I really salute these guys for doing this. It's freakin' awesome. This I've added to my next letter to my representatives in Congress:
"Dr. Smith said federal Medicare regulation would not allow for their online price menu.
They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."
I've suggested that one non-controversial way in which Healthcare could be "reformed" would be to make it easier for hospitals to be transparent about their prices. Any sort of regulation that prevents hospitals from disclosing their prices is bad for the citizenry, please fix that part of the regulations.
Copying my comment below. The government not only allows healthcare providers to reveal their prices, it encourages it. The graf about the government is a political statement, not a policy fact, and does not belong in a news story.
-----
Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures.
Dealing with Medicare/caid involves lots of additional overhead and billing oversight, but that graf is a political cheap shot, not anything related to transparency.
-----
Hijacking my top comment with a more info edit -
If you don't know, Pricing Data in the US for health care is super insane, partially because both insurers and regulators need billing to fall into a semi-standardized set of 'billing codes' that don't really map well to actual care.
There are regulations about only billing the government for 'procedures' and not 'overhead', and medical procedures often don't map well to billing codes because they're new or slightly different. So basically after a procedure or hospital stay, the care givers make up a basic list of the things they did and the drugs given, etc, and it's passed on to a billing department, who maps to a set of codes that might differ depending on who's paying (gov't vs insurer 1 vs insurer 2). This is by definition lossy.
It's an oversimplification, but one hospital might say "Well we've got a superstar brain surgeon here whose time is 3x as expensive as normal, but can only bill for 'BRAIN SURGEON - 1 HOUR', so we'll crank the prices up on the scalpel and the tylenol to compensate", where another picks totally different things to compensate the prices on because they have a different cost structure.
Big insurers expect to be negotiated with separately for competitive advantage reasons, and sometimes use different billing codes anyway, so even if you had the closely guarded master price list of the hospital, it wouldn't necessarily do you any good.
For the uninsured, the occasional price-insensitive person rolls in (aka the "Saudi Prince wants his own wing for cancer treatment" situation), so they jack the uninsured prices WAY up only expecting a few percent back from 98% of patients. This further breaks the pricing data, and causes major problems for less-saavy people who are used to seeing a bill and being expected to pay it, as opposed to negotiate.
Bottom line: It's complicated, and politically fraught. If you're interested, Oreilly's "Hacking Healthcare" is a great intro to how billing and the new CMS Meaninful use stuff works.
The center was started by Dr. Keith Smith, who is very much a free-market guy. Even if you don't agree with a lot of his libertarian stuff, you have to admit that he's very well read and knowledgeable of economics, especially for a physician. He runs an active blog at: http://surgerycenterofoklahoma.tumblr.com/
There's a very large amount of medicaid/medicare practice (and 'obamacare' practice) that was written by insurance and hospital lobbyists with a financial incentive to perpetuate the status quo, if not outright extend regulatory capture and stymie any actual market competition.
Given that something as simple as allowing Medicare to negotiate with care providers and suppliers as any other insurer is massively controversial, I think you would be amazed just how controversial seemingly-straightforward reforms actually are. Particularly those things that would increase competition and thus threaten the status quo.
It is not correct to say that Medicare "would not allow" online pricing. Medicare doesn't care what hospitals charge. Medicare ignores hospital charges. It only pays what Medicare calculates is a fair price based on what hospitals report as their actual costs.
It would be more reasonable to say that Medicare will ignore any posted prices whether or not they are posted online.
I dream of a day when I can walk into an area which offers 'services' and be offered a pricing chart. From hospitals, banks, loan officers, home loans, cars, etc.
A cryptic itemized list, such as a mortgage's Good Faith Estimate (GFE), which falls short of describing the items in the list still fails my test.
This hope is not for me. Its for the misfortunate who run on impulse and have weak mathematical logic. Many people will nod their heads when you mention simple/compound interest or amortization. They will easily dig themselves into holes and take on the realization far too late in the game.
Another favorite which gets thrown in the air: 'Purchase this warranty.' Countless friends and family have worried that their purchase or lack of warranty was a mistake. Asking about said warranty usually results in: 'read the small text in the agreement.' Typically, walking away from the situation completely misinformed by a seller.
