
Hospitals release lists of retail prices for services - rgejman
https://www.modernhealthcare.com/article/20190107/TRANSFORMATION04/190109931
======
40four
This is very exciting to me. I have been wanting this for a long time, and I
belive it's a small step towards improving the healthcare system in the United
States.

It shouldn't matter these aren't he "real" prices, as so many folks have been
quick to point out. But it's the starting point for what ever you think the
"real" price is, and it's information that has never been easily accessible to
the public until now. A̶n̶d̶ ̶i̶t̶'̶s̶,̶ ̶m̶o̶s̶t̶ ̶c̶e̶r̶t̶a̶i̶n̶l̶y̶ ̶a̶
̶r̶e̶a̶l̶ ̶p̶r̶i̶c̶e̶ ̶i̶f̶ ̶y̶o̶u̶ ̶h̶a̶v̶e̶ ̶n̶o̶ ̶i̶n̶s̶u̶r̶a̶n̶c̶e̶.̶
Maybe not? Some are saying this isn't always the case in certain instances

We are all about markets in this country, so now it will be much easier to
determine if a facilities prices are out of whack with its peers in it's local
market. I don't know how much normal people will actually use this on a day to
day, but I'd imagine this will open the door to some new services / products
that could help regular people parse the data.

I hate that people think this is a bad thing. The comment thread in the story
about this trending here a couple weeks ago was so dissapointing. It makes
sense to hear the hospital executives try to downplay or spin this in a
negative light. I suspect some of them are nervous about what will be found...
that some shenanigans might be exposed.

I belive easy access to this data to be incredibly valuable. I think it's a
win for regular people and the health of our markets. Just because it's not
the price I pay after insurance doesn't make it misleading or irrelevant.

~~~
jtbayly
One hospital that I use immediately takes 48% off the bill if you are
uninsured without even being requested. As indicated elsewhere in this thread,
this is not generally the non-insured price.

I'm afraid it is mostly irrelevant, but it is _definitely_ the first step in
the right direction. As somebody else said, it's more important to find out
what real people ended up paying for a procedure after it was all said and
done.

~~~
mehrdadn
> As somebody else said, it's more important to find out what real people
> ended up paying for a procedure after it was all said and done.

Is there a bill-sharing website to cure this information from people
voluntarily? Maybe someone on HN would want to start one up? Or would people
be too reluctant to share details of procedures?

~~~
ceejayoz
Several news organizations are collecting bills (and doing some great
journalism with what they've collected thus far).

NPR / Kaiser: [https://www.npr.org/sections/health-
shots/2018/02/16/5855495...](https://www.npr.org/sections/health-
shots/2018/02/16/585549568/share-your-medical-bill-with-us)

Vox: [https://erbills.vox.com/](https://erbills.vox.com/)

------
abalone
_> Modern Healthcare decided to see how long it would take to present the data
in a more consumer-friendly format. It took less than two hours_

Having been through several hundred thousand dollars of chargemaster charges
with one of the hospitals on this list I can confidently say this info is not
consumer-friendly _at all._

First of all, did anyone look at the damn PDFs? Do you have any idea what a
"HCHG SP EVAL MTN FLUOR SWAL 75" is or a "HCHG XR RIBS BILAT W PA CXR"? Does
this really equip the typical healthcare consumer with the ability to "shop 'n
save"? No. They are going to ask their health insurance provider if the
hospital is in network, and the health insurance bureaucracy has the experts
who pour through and negotiate all this crap.

Second, even if you had about a year of your life to educate yourself about
the hundreds of myriad codes like this that are involved in various procedures
and take it upon yourself to compare hospitals, this would be like comparing
hotels based on their rack rate. You might get a sense for things but nobody
pays that. Everything is negotiated down. Even for the uninsured who usually
either get a 50%+ discount or pay whatever they can pay and kill their credit
or go bankrupt. Which is not to imply in any way this is affordable for
anyone, just that chargemasters aren't a super useful way to compare pricing
even if you could figure it out.

Third, it's a free market fantasy that more "consumer" info will fix this
system. Many patients are not in a position to comparison shop anyway. It is
the epitome of a market failure.

If you want to fix this system we need Medicare For All.

