Healthcare Price Transparency

[babysdaddy 2721]

Insurers Resist

This along with negotiated drug prices could greatly reduce the cost of care.  Transparency is critical to price competition.  The comment below pisses me off.  The consumer wants affordable healthcare.  Their copay or cost out of pocket could be reduced if their insurance costs less, which it would, if insurers new costs of treatment were reduced.  

“What is it the consumer wants? ‘What is it going to cost me out of pocket?’” said Tom Nickels, executive vice president of the American Hospital Association. “That’s what the health-care field needs to do a better job with. Let’s give the patient what they need.”

[Anastasis 23463]

Can you spoiler tag the article for WSJ poors like me. 

[52-80 19147]

I once mused about this long ago. 

 

People - not insurers, not insurance shills - shouted back blah blah people shouldnt people have to price out their treatment; we dont want people deciding their health based on cost yadda yadda

 

Of course, probably all of these people had the privilege and luxury of being covered by robust medical insurance.  Though its really myopic, arrogant, and almost puritanical to tell others how to live their life.

 

The rest of the world, prices of treatment are quite upfront, and it's worked pretty much fine. 

 

 

[babysdaddy 2721]

5 minutes ago, Anastasis said:

Can you spoiler tag the article for WSJ poors like me. 

Hospitals and insurers are gearing up to battle a Trump administration plan that could require the public disclosure of negotiated prices for medical services, part of an effort to lower U.S. health-care costs.

Patient advocates have largely cheered the idea, saying consumers should be able to price shop before they pick a doctor or undergo treatment. But industry groups are attacking the administration’s legal authority to mandate price disclosure, which could upend hospitals’ negotiations with insurers, and are criticizing any requirement as too complex to implement.

 

They also say such a move would force them to disclose prices that would be of little use to consumers, who just want to know what they need to pay out of their pockets, not the full price of the service.

“What is it the consumer wants? ‘What is it going to cost me out of pocket?’” said Tom Nickels, executive vice president of the American Hospital Association. “That’s what the health-care field needs to do a better job with. Let’s give the patient what they need.”

While hospitals fear new demands from insurers to lower prices, insurers could also face price pressures if hospitals that get lower reimbursements demand the higher rates their competitors have won. Also, insurers that have wrangled the steepest discounts may not want those rates exposed to competitors that would then be able to push for similar pricing.

The negotiated rates that insurers pay hospitals and other health-care providers often vary widely. In Ohio, the average price of a pregnancy ultrasound in Cleveland was $522, almost three times the $183 charged in Canton, Ohio, just 60 miles away, according to a 2016 study in Health Affairs.

These negotiated rates are typically closely held secrets, often shielded by contractual gag clauses. Unveiling them could mark a major change for many health-care markets. Ana Gupte, an analyst with Leerink Partners LLC, said the effect would likely be to push down the rates that some hospitals receive, as insurers seek to renegotiate after learning that their competitors may have gotten a better deal.

“As you start seeing the contracts with some of the major players, everyone will ask for that price,” she said. In many cases, local Blue Cross and Blue Shield insurers get the steepest discounts, and other insurers may push to match them, she said.

America’s Health Insurance Plans, an insurance trade group, said it is still reviewing the administration plan.

 

Moreover, insurer contracts are complex and hospital systems typically have multiple contracts with each insurer, each with different terms.

“It’s going to be a big lift to actually make this happen,” said Niall Brennan, chief executive of the nonprofit Health Care Cost Institute, who said he applauds efforts to make health-care pricing more transparent. If it does move forward, “it’s going to put a lot of hospital CEOs and CFOs in the hot seat.”

The institute’s research has suggested that growth in health-care spending on people covered by employer plans is due largely to rising prices, rather than increases in the volume of health-care services used.

If a proposal does go forward, providers that don’t comply could potentially face fines. The administration is seeking public comment through May 3, a request that marks the first step toward a possible rule. The prices could be posted on a public website or aggregated by third parties to enable consumer comparison shopping.

The actions are in line with the Republican stance of relying on competition and free-market factors to control prices. The administration this year already required hospitals to post their list prices, which don’t include any negotiated discounts. And under another administration proposal, drugmakers may also have to put prices in television ads.