As I prepare to move out of my apartment, I received an itemized list (hidden among a contract and various other documentation) which in total amounted to $11,500 in charges for potential neglect in leaving the apartment. Simple things on the list: patch holes ($80/hole), steam clean carpet with receipt ($500/room), replace drip pan ($200), etc. Nothing warns you of the potential threat.
> I dream of a day when I can walk into an area which offers 'services' and be offered a pricing chart.
I don't want to be offered a pricing chart when I have a kidney stone or get violently mugged. When that happens I don't want to have to deal with that sort of thing.
The free market in medicine is plain weird. Everyone needs the doctor on occasion, and everyone needs tyres on their car. Both things are pretty standardized, medicine is an established science, and tyres just need to have the correct dimensions and speed rating.
You show up at the doctor's, and they will treat you according to established procedure, most patients do not have complex illnesses, and you show up at your mechanic, and they will put new tyres on. It's very simple.
Yet on TV you see many many more ads for the local hospital or medication for condition X that you see for tyres. How come?
Wow, this (along with the whole health care thing) makes me glad I live in the UK.
Here renting property is very well regulated, you put down a security deposit when you move in (usually 1.5 months rent) and then any charges like this are taken from that. The best part is the security deposit legally has to be left with a third party (DPS), and then if the land lord wants to keep any of it, they have to go through the DPS, and show proof of damage and reasonable charges.
On the other hand, the weather here makes me wish I lived in the US :)
> "As I prepare to move out of my apartment, I received an itemized list (hidden among a contract and various other documentation) "
You yourself have trouble with our fine-print-society and yet you still write off the missteps of others who fall into similarly-shaped potholes as a result of their running on impulse or having weak mathematical logic?
While I agree with you on the medical, a GFE is exactly what you are asking for. Mortgages are complicated, so there's a lot of credits and debts involved. Just because you don't understand the terms doesn't mean they shouldn't be noted. The GFE(and HUD) are thankfully the two things that are absolutely legally binding and can be counted on for being a correct representation of everything.
I'm curious as to why you singled out the GFE as "falling short". I don't necessarily disagree with you, but between your GFE, TIL and a handful of other things, you "should" be provided with a decent high level overview of your mortgage.
There's certainly room for improvement, but it always seemed leaps and bounds better than, say, an itemized hospital bill.
This happens only now? In more civilized countries like Germany, prices for procedures have been set since time immorial. There is a provision for surcharges from the physician, but these aren't common, and the physician will have to have a good cause or the insurer will not pay it.
Same thing for new medications: they are not permitted in the clinic unless there is a genuine advantage for the patient.
All this is of course due to political circumstances: medicine is just too profitable.
All this is of course due to political circumstances: medicine is just too profitable.
No. Medicine in inelastic. There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not. When demand is inelastic, and supply is limited, prices will rise accordingly with no relief in sight.
The solution? Either set market prices (at the cost of stifling supply) or flood the market with supply (using technology to both drive down costs and replace what people do).
Really? You are really going to imply America is uncivilized when you compare it to a country that literally attempted to take over the world and exterminate an entire race of people? Within recent generational memory no less?
Europeans come in two flavors, smug, and really really smug. When will you all get off your high horses?
I think I should say it again because it bears repeating. The country that you just compared america to, implying we are not civilized and germany is, literally attempted to take over the world and exterminate an entire race of people. Civilized? Really?
the German welfare system (healthcare included) is taxing the living hell out of the working families. It's insane. I'm pretty sure that like anything else, there is a ton of beaurocracy in Germany that loves to "list" prices. Unfortunately, in the beaurocracy side of it, the US is in a worse state. Hopefully this is the beginning of free market competition in the healthcare sector.
One thing to keep in mind is that there's more to good medical care than a fair price:
Post-op infection rate - do all clinical employees regularly wash their hands before and after each patient encounter?
Re-admission rate - does the institution or surgeon do enough cases of a particular procedure to be proficient?
Error Rate - Are pre-op checklists ALWAYS used?
