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Medicine The Almighty Buck Software The Internet

Medicare To Require Hospitals To Post Prices Online (pbs.org) 156

Posted by BeauHD from the price-is-right dept.
An anonymous reader quotes a report from PBS: Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday. The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer. Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. It may still prove to be confusing to consumers, since standard rates are like list prices and don't reflect what insurers and government programs pay.

Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital's payments on how good a job they do. Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals. Seema Verma, head of the Centers for Medicare and Medicaid Services, also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It's an expensive gene therapy that turbocharges a patient's own immune system cells to attack cancer. The cost for such a procedure can exceed $370,000 per patient.
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Medicare To Require Hospitals To Post Prices Online More

Medicare To Require Hospitals To Post Prices Online

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  • So Trump keeps another campagn promise (Score:5, Funny)

    by greenwow ( 3635575 ) on Wednesday April 25, 2018 @05:04PM (#56502817)

    Dammit.

    • Re: So Trump keeps another campagn promise (Score:5, Insightful)

      by Anonymous Coward on Wednesday April 25, 2018 @05:07PM (#56502835)

      I don't care who made the happen. It's great news. The fact that hospital prices were shrouded in mystery and you had to find out with a surprise bill (for thousands) after the fact had all the hallmarks of a scam. Let's hope those days are behind us.

      • I wonder if this will drive some hospitals to stop taking medicare/medicaid?

        I've heard that a lot of doctors refuse to take medicare/medicaid.....I wonder if hospitals will do the same to avoid these types of rules?

        • Re: So Trump keeps another campagn promise (Score:1)

          by Anonymous Coward

          Doubtful. I work in a hospital (pharmacist) and Iâ(TM)ve never heard of a doctor refusing to take Medicare. Medicaid, yes. Those are two complexly different programs.

          • I have a doctor friend who was complaining that she lost money on Medicare patients. Her fixed expenses were higher than what Medicare could pay, so she lost money even when donating her time. (I'm confident of her skill as a doctor, not as a businesswoman, for whatever that's worth.)

      • Re: So Trump keeps another campagn promise (Score:5, Insightful)

        by PopeRatzo ( 965947 ) on Wednesday April 25, 2018 @06:29PM (#56503303) Journal

        I don't care who made the happen. It's great news.

        It's funny that the same people who believe it's too much regulation to require banks to disclose information about rates and fees are going to celebrate requiring hospitals to do the same thing. Government regulation of private industry was supposed to be bad, remember?

        And, there are big problems with requiring medical providers to post prices: First, all medical providers have multi-tiered pricing. This is a "feature" of our "free market", insurance-driven health care system. The price you would be charged is completely different from the price your insurance company would be charged. For example, let's say an abdominal surgery costs $100,000.00 to an individual. That's actually pretty close to what your hospital would charge you for say, a gall bladder removal. That exact same surgery, billed to an insurance company, would be $15,000.00. For those of you without calculators, that means insurance companies pay about 15% of what individuals pay for the same service. In any other industry, that kind of two-tiered pricing would be illegal.

        Second, posting prices really doesn't help the average person. Let's say your doctor tells you that you need cancer surgery for your kid, or your wife. Are you really going to shop for the cheapest price? If you actually have a wife or a kid, you know the answer is "No". Also, posting a price doesn't take into consideration what happens once you are getting a procedure. If there is any kind of complication, the price could skyrocket. If they open you up for a simple appendectomy, and they find your appendix has burst, that posted price will mean nothing.

        The experience of practically every country in the whole fucking wide world has taught us one thing: If you really want to get medical costs under control, and get better outcomes for everyone, just create a universal single-payer system and let the government regulate prices. It's the only thing that works. There are no "free market" solutions to health care costs. After all, in a "free market", what you would you be willing to pay to live instead of die? If you've been stung by a bee and you'll die without an Epipen, what's to stop a provider from expecting you to mortgage your house to pay for it? Would you do it? You're not in a position to say, "Oh, I'll just go elsewhere", because you're in fucking anaphylactic shock and you're going to choke to death.

        I'm sorry, but there are just no free market solutions to health care.

        • Okay, clown, I'll entertain your shit for about 4 seconds.

          It's funny that the same people who believe it's too much regulation to require banks to disclose information about rates and fees are going to celebrate requiring hospitals to do the same thing.

          Show me who is against branks disclosing rates and fees.
          Show me who is for hospitals doing the same.
          Show the overlap.

        • mortgage your house or just punch a cop and let the system pay for it/

        • Yes, I support requiring banks to disclose their fees and rates. And so should hospitals.