But some hospitals and insurers, which wield considerable lobbying clout, are planning to push back. At the state and federal level, some legislative efforts to mandate price transparency stalled amid industry resistance. More recently, Reps. Ed Perlmutter (D., Colo.) and Mike Gallagher (R., Wis.) introduced legislation in February that would require all providers, including insurers and drug companies, to publicize prices.

Sen. Chuck Grassley (R., Iowa) tweeted last week that he supported the administration’s transparency push. “Too much secrecy contributes to high cost of health care!”

Industry groups say that consumers with health insurance often already have access to estimates of what they will pay out of pocket for a medical service, often provided by the insurers.

Even then, research shows that consumers don’t always price shop. Spending actually increased when two employers offered an online health care price tool to employees, according to a 2016 study in the Journal of the American Medical Association. Only 10% of employees used the tool in its first year.

Sunita Desai, a health economist at New York University School of Medicine who led the study, said the Trump administration idea would still help move the needle on price transparency.

“There is not a silver bullet,” she said. “But just making prices available, getting to a point where that information exists, is important for helping patients navigate.”

Appeared in the March 12, 2019, print edition as 'Hospitals, Insurers Set to Resist Price Transparency Proposal.'

[TwiceHorn 31440]

Hospitals.

Hospitals need to get their ration of shit in this.  They have successfully avoided it so far.

[Anastasis 23463]

Thanks. 

Just now, TwiceHorn said:

Hospitals.

Hospitals need to get their ration of shit in this.  They have successfully avoided it so far.

Yep. The games they play with non-network physician groups practicing in network ER facilities stimulated a few threads on the old site. Price transparency. LOL. They are not even transparent about whether the doc takes your insurance or not. 

[SquishMitten 10403]

From a legal standpoint, it seems problematic to force private companies to reveal the confidential terms of their contracts. From a consumer standpoint, something has to be done. They’re been fleecing us forever. They’ve shown they are incapable of solving the problem on their own. They deserve every bit of government intervention they ultimately get. 

[Nice Guy Eddie 13509]

30 minutes ago, babysdaddy said:

Insurers Resist

This along with negotiated drug prices could greatly reduce the cost of care.  Transparency is critical to price competition.  The comment below pisses me off.  The consumer wants affordable healthcare.  Their copay or cost out of pocket could be reduced if their insurance costs less, which it would, if insurers new costs of treatment were reduced.  

“What is it the consumer wants? ‘What is it going to cost me out of pocket?’” said Tom Nickels, executive vice president of the American Hospital Association. “That’s what the health-care field needs to do a better job with. Let’s give the patient what they need.”

I think the quoted statement is correct. People have become conditioned to only caring what they pay out of pocket. "I want to see a highly educated team of professional to treat me, and I want to pay $10 for an hour of their time." Of course everyone understands that more money is being exchanged but that the one transaction isn't directly affecting your own personal healthcare bills other than out of pocket.

I believe that the real problem is with Medicare and Medicaid having to be propped up by commercial insurance because of low reimbursement rates. Physicians and facilities see these patients at a loss, or at best breakeven, and the commercial insurance patients more than their share of the medical costs. Think $20 aspirin.  If the US govt would actually pay their fair share, then healthcare costs should drop for commercial insured. 

Obviously this could lead to higher taxes to pay for higher reimbursement rates from govt payors but at least it would be more transparent.

[Anastasis 23463]

Medicare contracting, and specifically most favored nation clauses, would seem to have an upward pressure on pricing as well.

 

The reality is that we have an overly complex system of health care financing in this country.  Obviously perspectives can differ, but imo, much of the complexity is the result of government entry into healthcare. Price transparency is a huge part of the problem, but it is only a part of the problem. We need start over with a clean slate; however, the deeply entrenched financial interests make it extremely difficult to effect real meaningful change.

[TwiceHorn 31440]

Where it starts to matter is with ACA plans, which, as far as I can tell, all have deductibles of about 6-7000/12-14000. The lower tier ones (with premiums under or at about  $1500/month for a family) cover very little prior to hitting that deductible, so you are a cash customer until then. That means there is some incentive to spend that out-of-pocket money wisely.