Post-op care - Are supportive therapies like Physiotherapy available?
It bugs me to see medical interventions treated like a commodity, these "products" don't always follow generally accepted market principles - a price cut in colonoscopies will not significantly increase demand.
There's more to everything than a "fair price". People who want to explain why Microecon 101 doesn't hold in the medical arena really should take care to not accidentally explain too much and end up proving that Microecon 101 never holds, which is demonstrably false.
(And yes, there's more to the world than Microecon 101, just as there's more to physics than Newtonian mechanics or thermodynamics, but I still get to assume that glorious theories that somehow fail to conform to such basics are probably in error.)
I generally agree with your sentiment. However, here's something to consider
- medical practices mostly over-charge to avoid insurance fraud. Wait, what?? Yes, here's how it works: if they were to ask you, "what insurance do you have" and then charge you differently (i.e. one insurance pays them better than the other, so they'd charge more), they'd be committing a crime.
So, instead, they charge EVERYONE a crazy amount, and then they get X% of the amount billed from one insurance, Y% from another insurance, etc. Fair? Not really -- if you don't have insurance, you get hit with the FULL amount (since you don't have the negotiating power the insurance company has). So while company X paid $200 for an MRI, you'd pay out of pocket $2500 without insurance.
In reality, what happens? Normally, people without insurance are an underserved population. They send them letters, and they don't pay. At the end of the day, the hospital/private practice just ends up writing this amount off, and they call it a day. It ends up being a silly game where they bill knowing they won't get paid, and then spend more money on trying to collect rather than give more realistic prices.
I, therefore, welcome this transparency.
source: I work for one of the largest and prestigious medical/research institutions in the US, and I used to do Analytics for their financial data warehouse.
Wherever you decide to have your surgery, you should inquire about the rate of infection in their facility. Our rate of infection for 2006 was 0.3%, for 2007 was 0.2%, for 2008 was 0.04% and for 2009 and 2010 was .001%. These percentages are astoundingly low compared with an estimated national average of 2.6 % per year.
Actually, a 'fair price' would be reflective of all of these factors. If a hospital/health provider feels that it excels in these areas, then they could just as well publish these quantifiable measures along with their prices. Then it's up to the consumer to decide how valuable these factors are to them. However, there's no reason to assume that the hospital that's charging 1/4 what others are charging is demonstrably inferior in any of these ways just because of the price.
As someone with an High Deductible Healthcare Plan, I pay most medical costs out of pocket up to an annual limit. It's crazy that for such expensive services I NEVER know what my bill is going to be until months after the procedure has happened. I always try to guesstimate costs beforehand, but I've been off by an order of magnitude on more than one occasion. Having transparent pricing in the healthcare world, even if it was just an estimate, would help people with HDHPs immensely.
I get looked-at like I'm crazy when I try to explain my insurance and that I'd like to know more about the cost of a procedure or prescription before I agree to it.
I've always tried to just pay cash for services. Increasingly, though, I'm finding that providers are being put under exclusive contracts which prevent them from allowing me to pay cash. As soon as they find out who my insurer is they clam up, explain that they're under contract w/ that insurer, and say they can't give me cash pricing. It's doubly frustrating because they usually won't talk to me at all if I don't tell them who my insurer is. Catch-22.
The provider ends up billing my insurer who doesn't pay because I haven't reached my deductible. Then I get a bill from the provider, 4 - 6 weeks later. Sometimes the provider allows me to pay the "negotiated price" my insurer would have paid, but other times I've had to pay the full non-discounted amount.
> It's crazy that for such expensive services I NEVER know what my bill is going to be until months after the procedure has happened.
Not only that, but one often doesn't know if insurance will cover it, at all. One of my wife's surgeries was "pre-authorized" but rejected by insurance when the bill came through.
Let me start off with I worked in a medical billing office for the last 5 years and here are some things you'll never hear about:
Medicare pays only 15-25% of what they are charged, that is to say, if a surgery costs $40,000 they will only pay the doctor $10,000.
