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Hospitals release lists of retail prices for services (modernhealthcare.com)
150 points by rgejman 41 days ago | hide | past | web | favorite | 115 comments

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.

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.

> 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?

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...

Vox: https://erbills.vox.com/

This has been my experience as well. The one time I had to go to the hospital while uninsured, while in-between jobs, they immediately tried to negotiate a settlement with me.

This has made me wonder what the point of these high prices are if no one ever pays them. My guess has always been that it has something to do with tax write-offs for the services that they never recoup.

Legal reasons. They cannot collect more than advertised retail prices but may collect less.

Fair enough, so still maybe not actual price without insurance. In that case at least. Makes me wonder if all facilities do this or something similar? Maybe that facility is particularly generous, or in the financial position to do that without the patient having to negotiate themselves. Maybe this could be an interesting app to make where people could report what that paid in the end :)

No, it's not normal. But being able to get a discount if you are uninsured is normal.

I've wondered whether the facility is particularly generous or whether it just starts with insanely high list prices. Now I guess I can find out. :)

But I still won't know what the final bill would be for the same procedure at a different hospital.

I want to see that app.

I really wish routine procedures had fixed prices so you know exactly what you're in for. Obviously there should be some limits, but you should know what you're in for with a low chance of surprises.

If prices were fixed, you could shop around if your procedure wasn't urgent. This ability to shop around means that prices should stay competitive, which will benefit people who don't have that luxury.

> A̶n̶d̶ ̶i̶t̶'̶s̶,̶ ̶m̶o̶s̶t̶ ̶c̶e̶r̶t̶a̶i̶n̶l̶y̶ ̶a̶ ̶r̶e̶a̶l̶ ̶p̶r̶i̶c̶e̶ ̶i̶f̶ ̶y̶o̶u̶ ̶h̶a̶v̶e̶ ̶n̶o̶ ̶i̶n̶s̶u̶r̶a̶n̶c̶e̶.̶

Aside, I hope crossed-out-text generators don't become popular on HN. Maybe a trailing "(not)" will have the same rhetorical effect, though I don't think it added anything to your post.

It triggered my browser's "Do you want to translate from Vietnamese?" pop-up.

It was an edit, not meant for rhetorical effect, I don’t think.

Oops, yeah I it was a later update... never would have imagined. Good to know, I'll refrain from that in the future.

I am hopeful of these changes, too. But market alone won't have any influence in deterring hospitals from charging arbitrary charges. Market works best when there are range of options available, but in case of hospitals in US only few big players are hoarding all medicinal resources leaving patients with no choice.

That doesn’t seem true. I live in a small city and have three major hospitals within a 20 minute drive, plus half a dozen urgent cares.

Most of the urgent cares in my area (Rochester, NY) are being taken over by the local university medical system. Those that aren’t are closing as a new URMC urgent care opens up across the street.

They own several hospitals in the city. They’ve also bought up several formerly independent hospitals in the surrounding more rural areas.

My understanding is that this approach is becoming increasingly common.

Well said. In the Health IT community many have been quick to dismiss it as useless data, but data is data.

> but data is data.

No, data that doesn't have any coherent practical meaning is worse than no data (well, it's worth exactly the same as no data if and only if you recognize the fact that it has no coherent practical meaning and disregard it entirely.)

One of the classic bad-management failures is finding some easy to quantify it irrelevant to purpose number and optimizing around it because, hey, it may not be perfect “but data is data”.

The worst situation is to have high deductible insurance. Then you have to pay the prices the insurance negotiates out of pocket (at least if you want the costs to apply against that high deductible).

If you don't have insurance the hospital will take what they can get.

No, the worst situation is to have no insurance and develop a super expensive condition. A high deductible insurance is way better for most people than either expensive insurance (you're paying for care you're not receiving most of the time) or no insurance (bankrupt by bad luck).

If you have a high deductible insurance plan (mines pretty high at >$10k for my family), keep cash in your HSA so you're not put out if you max it.

Or just tell them you’re paying cash and ask for that price. It won’t count toward your deductible but it could be significantly cheaper. I’ve seen urgent care facilities that charge $50 for cash patients and $130 for those with insurance.

It can go both ways - often the insurance negotiated price is significantly cheaper.

> 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.

