post2399586
http://www.spurstalk.com/forums/showthread.php?p=2245233&highlight=cost+control#post2245233

I am lazy, WH. You, on the other hand, are not. You're also very good and finding shit in this forum:


Generally regulations raise the cost of insurance, but not the cost of healthcare.

Ultimately, our healthcare is expensive because people get very sick, and it costs a lot of money to try to save their lives. No matter how you choose to pay for it, that is a truism.

I don't understand why people ascribe rules for health care that are different than for everything else. If your house burns down, it costs the same to build it again, regardless of how much premium you paid to insure it, or even if it was not insured at all.

That's not to say that in individual cases, the cost of healthcare is different depending on who's paying; but it macro, on a nationwide level; there are going to be X number of claims, and those claims are going to cost Y number of dollars. The majority of those claims dollars are going to be spent on very sick people either dying, or coming damn close to it; cancer/heart disease/dialysis/premature births.

Anecdote: My company's health plan spends about $12,000 per month - coerage for 25 employees; several spouses, and some children. $144,000 per year, for ALL of their healthcare. An employee in 2004 got Pancreatic cancer; was sick for 6 weeks, and died. Cost for that single episode? $620,000. Nearly six years of coverage for 25 families spent in 6 weeks on a single individual. The case is not unique.

Now, unless we limit what doctors are paid, or hospitals can charge OR don't pay for some of those "heroic" treatments; the costs are there - they are going to be incurred. The question is: What is the most effective, efficient way to pay for it? Obviously, we can eliminate paper work and inefficiencies in the system; and save dollars. But, remember, paperwork and inefficincies = clerical jobs for many Americans. Reducing those $$$$ reduces jobs.

How about this; We put Uncle Sam in a position to do the most good; while not being able to do the most damage (day to day operation and control of people's healthcare). Make the fed the ultimate stop-loss; they pay claims on individuals over $100,000 - to $250,000 (and index it to healthcare inflation biannually); private entities cover everything up to that point - with subsidies for people who cannot afford that lower coverage. The payor's file claims with the govt. for claims over the stop/loss - the govt. reimburses the claim; but doesn't have to get involved directly with the processing - although, obviously, they must have an ability to audit. Pass a regulation, not controlling prices; but making pricing by providers transparent (doctors/hospitals/labs); they must post their charges publicly; and must charge everyone the same price - whatever that might be (I cringe at this suggestion; but for reasons that are more complex than I want to explain - there are a lot of shenanigans that go on in contractual pricing that should be stopped).


What I think would help; short of price controls, would be for the hospitals to be made to PUBLISH their price for whatever they do - and charge the same for everybody. Then people could make decisions on where they get the most bang for their buck. As it is, you choose hospitals in this "market" system; without ever knowing the charges for a couple of months after you're released!

[boutons_deux]

"Pancreatic cancer; was sick for 6 weeks, and died. Cost for that single episode? $620,000"

which is insane. Pancreatic cancer is famously incurable and often very rapid after diagnosis, same with brain cancer. But the "cancer industrial complex" sees such cases not as chance for Hippocratic heroism and valiant efforts, but how to suck $Bs out of insurance companies and ultimately insurance clients.

[Winehole23]

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

[Winehole23]

http://www.spurstalk.com/forums/showthread.php?t=128644

[boutons_deux]

Hospital Billing Varies Wildly, Government Data ShowsA hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.

In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.

Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely.

The data for 3,300 hospitals, released by the federal Center for Medicare and Medicaid Services, shows wide variations not only regionally but among hospitals in the same area or city.

http://mobile.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?from=homepage

btw, as Repugs continue to gut and defund and knee cap Obamamcare, I read comment by the guy who implemented Medicare Part D, which was extemely complicated, and MUCH SMALLER than ACA health exchanges. Repugs' contribution? they have defunded the implementation of the exchanges to a number much smaller than they spent implementing their BigPharm subsidy called Part D, which includes the Repug regulation that the govt is forbidden from negotiating drug prices, must pay whatever the BigPharma wants.

for-profit health care is a huge, wealth-sucking/upward-redistribution disaster, and there's nothing Human-Americans can do about it.

[boutons_deux]

Anatomy of the World's Most Insane Health Care Billing System
A permanent pacemaker implant at Pennsylvania's Phoenixville Hospital is billed at $211,534. Four hours away at Unitown Hospital, the same procedure costs $19,747, or 91% less. 163 hospitals across the country charge at least $100,000 for a pacemaker, while 46 charge less than $30,000.

The official bill rate to treat chronic obstructive pulmonary disease, or COPD, at Bayonne Hospital Center in New Jersey is $99,690. At Lake Whitney Hospital in Texas, it's $3,134, or 97% less. Thirty-five hospitals bill an average of more than $50,000 to treat COPD, while 161 bill less than $7,500.

A kidney and urinary tract infection faces a $132,569 bill at Crozer Chester Medical Center in Pennsylvania, but $6,224 at Wyoming County Community Hospital.

http://www.dailyfinance.com/2013/05/14/anatomy-of-the-worlds-most-insane-health-care-bill/

iow, for-profit health care is a disaster, nothing but a strategy to extract/redistribute wealth upwards.

[Winehole23]

more of the same: CA hospitals charge from $10 to $10,000 for a lipid panel

http://bmjopen.bmj.com/content/4/8/e005482.short?g=w_open_current_tab

[TDMVPDPOY]

my friend paid for a pacemaker for his dad around 10k only in vietnam...

[HI-FI]

my friend paid for a pacemaker for his dad around 10k only in vietnam...
my vietnamese neighbor paid very little to have a kid in Vietnam, she went back home to have the insemination done for real cheap. I would've gladly creampied her repeatedly but I think she wanted a pure nip, which is understandable. I think our kid would've looked fucking weird, but the offer for filling her pussy still stands.

[TDMVPDPOY]

my vietnamese neighbor paid very little to have a kid in Vietnam, she went back home to have the insemination done for real cheap. I would've gladly creampied her repeatedly but I think she wanted a pure nip, which is understandable. I think our kid would've looked fucking weird, but the offer for filling her pussy still stands.

im going back to get some dental work done, fkn crown down here costs like $2k, back there probably lesser then that.....going for 3months hopefully...

[boutons_deux]

Another transparency problem with medical costs

Government Will Withhold One-Third of the Records from Database of Physician Payments

Next month, when the federal government releases data about payments to physicians from pharmaceutical and medical device makers, one-third of the records will be withheld because of data inconsistencies

The issue is the latest hurdle for the federal government as it seeks to launch the already-delayed Open Payments database (http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/index.html)mandated under the Physician Payment Sunshine Act, a provision of the 2010 Affordable Care Act. Making this information public is a crucial step in promoting greater transparency about conflicts of interest in medicine.

The Centers for Medicare and Medicaid Services first turned up flaws in the data in the past two weeks, while investigating a physician's complaint (http://www.propublica.org/article/glitch-prompts-temporary-shutdown-of-pharma-payment-verification-system) that payments were being attributed to him even though they were made to another physician with the same name. In the process of reviewing that issue, it found "intermingled data," meaning physicians were being linked to medical license numbers or national provider identification numbers that were not theirs.

"CMS is returning about one-third of submitted records to the manufacturers and [group purchasing organizations] because of intermingled data, and will include these records in the next reporting cycle," CMS spokesman Aaron Albright said by email. These records won't be posted until June 2015.

CMS didn't say how many records were involved, but the number of records withheld could be in the millions, if not tens of millions.

http://www.propublica.org/article/government-will-withhold-one-third-of-the-records-from-database-of-physicia