          Furthermore, what we need to know are not the ‘chargemaster’ list prices that nobody but the occasional Saudi tourist actually pays but the going rate that insurance companies negotiate for their patient pools.
          In medicine, you can’t negotiate prices while you lie unconscious and bleeding. What price transparency would allow you to do is prearrange your medical access on a more open basis than just roll

          • And if you want to try out the single payer approach, why don’t we just allow our existing government-operated medical plans to buy in bulk and negotiate prices? That way, we find out what advantages single-payer might have without having to radically change our whole medical system.

            Yes, and offer everyone a Medicare buy-in, so we can compare directly with an insurance-based system.

            But really, everything that's happened since 2010 (including over the past year and a half) has moved us closer to single

        • Re: (Score:2)

          by mjwx ( 966435 )

          I'm sorry, but there are just no free market solutions to health care.

          Depends on what you mean by "free market".

          True that there is no laissez faire "libertarian" solutions and that all that have been tried have been or are abject failures, but the free market can still play a part. I'm a big fan of universal health care, for all it's problems the NHS here in the UK does it's job well and relatively efficiently but the government provides the minimum standard of care, should you want anything further than the market can and should be able to provide. Keep in mind I'm not re

        • This is, frankly, nonsense. One of the biggest driving factors of high medical costs in America is that the government cannot generally negotiate drug prices with manufacturers, and insurance/private rates are often pegged to the government prices. Allowing the government to negotiate would lower prices for Americans (possibly raising prices elsewhere as companies try to recoup that lost revenue).

          Most people want banks to have to disclose rates and fees; criticizing how the CFPB is run or organized isn't

      • Want affordable medicare, apply for residency/citizenship to not other world class countries.
        Many years ago my son went on business to Russia. He Had a major attack of kidney stones. He went to the hospital, was admitted, given treatment and medication. All at no cost. Medicare is universal in Russia and people did not need to provide proof of insurance, or even carry a medical card.

    • Re:So Trump keeps another campagn promise (Score:4, Informative)

      by thegarbz ( 1787294 ) on Wednesday April 25, 2018 @05:15PM (#56502879)

      I wouldn't say dammit. This isn't doing anything to fix the fucked up pricing practices of the USA medical system. Most people don't pay what the hospital quotes on their *first* bill.

    • Old people vote.

  • and use cookies to tell if you've been there before and raise the prices?

  • the quality of care thing is a money pit (Score:3)

    by known_coward_69 ( 4151743 ) on Wednesday April 25, 2018 @05:08PM (#56502839)

    just an excuse for hospitals to keep you and run lots of tests. happened to a family member where she spent a month in the hospital and was told she might have cancer only to leave diagnosed with a bacterial infection. and one of my kids. a day in the ER with an MRI and lots of other tests only to be diagnosed with strep.

    people need to accept the fact that medicine is not perfect and doctors don't know everything and not sue anytime a diagnosis is wrong

  • Will be even better if they post patient outcomes too. That would be pretty significant data in determining whether cost of care correlate to results.

    • Will be even better if they post patient outcomes too...

      What would be even better is to post patient outcomes and cost v comparable hospitals in places which don't have profit driven health systems.
      Like that would ever happen. Turns out the US health system is a giant machine built to funnel money from taxpayers into shareholders pockets.

    • There's a problem with patient outcomes (and trial results.) They incentivize cherry-picking the easy cases. Meanwhile, I want the best doctors to work on the hardest cases (after they're done with me that is)

  • Here is the simple reality of the medical system. IT is full off overpriced and downright illegal pricing tactics. when people see what medical systems have the balls to charge you compared to other services around especially on a global scale... there will come a change. having a basic universal health coverage will be totally doable once people figure out they are getting charged $1000 for a dose of Tylenol and nip that crap in the butt.

  • Hospital costs are a joke to begin with (Score:5, Insightful)

    by quonset ( 4839537 ) on Wednesday April 25, 2018 @05:27PM (#56502953)

    Hospitals overcharge [youtube.com] for pretty much everything. Any prices they show shouldn't be trusted anyway.

    It's another example of why insurance is nothing but a scam.

    • It's every level of the healthcare system, though, not just hospitals. I used to work in a warehouse that shipped medical supplies, and sometimes I got a peek at our invoices. It was an eye opener to see not only what the manufacturers charge, but the various markups among all the middlemen (including us).