There is some notion that the ACA "catastrophic" model is how health "insurance" should be handled in the future, which will increase the need for spending the deducible wisely.

Of course, countering this incentive is that the lower cost plans have very narrow networks, so there isn't any choice to exercise the competitive price option.  And, of course, the deductible scenario itself disincentivizes spending it wisely (might as well burn through that fucker and get what you pay for).

Edited March 12, 2019 by TwiceHorn

[JimmyHoffa 1188]

27 minutes ago, Nice Guy Eddie said:

I think the quoted statement is correct. People have become conditioned to only caring what they pay out of pocket. "I want to see a highly educated team of professional to treat me, and I want to pay $10 for an hour of their time." Of course everyone understands that more money is being exchanged but that the one transaction isn't directly affecting your own personal healthcare bills other than out of pocket.

I believe that the real problem is with Medicare and Medicaid having to be propped up by commercial insurance because of low reimbursement rates. Physicians and facilities see these patients at a loss, or at best breakeven, and the commercial insurance patients more than their share of the medical costs. Think $20 aspirin.  If the US govt would actually pay their fair share, then healthcare costs should drop for commercial insured. 

Obviously this could lead to higher taxes to pay for higher reimbursement rates from govt payors but at least it would be more transparent.

 

It's a massive system wide issue and one that is going to take a complete revamp to fix. 

In theory Price Transparency is obviously a good thing. However.........................

Aside from an office visit the line item charges for doctors, facilities, exams, tests, band aids, needles, medicine, instruments,  and the codes that go along with them well good luck to anyone that is looking to see those up front costs and having even have a clue what the majority of those charges are for. 

I'm not saying it's fine the way it is but again until they fix cost of care it isn't going to matter showing someone what costs are up front. Aside from truly elective surgeries or tests most people aren't going to be looking at what their costs will be when they are on the table needing to get their appendix removed before it explodes. 

The easiest place to start would be with drugs. 

And yes the Medicare/Medicaid reimbursement rates are a massive issue. There is a reason why many rural hospitals are closing shop as they can't afford to only have Medicare patients in their beds and using their services. 

 

[Nueces River Rat 5537]

17 minutes ago, TwiceHorn said:

Where it starts to matter is with ACA plans, which, as far as I can tell, all have deductibles of about 6-7000/12-14000. The lower tier ones (with premiums under or at about  $1500/month for a family) cover very little prior to hitting that deductible, so you are a cash customer until then. That means there is some incentive to spend that out-of-pocket money wisely.

There is some notion that the ACA "catastrophic" model is how health "insurance" should be handled in the future, which will increase the need for spending the deducible wisely.

Of course, countering this incentive is that the lower cost plans have very narrow networks, so there isn't any choice to exercise the competitive price option.  And, of course, the deductible scenario itself disincentivizes spending it wisely (might as well burn through that fucker and get what you pay for).

While not an expert in this area by any means, I think going back to a catastrophic based system would be better than the nickel and dime co pay type of crap we have in place now.   Add in some transparency in pricing and it could be a good thing, especially with the stuff most people use their current health plans for now which is the nickel and dime stuff like going to the Doc to get some meds for a cold, etc.   If I were a Doc or Physician Groups (which many Docs are belonging to  more and more these days), I would rather set up a credit/cash account with a patient vs paying a couple of ICD 10 coders to have submit a claim  which in many cases gets rejected which then has to be resubmitted and maybe multiple  times to get that $65 or so the insurance company contracts you  for that simple office visit.  What is your profit at the end of the day?    If a patients co pay under the current system is $50 or $75 , wouldn't it be better to capture it  without having to go through all the BS noted above?   

The increases in cost in the system went into overdrive with the invention of the HMO and government mandates for all plans to cover certain things like maternity care.  Health insurance should be like other types of insurance where if I have a need to cover a risk,  I should be able to chose whether I increase of decrease accordingly.   

 

[Brisketexan 105075]

I am far from an expert in the field.  But it has always seemed to me that the public v. private discussion is a damned red herring.

