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Comment by satronaut | Hacker News Reader

You're in charge of literally saving lives but you can't handle something as standard as cost estimation? How can you joke about that? Figuring out the cost to the hospital in terms of materials and labor should be standard.

Example, an x-ray. You know you need to pay an x-ray tech X$/Hour and after doing 1,000's of x-rays, a hospital should have it down that somebody with a broken leg will require N hours (maybe .5, maybe 1.5) to setup and take the x-ray. x-ray film costs HAVE to be known. the x-ray machine life time and number of shots should be known. Then do something like a 30% surcharge for admin fees and boom, x-ray cost.

Every other industry estimates this way, what makes a hospital different?

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You forget that the x-ray is propping up about 50 admin job positions that don't directly generate revenue. The army of compliance, insurance, billing, etc etc etc employees have to get paid somehow.

But hopefully this price transparency helps us ask the question of why does an x-ray have to pay for a ton of positions which have nothing to do with x-rays, and how do we correct this situation.

You could say the same about any other service work. If I have the internet guy come out there's probably 50 admin job positions that bill for that time too. Internally they bill the installation department. Hospitals are just complaining to make it seem more complicated than it actually is.

> You're in charge of saving lives but you can't handle something as standard as cost estimation.

The irony, coming from a profession which is notoriously bad at cost estimation.

But in any case, the difficultly is not so much the materials/services as much as figuring out what the patient's insurance company (which is completely different then the practice) will cover and by how much. But of course that's actually what matters to the patient.

They know medicine, not the intricacies of your particular insurance policy.

Source: Am founder of rivethealth.com which does cost estimation.

Because the broken leg could be a gun shot wound, or an alcoholic who fell down and now is withdrawing, or a geriatric patients who is abused at home or a person who fell due to side effects of drugs with alternatives, or a cancer patient with bone metastases.

No one gets an x-ray for a broken leg then leaves with their foot broken. Even assuming that you are just trying to figure out the cost of an x-ray - there is a radiologist involved (unless you want to read it the x-ray on your own) and how they bill is a whole total beast!

But we are just talking about an x ray here. Estimating the price of a radiologist per hour is not hard.

It shouldn’t be this difficult to price x rays at a per hour or per shot basis.

Pretty much every industry has variability in their jobs. Sometimes they eat some money and sometimes they make more based on what actually happens during the job fulfillment.

No one expects (or should expect) hospitals to literally know the amount of parts and labor for every single x ray they could perform. However, like literally every other business, they should know rates and tiers such that on average they make money. Then, disclose that.

I'm not following why any of that matters to the cost of an x-ray. If there's a gunshot wound and there needs to be a nurse attending to the patient while the x-ray is being taken, the nurse is an extra cost, separate from the x-ray and the x-ray tech. The cost of the x-ray itself shouldn't change.

I'm talking about the x-ray, nothing more and nothing less. If they have a broken foot and need a cast, the cast should be an estimatable line item based on where it's broken, age/gender/size of the patient, and materials used. If a doctor has put a cast on 1,000 broken feet on men aged 12-16, they should have a very good idea of the material and time it will take and the number of nurses or whatever else they need to put it on.

To be fair Boeing doesn’t know how much an airplane cost.

There's R&D, and then there's the actual manufacturing. Sure, prices go down after a while, but you can track costs accordingly.

If you know (because you have blue prints) that the materials will cost 1,000,000 to build the plane (because your suppliers gave your price quotes), you can have a very good idea of what that plane will cost before putting it on the assembly line.

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