This isn't only medicare, it's literally every company. Every single insurance company pays only a fraction (usually 50%$ or less) of what the hospital actually charges you. If you don't have insurance you can just call up and usually if your semi-nice and fairly strait forward you can get the bill reduced to a fraction (30-40%) because that's about what they accept from insurance anyways.
Their prices are simply what they'll get paid in either case, so good job to these doctors, hope it helps less people get scammed and pay their full bills.
They have avoided government regulation and control in
that area by choosing not to accept Medicaid or Medicare
payments.
I don't understand how the government itself is causing lack of price transparency, but this should be addressed by any president or congressman who imagines he's going to do something about healthcare costs. If you don't have price transparency, you have no chance at cost cutting.
Congress froze the number of Medicare-supported residency slots at 100,000 under the Balanced Budget act of 1997 [1]. The cap remains in place to this day, despite a massive shortage of physicians.
The AMA's official position in 1996:
"To decrease the rate of physician supply, limits must be placed on the number of medical school graduates entering GME [graduate medical education]. Since the federal government currently plays a major role in financing GME and is responsible for establishing immigration laws that affect IMG participation in GME in this country, it is imperative that the federal government partner with the medical education community to achieve this goal." [2]
The AMA worked closely with then Speaker of the House Newt Gringich to overhaul Medicare's relationship with physicians. [3]
The AMA is typically the biggest spender among lobbying groups in the health care sector.
Mercy Hospital charged $16, 244 for a breast biopsy; the procedure will cost $3,500 at Surgery Center of Oklahoma.
WTF?!? I don't know what we charge for a routine biopsy, but for an MRI guided one with vacuum assistance - vasty more complicated, expensive and time consuming - we charge about $2000USD.
Come and have a holiday in New Zealand at the same time and it may still be cheaper.
In Singapore it's required for all hospitals to post their prices and they have some of the lowest health care costs around. This should be mandatory in the United States.
"Dr. Smith said federal Medicare regulation would not allow for their online price menu.
They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."
This is simply not true. If they were undercutting Medicare with their pricing, the government would likely have issue with it (i.e. if they were contracted with Medicare but charging Medicare more than what they charge other insurers/patients - this never happens). But their pricing is multiple times what a Medicare claimant would have to pay, so it's a non-issue.
Take, for example, the One Medical Group. They accept Medicare and although the services they provide are limited to primary care, they are transparent with their basic fees.
http://www.onemedical.com/nyc/pricing/insurance
Our own medical group is heading in the direction of transparent pricing as well, and we accept Medicare.
This is the kind of wording the medical industry has set. The reasoning goes like this: clear prices => competition => iron law of wages for specialised professionals => corners being cut.
Crony capitalism only believes in competition for others. Competition in their own sector suddenly brings doom and the Iron Law of Wages.
I am not sure if mandating it is necessary. I think that hospitals should publish their pricing lists to differentiate themselves from their competition.
"OKLAHOMA CITY – An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed all-inclusive surgery prices online. The move is revolutionizing medical billing in Oklahoma and around the world."
One of the major problems with U.S. healthcare is that, financially speaking, patients have been increasingly taken out of the mix beginning in the fifties. Providers and insurance carriers shield consumers from actual costs giving a false impression of the value of competent healthcare.
Insurance companies’ reimbursement rates are a fraction of the billed amount. Of course, it is the person without insurance, who is stuck with what can be a very inflated invoice.
Of course, there are manifold problems with this industry; but until patients are exposed to accurate financial comparisons, the costs will continue to escalate.
every. single. industry where efficiency and profit are the main concerns and externalities are captured accurately and true competition can exist. That is not always true. Off the top of my head the justice system and emergency service providers (think fire/hazmat etc) come to mind.
Lets not let the bizarre state of the US medical industry act as some sort of straw man to support some ultra libertarian viewpoint.
Can you call transparent pricing a "revolution" when the status quo is purposefully obfuscated and archaic in order to nickle and dime you? It seems more like just doing the right thing.
Can you call desegregation revolutionary since it was just "doing the right thing?"