      Oh, and almost all American medical products are imported. Support hardware like tubes, trays, and crutches come from China, of course, but the expensive stuff, like drugs and sutures, come from Eastern

  • The Medical Bait-and-Switch Game (Score:5, Insightful)

    by Rick Schumann ( 4662797 ) on Wednesday April 25, 2018 @05:27PM (#56502955) Journal
    Also dental, and I imagine vision, too. Nobody can tell you what something is actually going to cost you out-of-pocket, because the insurance company will say "we'll pay this much", but when the doctor/dentist goes to submit the claim, they say "oh well we're only really going to pay this much, LOL" and the patient gets stuck with the bill. WHY IS THIS ALLOWED!? If it were anything else I'm pretty sure it would be considered fraud.

    • Also dental, and I imagine vision, too. Nobody can tell you what something is actually going to cost you out-of-pocket, because the insurance company will say "we'll pay this much", but when the doctor/dentist goes to submit the claim, they say "oh well we're only really going to pay this much, LOL" and the patient gets stuck with the bill. WHY IS THIS ALLOWED!? If it were anything else I'm pretty sure it would be considered fraud.

      Most of the time I've seen a discrepancy between the estimated and actual bill, it happens because the doctor doesn't take the time to check what the insurance actually covers when the write up the estimate. Just my experience though.

    • Nobody can tell you what something is actually going to cost you out-of-pocket, because the insurance company will say "we'll pay this much", but when the doctor/dentist goes to submit the claim, they say "oh well we're only really going to pay this much, LOL" and the patient gets stuck with the bill.

      Back in the real world, the doctor/dentist has agreed to accept only the reimbursement allowed by the insurance company for a given medically necessary procedure in order to be part of that insurance network. If you signed a piece of paper saying you would be personally responsible for anything the insurance company didn't pay even if the doctor/dentist performed medically unnecessary services, well, maybe you should read before signing next time.

      • " If you signed a piece of paper saying you would be personally responsible for anything the insurance company didn't pay even if the doctor/dentist performed medically unnecessary services, well, maybe you should read before signing next time."

        Had any surgeries or in-patient services recently ? One of the forms you -must- sign is the one that states you will be responsible for all costs that your insurance decides not to pay. Don't want to sign it ? No procedure for you. Guess you don't really need it

      • Don't give me that "you're not living in the real world" bullshit. I used to have dental insurance. I had some cavities filled. I had to go get a loan from my bank to pay my end of it. Then all the work is done, I think we're done with the whole deal, and they send me a bill. I say "What's this?" They tell me "your insurance didn't pay this, so you have to". I say "How the hell does that work?" They tell me "Your insurance told us they'd pay such-and-such amount. When we sent them the claim they said they'r

        • For whatever reason, that's never happened to me.

          The other thing about dental insurance, in my experience, is that it isn't. It's primarily a payment for routine care. The deductibles start when you actually have something wrong with your teeth, and if something does go wrong and you need something expensive you'll easily hit the limit of your insurance.

        • They tell me "Your insurance told us they'd pay such-and-such amount. When we sent them the claim they said they're only paying so-and-so amount. Happens all the time. Nothing we can do about it".

          There are really only two choices: Either your dental insurance plan describes in writing what procedures are covered and what the copays/deductibles are, or it doesn't. If the former, you should have a claim against the insurance company for not providing the coverage they committed to provide. If the latter (and this of course would not be the case for a Delta Dental plan), there's no bait and switch since they didn't commit in writing to reimburse one penny. And if you're relying on your dentist's bi

    • Bonus points for dental and vision insurance for being separate from regular insurance in the first place. You can't even have a tooth extracted by a dentist anymore -- you need to go to a specialist: the oral surgeon. Gotta add more middlemen to go along with those insane price scams.

      • I've had a few teeth extracted. With one exception, they were extracted by dentists. One was entirely inside the jaw, below the gum, and was growing forward rather than up. That required an oral surgeon. Almost all my dental work was performed by my dentist of the time.

    • My dentist informs me what the price is going to be for a procedure, and sticks to the price. I know what I'm paying before I go in.

      Complications do happen, unfortunately, and my last root canal did cost more than estimated. That's going to happen. Every other thing I've had my dentist do has been on a fixed cost basis.

  • If providers were bound by a 20% price variation for any given service or product, the health care problem would be eliminated.

    Imagine such a world. if you pay for something yourself, use your small insurance plan or your big insurance plan, the price would be roughly the same(from least to most discounted would be at most a 20% difference.

    This would increase direct competition between products, expose more realistic prices across the board (usually lower).

    Imagine the price difference now between the price

    • and an ER price cap / must be in market for any ER service

    • Don't like 20%, pick another number that is fair. 50, 100?

      Why not 0? As in, why not force hospitals to charge individuals the same rate as big insurers?

    • Re: (Score:1)

      by AvitarX ( 172628 )

      I agree with this entirely, but feel the number should be 0%.

