Does such a thing exist? It seems possible with 2023 tech, although it probably needs to know health insurance details to do its job well. I think millions of US citizens would subscribe.
Does such a thing exist? It seems possible with 2023 tech, although it probably needs to know health insurance details to do its job well. I think millions of US citizens would subscribe.
Even beyond just collecting and organizing the disparate files (which Alec has been doing a yeoman's job of with an all-volunteer force), you quickly realize that many of the quoted prices are just flat out wrong, or, at best, misleading. Even people in the business struggle to make sense of them.
An example: you look at a hospital MRF to see the cost for a knee surgery on a BCBS plan and it just happens to be exactly 3.5x the Medicare rate. Then you look at all their other quoted prices in the MRF and realize they're _all_ 3.5x Medicare. Someone in the billing department was really lazy putting together that MRF! Then you look at the BCBS MRF and see a rate which is 1x Medicare. Definitely not right. So you ask the BCBS affiliate what gives and they say the hospital you're looking at is on the ancient APC billing codes which means the HCPCS code you were looking at for the knee surgery would never be billed by this hospital and all the rates you just looked at are complete bunk. Now, take that knowledge and make a simple-to-use, mostly correct user-facing website! Because if you quote the wrong $ amount, the internet will roast you alive.
As I said, it might exist sometime in the next few years, but it will take a lot of behind the scenes effort to make it work.
Some of the folks working on this problem:
It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.
Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.
On the optimistic side, what will happen sooner rather than later is that most billing codes will converge to an average market rate. Right now, there's no invisible hand guiding reimbursement rates because no one knows what anyone else is getting.
Once a market rate is established, it'll be easier to compare providers. Provider A will be 15% less across the board than Provider B, but might have younger docs or lower quality scores.
Yes, such thing exists.
My friend just had an endoscopy & colonoscopy together. She was able to get a price estimate through her hospital's portal both with and without her insurance, prior to her procedures, requiring no special interaction besides picking the service she was interested in and if she wanted to see the price with or without insurance.
The system seem to show her anything and everything she needed, from a routine office visit, these procedures, to delivering a baby. It not only includes the price at that facility but also a range from low to high, and where the facility fits. It also gives breakdown of the fees, although not deep enough.
The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.
Epic is the biggest provider of hospital information systems in the US by market share. The hospital was probably using their software.
Lol, that mom and pop shop.
That’s the largest EMR vendor in North America and second in the world.
They’re the provider of the patient portal frontend amongst other things but there’s a lot more behind the scenes that must be done (with varying levels of quality) that is institution specific. Just using Epic does not make this work.
I grew up in Madison, Wisconsin. Most of my graduating high school class works for Epic. Their campus rivals Google's. Fun fact, they bought all the farm land you can see to the horizon and rented it back to the farmers for below market rates just to ensure the view from their campus was unobstructed by new development.
If you think anything about Epic is free or in the patient's best interest, check out their auditorium: https://cuningham.com/portfolio/epic-deep-space-auditorium You could host a Taylor Swift concert in there and have unused seating.
Taylor Swift regularly sells out venues with capacity of 70k+ (football stadiums), it's doubtful she would even consider an 11k venue unless it was a private event.
So I would say your statement is extremely disingenuous to say the least.
Might well be the actual care runs you $3500, but then you need to add $1000 for the aspirin they gave you, $800 for some gauze, and another $2500 for that MRI, because by jove it will be amortized.
And at that point, you have a negotiable bill - because all health care bills in the US are open to negotiations. The insurance strategy to negotiation is usually a simple "yeah, we only cover that much, and you'll like it". The private strategy is reminding hospitals that they only make cents on the dollar if it goes to collection.
Don't get me wrong, price transparency would be an enormous step forward for the US, but it's still just one step on a long road, and it won't be as useful as you'd hope.
And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.
“Hold please 911, I need to first get three competing quotes for ambulance service”
I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional.
I've also been in the ER when brought in by an ambulance, in which case I was seen immediately.