In a corrupt market or system, doing the right thing is in and of itself a revolutionary act. Doctors standing up for what's right instead of their pocketbook and pharma reps is a revolutionary act.
I don't know if other states do this, but at least in California hospitals report their prices (known as a chargemaster or master charge description file) online at OSHPD (http://www.oshpd.ca.gov/chargemaster/). Even looking through these you'd be surprised what prices there are.
This isn't a new controversy, but still quite problematic - for some fun try Googling "usual, customary and reasonable" (UCR charges).
-- offer a "price match guarantee" against any procedures versus in-network hospitals
-- offer a discount for low-risk patients (non-diabetic non-obese) who need to have surgery done
-- do "bundle deals" with local hotels and/or attractions like they do with plane flights, so if you are travelling to the hospital you would have something for the family to do
-- free 1-month nurse concierge where you can call a hotline to followup after any procedure (would be great for baby deliveries)
-- discount on 3-months of physical training, along with a bundle deal at a local gym
-- offer a "retainer" that would lockin a price of any procedure for 5 years. Good for those who are family planning or have a low-priority surgery
It just seems like there's a market for something-that-doesn't-suck in healthcare.
[+] [-] ChuckMcM|12 years ago|reply
"Dr. Smith said federal Medicare regulation would not allow for their online price menu. They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."
I've suggested that one non-controversial way in which Healthcare could be "reformed" would be to make it easier for hospitals to be transparent about their prices. Any sort of regulation that prevents hospitals from disclosing their prices is bad for the citizenry, please fix that part of the regulations.
[+] [-] showerst|12 years ago|reply
-----
Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures.
http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...
Dealing with Medicare/caid involves lots of additional overhead and billing oversight, but that graf is a political cheap shot, not anything related to transparency.
-----
Hijacking my top comment with a more info edit -
If you don't know, Pricing Data in the US for health care is super insane, partially because both insurers and regulators need billing to fall into a semi-standardized set of 'billing codes' that don't really map well to actual care.
There are regulations about only billing the government for 'procedures' and not 'overhead', and medical procedures often don't map well to billing codes because they're new or slightly different. So basically after a procedure or hospital stay, the care givers make up a basic list of the things they did and the drugs given, etc, and it's passed on to a billing department, who maps to a set of codes that might differ depending on who's paying (gov't vs insurer 1 vs insurer 2). This is by definition lossy.
It's an oversimplification, but one hospital might say "Well we've got a superstar brain surgeon here whose time is 3x as expensive as normal, but can only bill for 'BRAIN SURGEON - 1 HOUR', so we'll crank the prices up on the scalpel and the tylenol to compensate", where another picks totally different things to compensate the prices on because they have a different cost structure.
Big insurers expect to be negotiated with separately for competitive advantage reasons, and sometimes use different billing codes anyway, so even if you had the closely guarded master price list of the hospital, it wouldn't necessarily do you any good.
For the uninsured, the occasional price-insensitive person rolls in (aka the "Saudi Prince wants his own wing for cancer treatment" situation), so they jack the uninsured prices WAY up only expecting a few percent back from 98% of patients. This further breaks the pricing data, and causes major problems for less-saavy people who are used to seeing a bill and being expected to pay it, as opposed to negotiate.
Bottom line: It's complicated, and politically fraught. If you're interested, Oreilly's "Hacking Healthcare" is a great intro to how billing and the new CMS Meaninful use stuff works.
[+] [-] clarkm|12 years ago|reply
Reason also did a story and short video on the Surgery Center of Oklahoma last year that I think is worth watching:
http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-o...
The center was started by Dr. Keith Smith, who is very much a free-market guy. Even if you don't agree with a lot of his libertarian stuff, you have to admit that he's very well read and knowledgeable of economics, especially for a physician. He runs an active blog at: http://surgerycenterofoklahoma.tumblr.com/
[+] [-] roc|12 years ago|reply
Given that something as simple as allowing Medicare to negotiate with care providers and suppliers as any other insurer is massively controversial, I think you would be amazed just how controversial seemingly-straightforward reforms actually are. Particularly those things that would increase competition and thus threaten the status quo.