We the people spend $X on healthcare.  Included in that -- using me as an example -- is 1) huge premiums I pay, 2) co-pays, deductibles, and other out-of-pocket stuff I pay directly, and 3) tax dollars I pay that go to medicare/medicaid.  That is, again using me as an example, there is a defined pool of dollars that goes out of my side of the ledger and ends up being spent on healthcare.  And it's a not insignificant number.

And I can live with that number.  I pay a lot towards healthcare, and I can live with continuing to pay a lot.  But why can't it be a streamlined, relatively singular, relatively transparent system?  Shit, I pay for food two ways (out of pocket for my family, and some tax dollars that go to SNAP etc.), but goddamn, when I walk into HEB and want to buy a box of Cheerios, the price is marked on the shelf, I don't need pre-approval, I am not limited to one particular size box, etc. etc.  I need food, I obtain food, for a transparent price and with ease.

Yes, I know that we've created a byzantine system with too many interested parties to ever unwind, but in a wave-a-magic-wand world, it sure seems like a single-payer system of some sort (with options to buy-up/pay for additional services out of pocket) makes all the sense in the world.

[Nueces River Rat 5537]

30 minutes ago, JimmyHoffa said:

 

It's a massive system wide issue and one that is going to take a complete revamp to fix. 

In theory Price Transparency is obviously a good thing. However.........................

Aside from an office visit the line item charges for doctors, facilities, exams, tests, band aids, needles, medicine, instruments,  and the codes that go along with them well good luck to anyone that is looking to see those up front costs and having even have a clue what the majority of those charges are for. 

I'm not saying it's fine the way it is but again until they fix cost of care it isn't going to matter showing someone what costs are up front. Aside from truly elective surgeries or tests most people aren't going to be looking at what their costs will be when they are on the table needing to get their appendix removed before it explodes. 

The easiest place to start would be with drugs. 

And yes the Medicare/Medicaid reimbursement rates are a massive issue. There is a reason why many rural hospitals are closing shop as they can't afford to only have Medicare patients in their beds and using their services. 

 

I heard two separate stories yesterday from two people about some prescriptions they take.   Both said it was cheaper to pay for them off their plan vs with their plan and only discovered the fact when they asked about it.   But big Pharma and their minions at the Big Pharmacy Companies like CVS, etc do not tell you right out of the gate what the cost is without insurance.  They just ring it up and assume most people think the drug is more expensive without insurance.  

That's the thing I like about going to Mexico.  I don't buy many prescription drugs nor do I have medical procedures done over there like dental visits.  But when you  go across to Progresso or somewhere over there which cater to Americans, you see all their pricing up front.  I do think next time I do need major dental work I will venture across.  The first and only crown I have cost me a small fortune even with dental insurance.  Over there, about a 1/3 the cost for the same stuff.  

[52-80 19147]

3 minutes ago, Nueces River Rat said:

I heard two separate stories yesterday from two people about some prescriptions they take.   Both said it was cheaper to pay for them off their plan vs with their plan and only discovered the fact when they asked about it.   But big Pharma and their minions at the Big Pharmacy Companies like CVS, etc do not tell you right out of the gate what the cost is without insurance.  They just ring it up and assume most people think the drug is more expensive without insurance.  

That's the thing I like about going to Mexico.  I don't buy many prescription drugs nor do I have medical procedures done over there like dental visits.  But when you  go across to Progresso or somewhere over there which cater to Americans, you see all their pricing up front.  I do think next time I do need major dental work I will venture across.  The first and only crown I have cost me a small fortune even with dental insurance.  Over there, about a 1/3 the cost for the same stuff.  

also big businesses in the european borders.  think czech republic, slovakia, hungary.  they even have hotels with built-in dental offices, full-on services with chartered buses, to treat people point-topoint.  more importantly, they operate better hours.  whereas in some peoples home countries, doctors and clinics operate 8-11 monday, 2-4 tuesday, 1130-130 wednesday, and other random ass hours, these places will be almost 24/7 with rotating physicians.  way more convenient

[Asithappens 974]

2 hours ago, babysdaddy said:

Insurers Resist

This along with negotiated drug prices could greatly reduce the cost of care.  Transparency is critical to price competition. 