These were both billed at the highest level, when the 1st case clearly shouldn't have been.
If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
The equivalent would be when you're hungry and need to buy food at the grocery store, asking how you can manage that since you are going to have to pay for the food cost, the shelf space cost, the trucking cost, the refrigeration cost, the cashier, the bagger, etc. In actuality, the grocery store comes up with a single price that they're comfortable selling an item of food for, puts in on the shelf, and you can take it or leave it at that price.
The only way the medical industry can get away with their ridiculous bullshit is seemingly through a bunch of laws they bought whereby they can saddle people with debt without actually having done the work of forming a contract. Hence why you can visit a single business, and then end up getting a slew of bills from arbitrary providers that you had no relationship to. That simply cannot happen in other industries, where the only basis for billing is having formed a contract.
The equivalent for cancer is they'd lay out several treatment options (as they're already doing while ignoring prices), listing the price for each, the price and recommended frequency for followup monitoring, etc. You could then ask different providers for how much their treatment cost. Ideally the places administering treatment would be unbundled from the doctors doing the diagnosis, and the diagnosing doctors' office could give you a list of competing treatment providers. I know I'm hand waving away a lot of details here, but the whole point is that the intrinsic complexity of the problem needs to be modeled around cost, rather than treating it as an afterthought, creating a bunch of accidental complexity that ignores cost, then trying to manage it after the fact.
(And note that this is still orthogonal to who is ultimately paying, whether legitimate insurance to pool risk, subsidies for those who can't pay, etc. It's easiest to see what the current system is lacking when you look at things that "insurance" doesn't cover. For example a hospital stay, I would guess most people here would pay $100/night to have a single room rather than a shared room with a roommate always setting off their bed alarm etc. But there's simply no way to express that to the system currently, creating a zero-sum environment of scarcity, rather than a positive sum environment of abundance)
My point is that we have a whole bunch of policy nerds hand waving this complexity away and saying “enjoy your hsa- go forth and price compare as the invisible hand of the free market will provide!” Unless there is force from above, there certainly is no way the masses can navigate the system and force change themselves.
And the truth is that stuff does happen that’s not anticipated. My wife’s surgery was supposed to be routine. I would have had no idea ahead of time that there would be a lingering internal infection afterward. Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”.
If a tradesman screwed up a plumbing job, he would be called back to fix it at no cost. Instead I’m (or in this case my insurance) is stuck with >$100k of bills from the ICU to bring her back from the brink. I consulted with several malpractice attorneys who basically said unless the surgeon was drunk and slurring his words while operating, there is no case. The standard of care is so low.
High level points, from what I can tell -
1. The laws/regulations enabling the current system/cartel need to be scrapped. This includes the ability for providers to unilaterally assign arbitrary debts to patients, and the regulations enshrining the existence of HMOs (I assume these exist because HMO "networks" look exactly like what an 80's Coase fallacy drunkard would think constitutes competition)
2. New regulation / anti-trust enforcement needs to be applied to providers, such that they must publish clear prices for standard services that are comparable across providers, and straightforward hourly rates for anything that cannot be captured on there (with any nonconforming bills being considered attempted fraud).
3. New regulation / anti-trust enforcement needs to be applied to insurance companies, outlawing "provider networks" and rephrasing all insurance coverages purely in terms of prices, applying to any medical service from any licensed medical provider. That parallel "medically necessary" approval system needs to be entirely eliminated.
> Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”... The standard of care is so low
Routinely experiencing that dynamic of poor care [0] from the medical industry is exactly what makes me shake my head at the simplistic "fix it by having the government take it over" narrative. Ballooning costs and individual ability to pay is a problem, yes. But the much larger problem is the utter waste of medical talent, because the system has been designed around terms of top-down paperwork-filling rather than responsiveness to patients. The doctor should have been working for you, and you should have been able to get more time/attention for the doctor to have taken you seriously. But that was impossible because the "insurance" company dictated that you got one tiny follow up appointment, with the doctor focusing on filling his seat during that appointment, doing the bare minimum that conforms to the top-down standard of care, and avoiding doing anything extra that might create legal liability.
