I would hesitate to interpret this so naively. For example, there are some vascular surgeons who take on patients that nobody else will touch. These are patients with many bad prognostic risk factors, but they will die without the surgery.
The surgeons who take these patients may end up having terrible stats, but be the most skilled if only because their mortality rate is not pushing 100%.
Comparing this statistic the way people compare gas mileage is a disincentive for these surgeons to operate on patients that need help, but are high risk.
Selection bias (by the physicians) should make that extremely challenging. You could adjust for underlying comorbidities, though that will often not give enough adjustment to make an impartial expert observer feel that it is sufficient.
CMS is actually doing that already (at least for hospitals).
Early next year, CMS will post healthcare quality metrics that it's collected from providers who bill to CMS. In 2015, hospitals will start getting reimbursed based on quality, which is a step in the right direction, however, it is chocked with problems (i.e. treating the best patients will advantage a hospital)
Some states already do this. For example, for CABG and valve surgery, NY State publishes raw, as well as risk-adjusted mortality rates (RAMR) broken down by surgeon: (warning, PDF) http://www.health.ny.gov/statistics/diseases/cardiovascular/... (begins on pg 21)
Fun fact: Dr. Oz is in there and it even looks like he might be one of the better performing surgeons too. Another fun fact: it can be hard to draw inferences about individual providers this way; check out just how wide some of the the 95% CIs for the RAMRs are, and a lot hinges on how good your risk adjustment model is (details on pg 13).
If you were a doctor, would you rather charge more, or less? What keeps you from charging the highest fees in the world? Your reputation. If you're not the best, you cannot charge the most. All of capitalism works this way.
agreed. How many times have you actually shopped out a procedure by making 10 doctors appointments for checkups and quotes, typically, when they need to operate, you just go with what they say.
Most doctors in rich (i.e. insured patients) hospitals have no idea. My ENT was quite surprised when I told him the charge (>$1000) for his quick look down my throat. And that was only after a lot of shopping around and negotiating on my part. And it didn't include any "treatment" - it was just to look and possibly diagnose.
I'm usually asking the receptionist or other office person - they handle most of the billing stuff, and the other response I sometimes get is "oh, we have to run it through insurance first". They just run a code, and get told what they'll get paid (apparently), not necessarily what my cost/price is.
The system is so fundamentally out of whack, and not at all 'market driven' and yet somehow... my 'free market capitalist conservative republican' friends (I have a few) are really against "socializing" medicine/healthcare. As if, somehow, what we have now in the US is a bastion of free market enterprise.
The cynic in me thinks that the conservative elite really really really enjoy having a dependent class, and ensuring people are at the mercy of private health insurance companies vs the federal or state government helps ensure that dependency in a way they can still control. But... I'm overly cynical, it's late, and my words aren't coming out exactly as I think they should. :/
Medical care is not really capitalism. Doctors get about the same reimbursement from any given insurance company no matter how good (or bad) they are, unless they are bad enough to get dropped from the insurance company's panel. Some negotiate for slightly better rates, but that often has more to do with the number of similar specialists in their geographic area on the insurance panel.
Insurance companies consider doctors a commodity. They only place where capitalism really applies is when patients are paying cash.
Source: I'm an MD. My specialties are forensic and child psychiatry. Interestingly, despite severe shortage of child psychiatrists, it is not reimbursed as well as some specialties that have a glut of providers (like cardiology). Not complaining, it's well reimbursed enough for me, but just making another point that it's not really capitalism.
You forgot things like consumers needing information and having a choice. Those need to be present for capitalism to work.
For fun I ask how much it is going to cost when going to my doctor. They refuse to tell me. They can't even make an estimate (tens? hundreds? thousands?) Even after seeing the doctor they can't. I pull out my card and say "I would like to pay now". I get told I have to wait for the bill. It is virtually impossible to find prices. Things are more complicated because the patient is often not the one paying directly due to the "insurance" that goes on.
A few years ago I had a ride to the emergency room. There was only one ambulance company and only one relevant hospital. The morphine in the ambulance was $27. At the hospital it was $129 plus another $75 fee to add it to the drip. Capitalism is not at play there.