Price competition isn't the same thing as lowering the price of health care.

Look what happens when more providers move into an area. Take a guess: prices don't drop.

[Anastasis 23463]

1 hour ago, Nueces River Rat said:

While not an expert in this area by any means, I think going back to a catastrophic based system would be better than the nickel and dime co pay type of crap we have in place now.

 

1 hour ago, Brisketexan said:

Yes, I know that we've created a byzantine system with too many interested parties to ever unwind, but in a wave-a-magic-wand world, it sure seems like a single-payer system of some sort (with options to buy-up/pay for additional services out of pocket) makes all the sense in the world.

My ideal wave the wand world system would involve:

1. Catastrophic backstop coverage for all Americans.  This could be implemented via a single payer framework. 

2. Decouple insurance from employment. Insurance plans compete on open market to sell "supplemental plans" that cover the pre-catastrophic phase. Public safety net options also operate in this phase. The backstop of the catastrophic coverage above should create downward pressure on base case premiums making coverage more affordable.  

3. Significant expansion of HSA's to cover expenses associated with supplemental plans and out of pocket expenses. 

4. Requirements for pricing transparency at provider, facility, and pharmacy.

5. Various reforms to drug approval process, patent law, and NIH research funding to drive cost-effectiveness.

 

IMO, something along the lines of above optimizes the contributions from public and private sectors, maximizes individual engagement in their healthcare decision making, and allows market forces to operate with appropriate inputs.  It's also a total pipe dream. 

 

[clapclapclap 9000]

We had two emergency room visits within 3 months for the same issue, same time of day, and almost the exact same tests run.  St. Joseph's Med Center  in the Heights was more than twice the copay as the hospital in DFW (same insurance.)  Total charge shown as billed to insurance (who knows if that is accurate) was $7,000 versus $3,000.    Older facility, too.

[pacman 7355]

Here is a site,https://clearhealthcosts.com/

 

The owner recently did a Ted talk, giving examples of the same care costing 60x the amount with the only difference being one zip code over.

 

[EuroHorn 3257]

Why does a hospital need to know who my insurance coverage is with?  If my house is damaged, I will settle with the insurance company and then go out and choose a builder for repairs or  go to Home Depot, Lowes, etc. to buy materials to fix myself.  The builder or Home Depot/Lowes won't ask me who my insurance is with.

[bschoolprof 6252]

1 hour ago, Anastasis said:

 

My ideal wave the wand world system would involve:

1. Catastrophic backstop coverage for all Americans.  This could be implemented via a single payer framework. 

2. Decouple insurance from employment. Insurance plans compete on open market to sell "supplemental plans" that cover the pre-catastrophic phase. Public safety net options also operate in this phase. The backstop of the catastrophic coverage above should create downward pressure on base case premiums making coverage more affordable.  

3. Significant expansion of HSA's to cover expenses associated with supplemental plans and out of pocket expenses. 

4. Requirements for pricing transparency at provider, facility, and pharmacy.

5. Various reforms to drug approval process, patent law, and NIH research funding to drive cost-effectiveness.

 

IMO, something along the lines of above optimizes the contributions from public and private sectors, maximizes individual engagement in their healthcare decision making, and allows market forces to operate with appropriate inputs.  It's also a total pipe dream. 

 

These are all great ideas and will therefore never be implemented.  

[CleverNickname 1308]

not totally germane to the topic, but I like the morally iffy Split Insurance proposal: (subject to qualifications, like X months to live etc) Health Plan will cover treatment, expected to cost $X. Let's say $200k. Offer to patient: we will totally cover your treatment, no worries. But if you skipped it, we'd give you $100k cash on the barrel head. Give it to your grand kids, take a vacation. Whatever. Win-win (except for the squicky part). 

[JimmyHoffa 1188]

3 hours ago, Anastasis said:

 

My ideal wave the wand world system would involve:

1. Catastrophic backstop coverage for all Americans.  This could be implemented via a single payer framework. 

2. Decouple insurance from employment. Insurance plans compete on open market to sell "supplemental plans" that cover the pre-catastrophic phase. Public safety net options also operate in this phase. The backstop of the catastrophic coverage above should create downward pressure on base case premiums making coverage more affordable.  