[+] [-] bobwyman|12 years ago|reply
[+] [-] joewallin|12 years ago|reply
[+] [-] ambiate|12 years ago|reply
A cryptic itemized list, such as a mortgage's Good Faith Estimate (GFE), which falls short of describing the items in the list still fails my test.
This hope is not for me. Its for the misfortunate who run on impulse and have weak mathematical logic. Many people will nod their heads when you mention simple/compound interest or amortization. They will easily dig themselves into holes and take on the realization far too late in the game.
Another favorite which gets thrown in the air: 'Purchase this warranty.' Countless friends and family have worried that their purchase or lack of warranty was a mistake. Asking about said warranty usually results in: 'read the small text in the agreement.' Typically, walking away from the situation completely misinformed by a seller.
As I prepare to move out of my apartment, I received an itemized list (hidden among a contract and various other documentation) which in total amounted to $11,500 in charges for potential neglect in leaving the apartment. Simple things on the list: patch holes ($80/hole), steam clean carpet with receipt ($500/room), replace drip pan ($200), etc. Nothing warns you of the potential threat.
[+] [-] HarryHirsch|12 years ago|reply
I don't want to be offered a pricing chart when I have a kidney stone or get violently mugged. When that happens I don't want to have to deal with that sort of thing.
The free market in medicine is plain weird. Everyone needs the doctor on occasion, and everyone needs tyres on their car. Both things are pretty standardized, medicine is an established science, and tyres just need to have the correct dimensions and speed rating.
You show up at the doctor's, and they will treat you according to established procedure, most patients do not have complex illnesses, and you show up at your mechanic, and they will put new tyres on. It's very simple.
Yet on TV you see many many more ads for the local hospital or medication for condition X that you see for tyres. How come?
[+] [-] MattBearman|12 years ago|reply
Here renting property is very well regulated, you put down a security deposit when you move in (usually 1.5 months rent) and then any charges like this are taken from that. The best part is the security deposit legally has to be left with a third party (DPS), and then if the land lord wants to keep any of it, they have to go through the DPS, and show proof of damage and reasonable charges.
On the other hand, the weather here makes me wish I lived in the US :)
[+] [-] roc|12 years ago|reply
You yourself have trouble with our fine-print-society and yet you still write off the missteps of others who fall into similarly-shaped potholes as a result of their running on impulse or having weak mathematical logic?
[+] [-] deelowe|12 years ago|reply
[+] [-] rubberband|12 years ago|reply
There's certainly room for improvement, but it always seemed leaps and bounds better than, say, an itemized hospital bill.
[+] [-] HarryHirsch|12 years ago|reply
Same thing for new medications: they are not permitted in the clinic unless there is a genuine advantage for the patient.
All this is of course due to political circumstances: medicine is just too profitable.
[+] [-] toomuchtodo|12 years ago|reply
No. Medicine in inelastic. There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not. When demand is inelastic, and supply is limited, prices will rise accordingly with no relief in sight.
The solution? Either set market prices (at the cost of stifling supply) or flood the market with supply (using technology to both drive down costs and replace what people do).
[+] [-] Scaevolus|12 years ago|reply
Government regulations about not advertising prices blind consumers to the costs of procedures, so hospitals have little reason to lower prices.
It's another case where a small dose of regulation is worse than strict regulation or no regulation.
[+] [-] Vivtek|12 years ago|reply
[+] [-] hysterix|12 years ago|reply
Europeans come in two flavors, smug, and really really smug. When will you all get off your high horses?
I think I should say it again because it bears repeating. The country that you just compared america to, implying we are not civilized and germany is, literally attempted to take over the world and exterminate an entire race of people. Civilized? Really?
At least our country was on the right side.
[+] [-] beefman|12 years ago|reply
[+] [-] tylee78|12 years ago|reply
[+] [-] stephengillie|12 years ago|reply
[+] [-] easyfrag|12 years ago|reply
Post-op infection rate - do all clinical employees regularly wash their hands before and after each patient encounter?
Re-admission rate - does the institution or surgeon do enough cases of a particular procedure to be proficient?
Error Rate - Are pre-op checklists ALWAYS used?