[0] Although not as much malpractice and completely avoidable as yours. I'm sorry for what you both went through.
You are doing some extremely heavy lifting here with this sentence alone by trying to connect two unrelated clauses. Consider the following: Is Water expensive? Is it expensive due to an innate characteristic of water, or is it expensive due to scarcity?
Now with that in mind, why is water the first thing price gouged during a crisis? People need fresh and clean water and you have individuals selling water at a premium.
The same principle applies for healthcare. Plastic surgery is optional and on an indefinite timeline, so there is no patient lock in. If you have a severe injury or a heart attack or a stroke you cannot shop around. You cannot pre-shop for conditions you don't know you have. And so you pay the crisis premium.
In some ways you can. When hospitals acquire a reputation for being pricey without offering better care, people tend to avoid them, and even in a crisis the hospital's name won't be the first that pops into your head.
https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-...
Branded prescription drug prices are high mainly due to patent rights. But without patent exclusivity, most of those drugs wouldn't have been developed in the first place. It now often costs $1B+ to take a new candidate drug through phase-3 clinical trials; that money has to come from somewhere and private companies won't invest in that research unless they can expect to profit. The countries which impose strict price caps on prescription drugs generally don't do much new drug development. For example, during the past few years US drug companies have launched about twice as many new drugs compared to European countries.
https://www.efpia.eu/publications/downloads/efpia/the-pharma...
e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies.
A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues.
The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.
Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.
That’s what you think is the common root cause of complications?
You clearly are not interested in a productive discussion.
As for a fee for unpredictable occurrences - that’s what insurance is.
Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence. Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site).
If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself.
> more or less exists for each procedure
This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.
Their prices are all-inclusive with followups on case something goes wrong and therapy for procedures that need it.
The founder was on econtalk (https://www.econtalk.org/keith-smith-on-free-market-health-c...) where he also claimed that their prices have been steady and that surgeons earn more there than at other hospitals. Meanwhile insurances don't want to work with them because they don't get to advertise how much money was saved from the Brutto cost based on their negotiation with the provider because they would have to pay the sticker price like everyone else.
They are pointedly uninterested in calculating what your particular surgery will cost you or your insurance. All they know is that you're one of 200 this month and your insurance pays, on average after all the adjustments and adjudications, about 15% less than average so please be quiet and don't make a fuss.
The reason medical providers don't know is because they don't care to know. Their systems are purposefully complex so their computers can do battle with the "insurance" company computers. And when you try to ask a doctor this highly relevant question, they condescendingly feign as if money shouldn't matter despite it being the foremost thing in many people's minds.
Providers already treat you with disdain and the back office in most doctors offices can hardly function as it is. When you ask how much something will cost, you will get somewhere between a blank look - if you’re lucky - to outright disgust that you could ask such a pedestrian question. You wouldn’t understand how complex medicine is and what could happen, you pleb. So how could we do something like give you a dollar amount?
In other parts of the country, people are passive aggressive and it's extremely annoying. They won't admit they don't know, because it's all about appearances. Patients faced with such responses would become irate. What do you mean you don't know?! The workers hate themselves for not knowing, and they know this whole thing is a scam even better than you do. They hate themselves for participating in the scam, and so the cognitive dissonance manifests as rudeness towards you.
Your point of cognitive dissonance is an interesting one. But ultimately it doesn’t matter what their state of mind is; if you are treated badly as a patient you will just give up to save your own mental energy. After all you’re seeing a doctor because something is wrong already. Why am I layering on managing the precious feelings of the doctors back office personnel on top of all that too?
Why bother? Because they're just working stiffs trying to put food on the table like the rest of us. They're not responsible for the existence of this detestable system any more than you are.
At least from my understanding.
We provide this for the most common ICD codes, and will be adding more in the future.