~~~
zeroname
Medicare for all would easily bankrupt hospitals. The money needs to come from
somewhere. Either force people to buy insurance or raise taxes massively. Pick
your poison.

~~~
abalone
Literally every other industrialized country has a Medicare For All type
system and somehow the hospitals manage to stay open.

And you can’t mention a tax increase without mentioning the savings of not
having to pay for private insurance.

~~~
zeroname
I am talking about actual Medicare, which causes big losses for hospitals.
Those need to be covered, that is my point.

You can not just import other nations healthcare systems. Those are cheaper
because the doctors and nurses earn less and the service is worse.

~~~
abalone
You don’t cite any evidence to support your claim. Most U.S. doctors graduate
with >$100K in medical education debt. Other countries have better health
outcomes, so that pretty much kills your “worse service” claim.

Rob Delaney is a great example of an American who experienced both US and U.K.
systems in depth. Look him up.

~~~
zeroname
> You don’t cite any evidence to support your claim. Most U.S. doctors
> graduate with >$100K in medical education debt.

You posted a source yourself:

[https://news.harvard.edu/gazette/story/2018/03/u-s-pays-
more...](https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-
health-care-with-worse-population-health-outcomes/)

Salaries are almost twice as high. Those other countries also tend to have
higher taxes and other salary deductions, so doctors earn less.

> Other countries have better health outcomes, so that pretty much kills your
> “worse service” claim.

No it doesn't. Not every US citizen actually receives the service, because
they want to (or have to) save money, kicking the problem down the road,
exacerbating the issue. Americans also tend to be more obese.

You call the "cancer survival" rate a cherry pick, but it's actually a good
indicator how good the actual treatment is and how timely it is administered.

> Rob Delaney is a great example...

One guy's opinion isn't "evidence" either. I could give you individual health
care horror stories from single payer countries, but that would be emotional
manipulation.

~~~
DanBC
Everyone knows that 5 year cancer survival rates in the US are high because
the US over-tests so much.

This is evidence that harm is being caused. It's not evidence of a good health
care system.

Why are male incontinence products so prevalent in the states? It's because
men are pushed to get PSA and similar screening for prostate cancer. This
means the US detects a lot of slow growing cancer that's unlikely to kill
someone (which improves the 5 year survival stats), but it also means that the
US then provides treatment to those men. That treatment has side effects.

~~~
Sir_Vival
It doesn't seem like "over testing" or "harm" if the end result is less people
dying. The fact of the matter is that I was able to get an MRI the same day I
went to the doctor with an issue twice in the US. One of those times was for
severe recurrent headaches. The doctor didn't think it was a tumor (and it
wasn't), but he did it to be sure. If I were in Canada chances are I would
have waited months for that appointment. In the worst case that would mean the
tumor had time to grow. In the best case that's months of unnecessary worry,
which isn't healthy in itself.

~~~
icebraining
If you were in Canada you could get that MRI privately and still probably save
quite a bit of money.

------
curiousgal
I find this whole situation ironic because whenever I come across a news
article online of some Third World country making an improvement, mostly in
regards of human rights like Saudi Arabia allowing women to drive or Tunisia
passing inheritance equality laws, the general response is "Meh, this
shouldn't have been an issue to begin with".

When it comes to the U.S., particularly with anything that involves its
helathy care system, the slightest event is considered a step in the right
direction. Well guess what? I wholeheartedly believe that it is both sad and
pathetic to consider this as a win for the people against the healthcare
_industry_. A country as rich as the U.S. and that spends on healthcare per
capita more than other countries like Canada, should not have a for profit
system.

A "hospital's retail price list" is the epitome of a for profit system, those
words shouldn't even be in the same sentence together.

I understand that HN crowd is probably in the top 10% of the country so
advocating for the system to change probably is of no concern to us, but let's
not lie to people and say things are getting better when they clearly are not.

~~~
cdoxsey
Healthcare systems are not uniform. Canada or the UK's system is quite
different from other systems. For example the Netherlands has a hybrid system
that utilizes a competitive, private, for-profit insurance market (with
subsidies from the government). I think a lot of first-world countries have
systems like that. (they aren't publicly managed, single-payer systems) And
given the rhetoric on this issue I was very surprised to learn that.