I'm a doctor. I'm pretty sure I know what those things mean. But ya, wouldn't expect you to.

Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to.

I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.

I thought doctors had to be a but conservative due to lawsuit concerns and insurance requirements. I hear about concern over doctors misdiagnosing, so I'm guessing that doctors order more tests than strictly necessary to cover themselves.

> I think most doctors only recommend tests they feel will be helpful

Why are the rates of over-testing and over-diagnosis so high?

> Why are the rates of over-testing and over-diagnosis so high?

It is something health systems are aware of and working on, but if you go to the doctor with lower back pain and they say, get a better pair of shoes, take epsom salt baths, and deal with it, you might get frustrated. It doesn't cost the physician anything to order an MRI, but that procedure alone can costs $10k to your insurance, and may very well not reveal anything novel from the physical. But both the patient and physician feel more confident and there is no incentive against the physician for ordering the test. This particular example is such an issue, that a national quality measurement standards org has a measure dedicated to it:


And now that we are monitoring it (at some cases, down to the physician level), we can see awareness grow and individual physicians are changing their ordering habits. Very cool.

"helpful" may be defined as helpful in preventing the doctor from being sued

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.

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.

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.

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.

> 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:


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.

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.

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.

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

> if the end result is less people dying

That isn't the end result.

> > 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

So by “better” service you mean no service for the poor. That’s better? This is how you spin a system with worse health outcomes into something “better” — again, without citing a shred of evidence.

> the service is worse.

You keep saying this but you've never provided any evidence, and it's clear the US care is worse across a range of indicators.

Some people say the US system works best for the rich and healthy, but even they suffer because of the weird amount of over-testing and over-diagnosis that happens.


...is a total outlier country in every respect. It also has a vastly higher cost of living. Nominal salaries are not comparable with the US. Still, they're better than in other European countries, so their doctors (and many other professionals) flock to Switzerland (after having taken all their "free" training in their home countries).

By the way, health insurance in Switzerland is entirely private, but its affluent citizens are forced to buy insurance by law.


> literally every other country has "death panels"

Source? This term was invented by Sarah Palin and was judged 2009’s Lie of the Year by PolitiFact.[1]

> In America, everyone gets every treatment

You have no idea what you’re taking about. There are 28 million uninsured Americans and millions more who are unable to afford treatment due to high deductibles.[2]

You cherry-picked one statistic, but overall the U.S. has worse health outcomes vs other high income countries while spending 2X as much.[3]

[1] https://en.wikipedia.org/wiki/Death_panel

[2] https://www.cnbc.com/2018/09/12/rates-of-uninsured-in-us-hol...

[3] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

> Source? This term was invented by Sarah Palin and was judged 2009’s Lie of the Year by PolitiFact.[1]

The lie (or at least misrepresentation) was that Obamacare had a "death panel clause" in it. An argument could be made that it still does:


For the equivalent in the UK:


> You have no idea what you’re taking about. There are 28 million uninsured Americans and millions more who are unable to afford treatment due to high deductibles.[2]

Your source doesn't actually say that. It only says 28.5 million Americans are uninsured for whatever reason. A high deductible implies low monthly premiums. To give the example of the NHS, it's 13% of your paycheck - you don't have the choice. If everybody was forced to buy insurance, premiums could be lower as well. Obamacare is just a "have your cake and eat it too" system that cannot work in the long run.

You "Medicare for all" proponents simply need to own up to the cost and not keep bullshitting about how some European country has better care at less cost and therefore the US could have the same. It's just not comparable. Several countries like Germany or Australia also have a public-private mix system. That option shouldn't be off the table either.

> For the equivalent in the UK:

> https://www.bbc.com/news/health-28983924

What do you think this means? How are you understanding this article? Because I'm pretty sure it doesn't mean what you think it means.

Are you honestly saying US insurance companies don't do exactly the same thing?

When the government decides it isn’t worth it, you don’t have the option of paying for it anyway if you disagree. Hence the high-profile cases of parents with money, begging the government to be allowed to take their baby someplace else willing to treat him.

Insurance companies cannot prohibit you leaving the country.

> Insurance companies cannot prohibit you leaving the country.

Neither will developed-world single-payer systems, in virtually all cases. It sounds like you're referencing the Alfie Evans case, which a) was unusual enough to receive international headlines and b) involved a terminal, untreatable minor incapable of making their own decisions.