      If anything, me walking in without insurance but with check book should be discounted, not 3x extra (my experience with a lab running blood tests, $900, then reduced to $275 because insurance negotiated).

    • Exactly what is a given service or product? When doctors start doing things, unexpected things can happen. You can have a fixed cost for delivering a baby if there's no complications (my wife's experience), but I knew a woman who almost died from giving birth and was saved by several high-cost specialists. Different people have different chances of complications. I'm on a blood thinner, for example, and that can mean some procedures can be more difficult and potentially expensive. Should my prices for

  • if i get sick and die (Score:3)

    by FudRucker ( 866063 ) on Wednesday April 25, 2018 @06:20PM (#56503243)
    i will be sure to leave by rotting stinking corpse in front of a hospital so all their customers can enjoy the smell of death as they go in to visit the hospital

  • Nobody pays full price though consumers pay more (Score:4, Interesting)

    by RhettLivingston ( 544140 ) on Wednesday April 25, 2018 @10:08PM (#56504267) Journal

    In reviewing insurance bills for a recent uncomplicated procedure, the hospital billed a total of $65000 and the insurance paid about $8000 after prenegotiated discounts were applied.

    The insurance then ran into a technical problem/mistake in which it was retroactively cancelled. The hospital actually returned their payment. During the year it took to straighten that out, I was facing $65K in bills that they wouldn't negotiate to less than about $30K despite the existence of documentation that they had been satisfied with $8K from insurance. Needless to say, I focused on (and eventually succeeded in) reversing the insurance problem.

    I've heard that the real reason for this is so they could write off $65K if a patient doesn't pay instead of $8K. I'm not an expert in the accounting, but I'm sure in my case that is what they would have been claiming as their loss.

    The experience left me with a solid belief that posting prices alone would do nothing. That approach will only serve to drive more people into the wasteful net of insurance.

    What is needed is a truth in pricing act. Hospitals should be required to have fixed, public, non-negotiable prices that apply to all payees whether insurance or cash. If the hospital chooses to pay some of those themselves in indigent cases, that is the price they should be allowed to write off. This approach would make some true headway in getting the insurance problem reigned in.

    Posting their false prices does nothing except bolster their already drastically inflated claims of losses.

    • Needless to say, I focused on

      The problem with USA health system. You shouldn't have to focus on anything other than recovery and going on about your life.

      My own experience in Australia:
      1. Had a hernia
      2. Went to the doctor. He asked which system I wanted to be referred to, waiting list on the public system was 4 months. I said private.
      3. Went to private specialist. He quoted $8900 including a week at the hospital, gave him my insurance number, he said that my gap will be $2200 after insurance.
      4. Said fuck that went back tot he doctor an

  • For those interested in nuts & bolts reasons behind the difference in prices of drugs, from the 'list' or cash price to the lower insurance price I would highly recomend this site

    http://www.drugchannels.net/ [drugchannels.net]

    run by a person very knowledgeable in the industry. Short story is there is a gross to net bubble of about $150 billion which gets redistributed to every other entity (GPO, health insurer, wholesalers, manufacturers) except the consumer.

  • About damn time (Score:4, Insightful)

    by rossz ( 67331 ) <ogre@@@geekbiker...net> on Thursday April 26, 2018 @12:41AM (#56504711) Journal

    About 15 years ago I was working a shit job with zero benefits - so no medical coverage. My shoulder was hurting a massive amount and the problem wasn't going away. I went to a local medical service to have it checked out but could not get them to give me any kind of estimate of the cost for just looking at my damn shoulder. You have to just accept whatever they decide to charge you after the fact.

    No other business that I know of can get away with this.

    * it was bursitis

    • About 15 years ago I was working a shit job with zero benefits - so no medical coverage. My shoulder was hurting a massive amount and the problem wasn't going away. I went to a local medical service to have it checked out but could not get them to give me any kind of estimate of the cost for just looking at my damn shoulder. You have to just accept whatever they decide to charge you after the fact.

      No, you don't. They smelled a sucker (you, in case you're wondering) and took advantage.

      If someone can't tell you up front, go somewhere else. It really is that easy.

      You can also negotiate the rate. Just tell them you'll pay Medicare reimbursement rates for all procedures, cash up front. Trust me, it works.

  • It's an expensive gene therapy that turbocharges a patient's own immune system cells to attack cancer. The cost for such a procedure can exceed $370,000 per patient.

    Rather than trying to Find a way to pay for it; we need to figure out WTH is the cost per patient so high for such a promising procedure --- is it due to the actual amount of work involved, or is some company levying an arbitrary tax based on how much they think it's "worth" for those that need it? What are the complexities in the p

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