According to the site, for the 'Certificate of need', the main arguments seems to be following:
"A number of factors spurred states to require certificates of need in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an oversaturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily."
I couldn't understand this argument. Something seems to be wrong.
The argument for CON is that if a new facility came in and charged less, then the existing facilities would have to charge more to cover the patients they lost which would adversely affect their remaining patients. So a new facility would need to show the need of non-served patients - ie that they wouldn't take away patients from existing facilities.
It is of course hogwash, but is a nice way for existing facilities to have a monopoly, prevent competition, and not have pricing pressure. Standard rent seeking/corruption that exists in the US.
This has enormous impact by bringing transparency to medical procedure pricing. One could quite literally save $10-50K by opting to do a procedure just a few miles away.
Nice work. Where did you get the data for this? Is it publicly available?
This looks like DRG data by hospital released a few months ago by CMS, so what the hospitals bill for to Medicare, although the actual payments are set by CMS. Still, charge master data is the starting point for people not on Medicare/Medicaid
Thanks. Yeah, a lot of people travel abroad to save money, but its possible to find comparable prices nearby too. Patients aren't trained to shop around with procedures though.
Can I ask why you're spending thousands of dollars on Rx and care? From what I've gathered Medicaid patients have co-pays of $3-$5 on drugs and very small office visit co-pays.
I'm not questioning your story, just genuinely curious what the extra costs are.
My mother is covered by Indiana's medicaid program, as she's at the poverty level but not old enough yet to qualify for Medicare. Her prescription buydown/deductible every month is $550, which I pay for. If you don't mind, I don't want to list specific medications, as it might make it easier to determine her identity. She takes medication for bone mineralization, hormone replacement due to a heart condition, a medication to reduce her blood pressure, as well as a Schedule I pain killer 3-4 times a day for pain management due to lower body nerve damage. She'll very likely have some nerves in her lower back severed in the next 6-12 months to relieve the pain.
So, her prescriptions alone cost around $5K-$6K/year. This is before her GP or specialist copays (very few providers will take Medicaid patients, so its hard to find and keep them), or a hospital visit or two. Her recent open MRI was completely out of pocket (luckily only $600 at a low-income clinic).
Thanks for sharing. I wasn't aware of Medicaid patients who had to pay those types of costs.
I guess my question is, what if a Medicaid patient in IN was truly destitute? There must be some mechanism for patients who can't afford those types of costs.
People often claim that, but it's not a particularly credible argument. Emergency room visits account for less than 2% of total healthcare spending in the US.
EMTALA [0] requires the hospital to stabilize the patient, ie, make it so that it is no longer an emergency (the "E" in "ER"). If you "really can't pay" and it's not an emergency, you likely will find yourself in collections from the hospital.
So if you go and say you are seizing, they will just stabilize you till you are done seizing then kick you out? Or at that point they will attempt to collect for the emergency care and prohibit further care until you can prove you can pay for it?
Generally yes. This comes up occasionally with cancer patients; if they have an acute issue the hospital must stabilize them, but the hospital doesn't have to actually treat their cancer.
If they are very poor, they should in theory be covered by Medicaid, which will then pay for treatment. But this requires them to actually be in a condition (mentally/physically/education-wise) to figure out how to sign up and be approved for it, since coverage isn't automatic. Afaik, even if the hospital is able to determine the person should be eligible, they can't just treat the person and then sign them up on their behalf; the person has to do it themselves, and be approved before seeking treatment.
This is one area that I think the U.S. lags behind many other developed countries in: assigning a social worker to help people in bad situations navigate the system. I've noticed that with an uncle of mine who has MS, is on SSI disability, and can't really take care of himself. If he didn't have a family member who was willing to accept power of attorney and file all sorts of paperwork and make phone calls on his behalf, he would have huge problems, because he isn't able to do that himself, and the state has not assigned a social worker to help him out.
>But this requires them to actually be in a condition (mentally/physically/education-wise) to figure out how to sign up and be approved for it, since coverage isn't automatic.
This is a tough one. I have a disabled family member who would have never been able to do this themselves.
I think it really depends on the hospital. Some hospitals that are in major urban centers and provide services for a large indigent population often waive all expenses.
If you go into one of these hospitals looking like you have no money, you'll likely not be asked to pay anything.