Hell, even in the UK, you can opt for private treatment - they've got a dual private/public system, as do many single-payer systems.

> you don’t have the option of paying for it anyway if you disagree.

Completely untrue in the UK. We have private healthcare alongside our NHS system. You can pay for it through insurance, or you can sell your house and pay for it in cash.

Hang on, are you talking about cases like Alfie Evans? Because that case had nothing to do with coat, and was entirely about what was in Alfie's best interests.

Doctors proposed a plan. The parents disagreed with that plan. The doctor's had to go to court to get permission to go ahead.

Contrast this with the US system. Doctors propose a plan and if the parents disagree it is them who have to go to court to stop the doctors.

> Are you honestly saying US insurance companies don't do exactly the same thing?

I certainly don't think it's "exactly the same", but that's not my point. I just wanted you to move the goalpost from "there are no death panels" to "okay, there are death panels, but they are everywhere, potato/patata!". Kinda like this guy:


Another possibility is to reduce the cost of care.

Indeed! Countries with Medicare For All type systems have a cost of care that’s half as much as the U.S.[1]

[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

Below market rate? That will be a shortage then.

Find cheaper options for people who don't want to pay as much. Innovate.

That's what I'm hoping for by making procedure prices transparent.

Firing all of those billing specialists and insurance people would save a LOT of money.

They are nevertheless a small part of the total bill.

Nope. They’re 8% of the bill, several times higher than countries with Medicare For All type systems.[1]

[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

That's total administrative cost. Given that (current) Medicare has high administrative costs as well, there's no reason to believe that the US will suddenly do much better with all its regulations.

Either way, whether it is 2% or 8% the bill will be astronomical. You would have to cut health care worker's salaries significantly to make a big dent in it. I'm not saying that shouldn't happen, but you better own up to it.

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.

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?

> 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?

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:



To me, these can be used to shame hospitals by using relative rates in comparison with other hospitals.

“Hospital x is the most expensive in the area by a 15% margin on average” hurts. Ideally these comparisons start forcing hospitals to compete by sheer embarrassment.

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

> These are the prices they charge people who lack insurance.

No, they are the fake numbers they keep around as starting points so that (1) insurance can claim to have negotiated price down, and (2) they can claim the inflated numbers to be the “usual and customary charge to the general public” for purposes of government programs like Medicaid which include the usual and customary charge to the general public as one of the factors in reimbursement rates.

> They're very real if you get a bill with them on it.

A number of providers give an automatic, no negotiation needed discount from the chargemaster to uninsured patients, and most of the rest expect to allow themselves to be negotiated down. The chargemaster isn't the real price, and has no consistent relationship to it across providers.

I think the expectation in these situations is that the patient goes into the billing office and asks for a realistic price, and the hospitals mostly say yes. Kind of like how Verizon kept doubling my bill and then every 6 months I'd call them and ask them not to double it and they'd mostly say yes. I guess the outcome is that anyone sufficiently savvy or with savvy relatives gets out ok, and the un-savvy people get deeply, shamefully screwed.

Which is a horrible system, but it has an interesting property. The more likely someone is to complain, the more likely the system will actually work for them. To me it seems like some perverse evolved survivorship trait, for the system itself. But then I don't work in the industry, so I could be wrong about all of this.

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.

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.

Too true.

I had a health issue and told them "no insurance", the prices dropped to nearly a third of what they would have been. So, it worked for me...

Better to say the fair price is 10-50% of the chargemaster. But if you’re not an insurance company and the hospital refuses to negotiate it down then that is the price you face.

(Source: we were billed $16,666.30 for 30g of IVIG after being told it would cost around $2,000 if insurance didn’t cover it. Actual insurance rate would be $2,850 but the hospital won’t negotiate.)

It was my understanding that the chargemaster prices are the ones defaulted to so that the insurers pay them, and that for individuals (e.g. uninsured) they'll be more willing to negotiate it down to 10-50%.

Or at least that's what I gleaned from the billing side during my stint in healthcare IT. Possible that we were an outlier, or (most likely) I just misunderstood.

Out of network insurers only, I think. In network has their own negotiated price of between 10-50%.

Uninsured rates of discount vary dramatically. From none to 90% or more.