I agree that the US system is in need of major reform, but prices, competition
and markets can be an important part of a healthcare system for price
constraints, innovation, mitigating corruption, etc.

As an example, consider food stamps, which helps people get food, but does so
via the private market. The program would be a lot worse off if the Government
decided to open grocery stores or tried to run the whole supply chain.

Perhaps a similar line of reasoning applies to healthcare?

~~~
splintercell
> For example the Netherlands has a hybrid system that utilizes a competitive,
> private, for-profit insurance market (with subsidies from the government).

I am always skeptical of these claims. We have a hybrid system for higher
education which utilizes a competitive, private, for-profit education market,
with heavy subsidies from the govt (given to the students in the form of aid).
Look what it looks like, ever increasing prices.

Take our K-12 schooling system, again the same problem, somehow it works great
for other racially homogenous European and Asian countries, but in America, we
spend far more on public education per students, and get worse results.

So why is the belief that our healthcare system is going to look like
Netherland's when our education system doesn't look like that?

------
nonbel
Those are not the real prices. Those are "chargemaster" prices, they are
pretty much entirely irrelevant. The true price is usually going to be
somewhere between 10-50% of the chargemaster:

[https://en.wikipedia.org/wiki/Chargemaster](https://en.wikipedia.org/wiki/Chargemaster)

[http://selfpaypatient.com/2014/01/03/insured-patients-can-
sa...](http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-
by-pretending-to-be-uninsured/)

~~~
all_blue_chucks
Nonsense. These are the prices they charge people who lack insurance. They're
very real if you get a bill with them on it.

~~~
jtbayly
Nope. Those are the prices that they start with that your insurance claims
they negotiated down to 50% or whatever on your bill from insurance for your
copay.

You can see the problem. Both the hospital and the insurance company are
incentivized to keep that number artificially high.

~~~
toomuchtodo
They (hospitals, out of network specialists) are also under _no obligation_ to
negotiate with you. You are on the hook for whatever your insurance refuses to
pay, which can be substantial regardless of what your deductible is.

They might negotiate with you, but they might not, in which case you are at
the mercy of whatever your state's creditor laws are. Florida? Great laws
protecting your primary residence and wages from garnishment if you're head of
household. Missouri? Not so much.

~~~
jtbayly
Too true.

------
kylec
Now that this information is public, I'm looking forward to the startups that
will aggregate this info and let you cross-shop hospitals to get the lowest
price, like for flights

~~~
rocketpastsix
Not sure how that will be helpful if you are in the middle of a heart attack
though.

~~~
orangecat
True, but emergency care is a much smaller portion of medical spending than
many people realize: [https://www.politifact.com/truth-o-
meter/statements/2013/oct...](https://www.politifact.com/truth-o-
meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-
just-2-percent-all-hea/)

~~~
dragonwriter
That's emergency _room_ care, but it's not like you're going to be shopping
for care for most care provided in admissions from ER either (especially,
e.g., ER -> ICU admissions.)

------
adzm
What we really need is to make insurance coverages and deals public as well,
for services and prescriptions.

~~~
tehlike
One step at a time.

~~~
analog31
Indeed the entire ledger should be made public, so we see how prices vary
depending on circumstances, and also, where the money is going.

~~~
all2
What other for profit corporations do this?

~~~
bmogen
What other for-profit corporations operate within the premise of improving
public health and have multiple federal agencies overseeing their operations?

~~~
all2
My intent was not snarky, I actually would like to know if there are for-
profit organizations that open their ledgers for regulatory purposes. I think
its an interesting question, and there are implications if there is a
precedent that health care organizations could follow.

~~~
crankylinuxuser
Investment banks do. In fact, it's how the SEC catches fraud and other foul
play maneuvers.

------
nopinsight
Startup idea:

Help (potential) patients compare approximate total prices of different
hospitals based on the patient’s conditions, diagnoses, insurance plans (or
lack thereof), personal health profile, etc.

Display info as tables and charts in a user-friendly manner. Give users the
option to drill down to see details. Update estimates as more information is
known (e.g. after lab results come in).

