That is absolutely insane to me. I really don't understand how that's possible at all - I know no one really pays sticker price on any medical bills but still.
The MBA-ization of healthcare - they realized they could, so they did. Mostly because the business processes around medical billing have become so convoluted, with so many layers of middlemen, that it's essentially impossible for a layman to understand and reason about.
As someone in the healthcare field - the best way I can describe it is that providers and insurers fight it out however they can. The problem is is that patients get the shit end of the stick.
I think calling out that both hospitals and insurers are fucking over patients is a positive change. Hospitals used to always get a pass, but they’re a huge part of the problem.
I don't think many uninsured people are paying sticker. Sometimes they automatically get charged with a discount, sometimes they have to call and get it. Some folks don't know to call, but these folks' bills are, I expect, not usually getting paid in full in the end anyhow.
Which is stupid, since the price has no basis with reality.
The insurance companies know this - when they negotiate, they look at $90k for stitches and say “yeah, we’ll pay you $1,200”.
The uninsured get screwed because the hospital acts like their charge master prices have some basis in reality.
Since you're in the space, what do you think of the startup they mentioned in the thread, turquoise.health (or rather the idea behind it, not literally the startup)?
I went to the same ER in San Francisco with the same problem 3 months apart (kidney stones). The first time around I was uninsured and the bill was $2000- they told me that they'll cut it down to $500 if I paid on the spot, which I did. 3 months later I had the same problem, had purchased insurance, my bill came out to $8000 and my deductible was $2000.
I have been assuming the magic discount is some sham the insurance companies push for to scare people into believing they would not get it if it weren't for the insurance.
It's BS IMHO to not be advertising the ACTUAL cash amounts they would quote somebody..
One reason that stitching up minor cuts is so expensive could be that those who need that treatment (e.g. because they were in a fight) are statistically less likely to ever pay their bills…
But it still sounds scammy pricing tactic to me. That is not how stores or anything else works or should work.
I work in radiology and entered a few common procedures I see a lot in our data on https://turquoise.health/ (also linked in the Twitter thread). Then I entered information for our own HDHP+HSA plan. Guess what, having insurance costs you 40-60% more if it's an acute issue. So if you're healthy, you have zero incentive to use your insurance if you suddenly need a CT of something. The rub of course is if you pay cash, it doesn't count toward your multi-thousand dollar yearly deductible, so if it turns out to be a chronic issue you just shot yourself in the foot. But if it doesn't, you just burned thousands by using your insurance when you didn't have to.
It's a complicated issue and anyone who says they have the solution, including "just make it free / just have the government pay for everything," is either being disingenuous or doesn't understand the problem. As was stated in the Twitter thread, running a hospital 24/7 is astronomically expensive. Everyone has their finger in the pot trying to get paid for their services in a world of increasingly small reimbursements. Attending physicians as resident-run hospitals will sleep overnight while getting paid literally half a million dollars a year. Insurance companies will just decide not to pay something and will spend years in court to defend their right to pay whatever they want, down to and including $0. Vendors will charge tens of millions of dollars to implement monolithic thick-client applications where everything is so configuration-heavy that you literally can't have a test environment because it won't match. Interoperability is managed by a text-based standard named HL7 that if you're not familiar with, will make you rip your hair out. The standard itself is ignored by every organization who ends up with their own flavor, so every app needs to be configured to support nearly any value in nearly any field. Hospital IT is staffed by people making $40k/yr who don't understand modern computing, and run by executives with no technical background.
Every single entity and company involved in healthcare is complicit in the end result, which is skyrocketing patient costs with at best no change in patient care or patient outcomes.
But you said something that stood out - "Everyone has their finger in the pot trying to get paid for their services in a world of increasingly small reimbursements." Given the rising prices, why isn't the pot getting bigger?
What do you think of Epic systems and EHR stuff?
I think the pot is getting bigger but it's getting bigger for gigantic organizations like Kaiser (not calling them out specifically but it's a name everyone knows). Someone pointed out, either here or in the tweet thread, that the 2011-2020 price increases are just going to Stanford. The physicians don't see any of that because they have their own reimbursement, and the patient gets their own bill. When we ran billing in-house it was not uncommon for patients to call us with billing issues because they didn't understand (nor should they have had to) that our radiology service bill was separate from the hospital. Which was separate from the anesthesiologist. Which was separate from the lab. Etc.
I see the pot getting bigger mainly for insurance companies, and large hospital systems, in that order. Some docs in some specialties are doing as well or better than they were ten years ago but a lot of the primary care specialties just get whatever the Medicare reimbursement is and don't have any control over it. Insurance companies will pay them whatever they decide to pay them. So short of increasing the cash price on that minority patients, all of whom are going to be very price sensitive, the independent docs and small practices can't do much to move the lever. Healthcare software vendors seem to be making out like bandits because their clients are typically the large systems and insurers who are flush with cash.
How does almost every other country in the world manage to do exactly this then? Clearly it's a feasible solution elsewhere, so why not in the US? As much as I'd like to believe we're exceptional, I know that in the end we're really not.
There are some extremely good elements of American healthcare. Our healthcare education system with all its flaws is among the best in the world. We're a global center of medical and pharmaceutical research. Changes to the provider side need to take that into account or the entire world could suffer as a result.
How can anyone price shop without knowing any of the prices, and if no one is price shopping there isn't any pressure to lower prices.
It blew my mind - how can you NOT know?
Also, does your insurance cover these random bills or is it copay/80%?