3. Significant expansion of HSA's to cover expenses associated with supplemental plans and out of pocket expenses. 

4. Requirements for pricing transparency at provider, facility, and pharmacy.

5. Various reforms to drug approval process, patent law, and NIH research funding to drive cost-effectiveness.

 

IMO, something along the lines of above optimizes the contributions from public and private sectors, maximizes individual engagement in their healthcare decision making, and allows market forces to operate with appropriate inputs.  It's also a total pipe dream. 

 

 

1. Yes but don't ever say "single payer" again as it's a bad word and no matter how great a non starter for a lot of idiots

2. Disagree, allow companies to subsidize the coverage or buy add on coverage similar to the Medicare Supplement market but for office visits, accidents, critical illness, etc. And allow individuals to buy their own if companies don't offer it

3. Yes

4. Yes, but lets go for a total revamp of the system. Sorry hospitals you aren't charging $50 for a Kleenex that's part of the "visit" or total "stay charge" 

5. yes and also tell the rest of the world to fuck off we are no longer paying the subsidy for you to get the same drugs we use for lower costs.  

[Nice Guy Eddie 13509]

2 hours ago, EuroHorn said:

Why does a hospital need to know who my insurance coverage is with?  If my house is damaged, I will settle with the insurance company and then go out and choose a builder for repairs or  go to Home Depot, Lowes, etc. to buy materials to fix myself.  The builder or Home Depot/Lowes won't ask me who my insurance is with.

Convince your health insurance company to give you the $80K in cash prior to a hospital stay, and the hospital will happily take the cash from you.

[52-80 19147]

20 minutes ago, JimmyHoffa said:

 

1. Yes but don't ever say "single payer" again as it's a bad word and no matter how great a non starter for a lot of idiots

i wonder how those idiots would react if they were told roads, fire service, police, and etc, were "single payer"

[TwiceHorn 31440]

51 minutes ago, Nice Guy Eddie said:

Convince your health insurance company to give you the $80K in cash prior to a hospital stay, and the hospital will happily take the cash from you.

Actually, the problem with that is that there is no such thing as a "health appraiser" or "health adjuster" that can give a fairly objective estimate of the cost of care.  There is the provider and the insurer, and they are irretrievably conflicted.

That's not to say that "health care adjustment" is impossible; it just doesn't exist.  Maybe it should.

[CleverNickname 1308]

21 minutes ago, TwiceHorn said:

Actually, the problem with that is that there is no such thing as a "health appraiser" or "health adjuster" that can give a fairly objective estimate of the cost of care.  There is the provider and the insurer, and they are irretrievably conflicted.

That's not to say that "health care adjustment" is impossible; it just doesn't exist.  Maybe it should.

there is already forced mediation for some claims in TX. Leg likely to expand the scope. Don't forget there are 3 parties aside from the insured: doctor, insurer, and facility. It's wicked complicated. 

[elfenix 34223]

6 hours ago, Nueces River Rat said:

I heard two separate stories yesterday from two people about some prescriptions they take.   Both said it was cheaper to pay for them off their plan vs with their plan and only discovered the fact when they asked about it.   But big Pharma and their minions at the Big Pharmacy Companies like CVS, etc do not tell you right out of the gate what the cost is without insurance.  They just ring it up and assume most people think the drug is more expensive without insurance. 

good old gag clauses.  when i balked at the price of my latest 'scrip (after looking at goodrx), HEB pharma dropped the price to 1/6 of what they'd first told me, even below the goodrx listing. 

[TwiceHorn 31440]

11 minutes ago, CleverNickname said:

there is already forced mediation for some claims in TX. Leg likely to expand the scope. Don't forget there are 3 parties aside from the insured: doctor, insurer, and facility. It's wicked complicated. 

Something you hear now and then is that medicine ought to be treated more like engineering than the mythical black art that it has been accepted as for centuries.  When you start talking engineering, you're starting to look at something that can be quantified like a damage and repair estimate for a car or building.  So it seems like that is something that might ought to be doable.  Public medical appraisers or something.  I dunno.