It is an incredibly abnormal for a hospital to be unwilling to negotiate. It is quite normal to be given prices ahead of time that have no connection to reality.

> It is quite normal to be given prices ahead of time that have no connection to reality.

Why is this acceptable?

(You aren’t advocating for it, and are only “the messenger”, so I’m not critical of your comment, simply that it even happens.)

Because everything was set up for the consumer to not care what the prices are. Because doctors bill separately from the hospital. Because the pricing depends on so many variables. Lots of reasons, sadly. But this is a (small) step in the right direction.

Seems to me that the first step in getting chargemaster prices to closer reflect reality would be to publish them, so that someone (consumers, journalists, cyber activists, hospital administrators) can compare hospital prices to ones near by. Likely not sufficient, but a required step.

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

There are several companies that aggregate this data -- the industry term is "Cost Transparency". Amino, Castlight, Healthcare Bluebook, Change Healthcare, Vitals are all players in Cost Transparency.

I bet if you logged into your health insurance portal you'd find a cost transparency tool that could give you a reasonable estimate of what a common procedure would cost.

The unfortunate truth is price doesn't really matter.

1 - Insurers have negotiated rates with providers. They don't want that information shared.

2 - There aren't that many "shoppable" procedures. Shoppable = you're going to make a conscious decision to find the best possible price. Most common were major, non-emergency surgeries like hip or knee replacements or small stuff like imaging. Once you're in the actual care "flow", its highly unlikely to tell the doctor "how much will that MRI cost me? Let me check this app to drive across town and save $20."

3 - For all the talk about consumer demand for cost transparency, Cost is low on the list when it comes to determining if/where to get care. Quality, Availability (accepting new patients, how soon can they see me), Word of Mouth (friend/family recommended), matter more. Largely because....

4 - After a certain point (i.e. once I've hit my deductible) consumers don't care about cost as long as they're in-network.

(former PM of cost transparency application)

I somewhat disagree about #2: you can (and I have) ask your doctor to get an MRI or X-ray from a standalone imaging center rather than a hospital. That alone can shave about 60% off your bill. The "but only somewhat" part is that if your doctor really prefers a certain imaging provider, they may steer you in that direction. Ultimately, though, it's your call.

Disclosure: I work at Amino, but I'm speaking from personal experience and not for them.

I’d rather see a Glassdoor-like portal where you can see what people really paid for billed services directly or via insurance vis a vis the “list price”. That’d be helpful to advise folks who might be negotiating a medical bill to know what payment is likely to be accepted.

What's stopping you from building it? I was also interested in this but wanted to wait until this data became available. Could probbably OCR out people's names pretty quick as well to privacy for them and make em feel better.

Nothing stopping me from building it but hours in the day :)

Would love to do it actually

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

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...

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.)

Still useful for other non-emergency cases. And also, you could pre-choose the hospital when you're healthy!

Maybe if the apps get good enough you just hit a button and it auto calls the cheapest hospital after a bidding war :)

It will by means of fostering competition.

Shopping this way doesn't make sense though since these are list prices. How much they knock off the price for your insurance company or for the uninsured customer is necessary to shop intelligently.

Edited to add: Plus, reality is you can't really know until you get all the bills. How are they going to code the million different things they have to choose between?

I took my son to prompt care once because he had split the webbing between two of his toes and it looked to me like it needed stitches. The doc swabbed it clean and said he couldn't stitch it. He put some superglue on it and sent us home. Paying on the way out they wanted like $450. I said no. They called the manager and told him I wanted a payment plan. I said, no I don't. I want a reasonable bill. He told them to recode it. They said they had looked for a different code and couldn't find one. They looked again. They had a coworker look again. Eventually they recoded from a laceration to a cut or something like that. Dropped the price to $120ish.

(The superglue came off in less than 24 hours.)

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

One step at a time.

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

What other for profit corporations do this?

I would say, ones that are begging to be regulated more intensively. Disclaimer: I'd like to see the government generally begin to tighten the noose around the health care industry.

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

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.

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

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.

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."

I liked how they described it as "a blob of incomprehensible script.". It's JSON, which is a data format, not an incomprehensible script. If you're looking for a machine readable format, it's a pretty solid choice for this type of data on the web.

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

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.

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).

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.

Those are publicly available.

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

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


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.

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."

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.

> 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.

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."


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.

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

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

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

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