Support what-if scenarios for cases which diagnoses are still unclear.

------
kbsletten
I _love_ the passive aggressive stab at Sutter.

"Modern Healthcare decided to see how long it would take to present the data
in a more consumer-friendly format. It took less than two hours - with a break
for lunch - to create the 29 PDF files linked below."

~~~
Forge36
The requirement did state "machine readable". Arguably Sutter's data is the
easiest to read, this is further evident through the creation of PDFs to make
the data human readable so quickly

~~~
AznHisoka
I agree. When i read that knock on Sutter, I thought it would be great if
_everyone_ released the data in JSON, making it easy to download, parse and
compare! Let a third party build that useful price comparison tool - just
provide the raw data.

------
bmogen
The startup that can take this data and hide it behind a UI that people use
WHILE THEY'RE HEALTHY and then optimize care pathways before a health issue
arises will be great (although probably not a great business).

------
jfoutz
I haven’t looked in years, but the prices and regional modifications paid by
Medicare were available. Check the docs for electronic submission.

Maybe that’s been taken down?

Always seemed like a reasonable place to start.

~~~
refurb
Those are publicly available.

And if you want a sense as to what the REAL prices are, those rates are pretty
damn close.

------
nickpsecurity
Adam Ruins Everything has a skit on this for people who haven't heard of it:

[https://www.youtube.com/watch?v=CeDOQpfaUc8](https://www.youtube.com/watch?v=CeDOQpfaUc8)

On one of my non-insured years, I did get a five-digit bill like one in the
video. Then some more from a bunch of other companies. It shouldn't have been
legal. Especially given I couldn't exactly shop around for better prices with
them all faking them.

------
EamonnMR
These are the stick that they threaten to beat the uninsured with to bargan
with insurance companies. The entire process is ridiculous, and while they can
hide behind whatever they want to say the "real" prices are, these are the
threat. "I won't pull this trigger, I'll just wave it in your face until they
empty the cash register."

~~~
nonbel
You've got it wrong. The uninsured don't pay these prices, the insurance
companies don't pay them either.

The people getting screwed are those who pay a deductible/co-pay based on the
inflated prices, ie the people who pay for health insurance.

~~~
dragonwriter
> The people getting screwed are those who pay a deductible/co-pay based on
> the inflated prices

I.e., insured patients getting service from _out of network_ providers;
otherwise, if you have insurance, and you are paying deductible or co-
insurance, it's based on the insurance negotiated price, not the chargemaster
price. OTOH, if you are paying a co-pay, it's a flat fee in your insurance
policy and the actual (chargemaster or negotiated) price is irrelevant.

~~~
nonbel
You sure about that? I am fairly certain I've read of cases where it made more
sense to pay the uninsured rate (because uninsured rate is even less than the
deductible).

Eg, the chargemaster rate could be $10k and you have a $2k deductible but the
uninsured rate is $1k:

> _" Because of the way insurance contracts are typically structured between
> providers and insurers, the provider is required to charge the full
> “negotiated” rate they and the insurer have agreed to, even though the
> patient is paying the entire bill themselves. This creates the odd situation
> where someone who is uninsured will get a better price than someone with
> insurance, even if both of them are paying the whole bill themselves."_

[http://selfpaypatient.com/2014/01/03/insured-patients-can-
sa...](http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-
by-pretending-to-be-uninsured/)

------
woogiewonka
Is anyone planning to scan all the available PDFs or data sources and put
together a comprehensive tool for all hospitals in each state? Now THAT would
be a hell of a tool to get hospitals scrambling to lower "not real" prices.

~~~
ocrcustomserver
Does a list of all hospitals (in each state) exist somewhere?

~~~
ocrcustomserver
Found this:
[https://www.reddit.com/r/datasets/comments/4lxnjj/request_li...](https://www.reddit.com/r/datasets/comments/4lxnjj/request_list_of_all_the_hospitals_in_the_us/d3vliej/)

------
spsrich
So it's not the first random number they pull out of their ass then ?

~~~
tehlike
You can still arrive at astronomical numbers by "combining" random number of
procedures, or having random negotiated prices with insurances.