Post-op care - Are supportive therapies like Physiotherapy available?
It bugs me to see medical interventions treated like a commodity, these "products" don't always follow generally accepted market principles - a price cut in colonoscopies will not significantly increase demand.
[+] [-] jerf|12 years ago|reply
(And yes, there's more to the world than Microecon 101, just as there's more to physics than Newtonian mechanics or thermodynamics, but I still get to assume that glorious theories that somehow fail to conform to such basics are probably in error.)
[+] [-] draz|12 years ago|reply
So, instead, they charge EVERYONE a crazy amount, and then they get X% of the amount billed from one insurance, Y% from another insurance, etc. Fair? Not really -- if you don't have insurance, you get hit with the FULL amount (since you don't have the negotiating power the insurance company has). So while company X paid $200 for an MRI, you'd pay out of pocket $2500 without insurance.
In reality, what happens? Normally, people without insurance are an underserved population. They send them letters, and they don't pay. At the end of the day, the hospital/private practice just ends up writing this amount off, and they call it a day. It ends up being a silly game where they bill knowing they won't get paid, and then spend more money on trying to collect rather than give more realistic prices.
I, therefore, welcome this transparency.
source: I work for one of the largest and prestigious medical/research institutions in the US, and I used to do Analytics for their financial data warehouse.
[+] [-] johndevor|12 years ago|reply
Wherever you decide to have your surgery, you should inquire about the rate of infection in their facility. Our rate of infection for 2006 was 0.3%, for 2007 was 0.2%, for 2008 was 0.04% and for 2009 and 2010 was .001%. These percentages are astoundingly low compared with an estimated national average of 2.6 % per year.
[+] [-] zdean|12 years ago|reply
[+] [-] bengebre|12 years ago|reply
[+] [-] EvanAnderson|12 years ago|reply
I get looked-at like I'm crazy when I try to explain my insurance and that I'd like to know more about the cost of a procedure or prescription before I agree to it.
I've always tried to just pay cash for services. Increasingly, though, I'm finding that providers are being put under exclusive contracts which prevent them from allowing me to pay cash. As soon as they find out who my insurer is they clam up, explain that they're under contract w/ that insurer, and say they can't give me cash pricing. It's doubly frustrating because they usually won't talk to me at all if I don't tell them who my insurer is. Catch-22.
The provider ends up billing my insurer who doesn't pay because I haven't reached my deductible. Then I get a bill from the provider, 4 - 6 weeks later. Sometimes the provider allows me to pay the "negotiated price" my insurer would have paid, but other times I've had to pay the full non-discounted amount.
What a screwed-up mess.
[+] [-] ceejayoz|12 years ago|reply
Not only that, but one often doesn't know if insurance will cover it, at all. One of my wife's surgeries was "pre-authorized" but rejected by insurance when the bill came through.
[+] [-] lettergram|12 years ago|reply
Medicare pays only 15-25% of what they are charged, that is to say, if a surgery costs $40,000 they will only pay the doctor $10,000.
This isn't only medicare, it's literally every company. Every single insurance company pays only a fraction (usually 50%$ or less) of what the hospital actually charges you. If you don't have insurance you can just call up and usually if your semi-nice and fairly strait forward you can get the bill reduced to a fraction (30-40%) because that's about what they accept from insurance anyways.
Their prices are simply what they'll get paid in either case, so good job to these doctors, hope it helps less people get scammed and pay their full bills.
[+] [-] pdx|12 years ago|reply
[+] [-] hremid|12 years ago|reply
The AMA's official position in 1996:
"To decrease the rate of physician supply, limits must be placed on the number of medical school graduates entering GME [graduate medical education]. Since the federal government currently plays a major role in financing GME and is responsible for establishing immigration laws that affect IMG participation in GME in this country, it is imperative that the federal government partner with the medical education community to achieve this goal." [2]
The AMA worked closely with then Speaker of the House Newt Gringich to overhaul Medicare's relationship with physicians. [3]
The AMA is typically the biggest spender among lobbying groups in the health care sector.
[1] http://usatoday30.usatoday.com/News/health/2005-03-02-doctor...
[2] http://www.ama-assn.org/resources/doc/PolicyFinder/policyfil...
[3] http://www.clintonlibrary.gov/assets/storage/Research%20-%20...
[+] [-] lostlogin|12 years ago|reply
WTF?!? I don't know what we charge for a routine biopsy, but for an MRI guided one with vacuum assistance - vasty more complicated, expensive and time consuming - we charge about $2000USD. Come and have a holiday in New Zealand at the same time and it may still be cheaper.
[+] [-] systematical|12 years ago|reply
[+] [-] forgingahead|12 years ago|reply
[+] [-] dr_|12 years ago|reply
They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."
This is simply not true. If they were undercutting Medicare with their pricing, the government would likely have issue with it (i.e. if they were contracted with Medicare but charging Medicare more than what they charge other insurers/patients - this never happens). But their pricing is multiple times what a Medicare claimant would have to pay, so it's a non-issue.
Take, for example, the One Medical Group. They accept Medicare and although the services they provide are limited to primary care, they are transparent with their basic fees. http://www.onemedical.com/nyc/pricing/insurance
Our own medical group is heading in the direction of transparent pricing as well, and we accept Medicare.
[+] [-] hcarvalhoalves|12 years ago|reply
Isn't clear pricing supposed to be a good thing? Shouldn't it be actually enforced by law?
[+] [-] muyuu|12 years ago|reply
Crony capitalism only believes in competition for others. Competition in their own sector suddenly brings doom and the Iron Law of Wages.
The US is one of the countries with the highest expenditure per capita in healthcare and the results simply don't match that. See the graph here: http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...
[+] [-] tekromancr|12 years ago|reply
[+] [-] alexholehouse|12 years ago|reply
"OKLAHOMA CITY – An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed all-inclusive surgery prices online. The move is revolutionizing medical billing in Oklahoma and around the world."
Around the world? Really?
[+] [-] methehack|12 years ago|reply
[+] [-] rhuppert|12 years ago|reply
[+] [-] javert|12 years ago|reply
> They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments.
Obama, better close up that loophole! Wouldn't want people to find out that capitalism works in every. single. industry.
[+] [-] kasey_junk|12 years ago|reply
Lets not let the bizarre state of the US medical industry act as some sort of straw man to support some ultra libertarian viewpoint.
[+] [-] plainOldText|12 years ago|reply
"FREE MARKET-LOVING, PRICE-DISPLAYING, STATE-OF-THE-ART, AAAHC ACCREDITED, DOCTOR OWNED, MULTISPECIALTY SURGICAL FACILITY IN CENTRAL OK."
[Edit]: The footer of the hospital in the article: http://www.surgerycenterok.com/
[+] [-] etler|12 years ago|reply
[+] [-] homosaur|12 years ago|reply
In a corrupt market or system, doing the right thing is in and of itself a revolutionary act. Doctors standing up for what's right instead of their pocketbook and pharma reps is a revolutionary act.
[+] [-] sixdimensional|12 years ago|reply
This isn't a new controversy, but still quite problematic - for some fun try Googling "usual, customary and reasonable" (UCR charges).
[+] [-] steveplace|12 years ago|reply
-- offer a "price match guarantee" against any procedures versus in-network hospitals
-- offer a discount for low-risk patients (non-diabetic non-obese) who need to have surgery done
-- do "bundle deals" with local hotels and/or attractions like they do with plane flights, so if you are travelling to the hospital you would have something for the family to do
-- free 1-month nurse concierge where you can call a hotline to followup after any procedure (would be great for baby deliveries)
-- discount on 3-months of physical training, along with a bundle deal at a local gym
-- offer a "retainer" that would lockin a price of any procedure for 5 years. Good for those who are family planning or have a low-priority surgery
It just seems like there's a market for something-that-doesn't-suck in healthcare.
[+] [-] swalkergibson|12 years ago|reply
This sounds to me like an insurance premium, no?
[+] [-] EvanAnderson|12 years ago|reply
This is great, and I hope it's a sign of a trend.