Moreover -- ER visits with fake names. I have no moral issues, completely nothing, 0, lying and stealing from the bastards that sell $300 for a bag of saline or $40 for a pill of aspirin. I don't care that nobody pays it, I don't care what complicated laws or accounting tricks are, if that is put on a bill and sent to a person who was just sick or injured, that is wrong. It is criminal. So if you are conscious and can get way with it (don't need prescription written out just want to get "stabilized"), give them a fake SSN, name, address and fuck them.
Um this is the reason for Obamacare.
People sticking other people with the bill.
People will gladly pay $500+ for an iphone but will not spend money on their own health. Yet they expect the hospital to be forced to take them even if the they can pay.
Are some hospital charges a ripoff. Oh yes. But they are also open 24 hours a day with highly trained staff ready to try and save your life even if you were doing something dumb. They are on stand by even though you pay them nothing to be waiting.
Ok, I think I understand now. I'm guessing your Mom is slightly above the poverty line?
* For people with incomes above 150% FPL, copayments for non-preferred drugs may be as high as 20 percent of the cost of the drug. For people with income at or below 150% FPL, copayments are limited to nominal amounts.[1] *
They include her husband's income, which is only social security and an extremely small pension that barely covers their food, utilities, mortgage, and property taxes. They don't, of course, take into account his medical expenses in the income calculation.
Have you looked at programs offered through the manufacturer of her medications? Many have programs for free or low cost meds for low income people who are un or under insured.
I'm anxious to see those reviews. Quality of care is highly subjective and difficult to measure. Patient reviews are probably the best thing, but may be skewed on short-term or trivial aspects of the treatment, like how nice a doctor is or the wait-time. It'd need to be more on how a patient recovers over a 3, 6, etc. month period and whether or not they need to be re-treated
Thanks for the link--haven't seen this. I think they use a different data set for the procedure prices, but I like how they also compare it to a quality ranking. I will look more into how US News quantified hospital scores.
What I think matters most for healthcare is not just price, but quality/cost. Quality is difficult to measure, but should factor in recovery speed, number of repeat-procedures, service, etc.
I think, when are showing some numbers, it looks much more perceivable when you have something to compare to, in our case, the top hospitals ranking from the US News.
Some more work will mostly likely be done soon to enrich the data we are showing.
Interesting. The prices listed by this tool are very different from the prices listed in the tool in this Show HN post. I wonder how their data differ?
Would it be useful to have a 'show me the cheapest' button? The range in cost hints at the massive variance. The US is crazy. How does a procedure costing 4k in one place cost 120k in another?
It doesn't. The price is set by a Chargemaster list that is drawn up by a committee. Hospitals are free to charge whatever they want above that, without any downward market forces.
Paying more sometimes means better outpatient treatment (and sometimes lower readmittance rates), but it's not a guarantor.
Thanks for the feedback. My next goal is to look more into why the price varies so much.
The price spread is pretty crazy. Some hospitals have higher fixed costs or salaries depending on the geography. Also, if a hospital is more research-oriented, R&D funds are normally tacked onto the price (one of the reasons why Stanford's Hospital is really expensive).
The cost adjustments you're talking about are MS-DRG adjustments (the amount the hospital actually gets paid by CMS). From what I can gather, the numbers on the website, are cost numbers, i.e. what the hospital tells CMS it costs them (which is a number they are free to make whatever).
If you want to know why costs vary so much, starting looking at reimbursement. Hospitals are incentivized to raise their list prices because many of them are paid a set percentage.
I thought medicare reimbursement is relatively fixed, with minor fluctuations based on geography and some hospital-specific practices? Based on a rough glance at the data, it seems like medicare reimbursement is only loosely correlated with the cost numbers, so I don't know how much raising prices would increase their Medicare revenue.
Also, from what I've learned about elderly care, Medicare reimburses a care center a fixed amount ($5000/mon/patient in California) regardless of the severity of the case. I'm assuming this number varies a bit too even in the same region.
As a side note, if you click on any of the prices in the map, it'll show you medicare's reimbursement rates too. Should've made that feature more clear--it's rather important.
What's the consumer use for this? Is it for people without insurance? From what I understand this is the rate that Medicare has negotiated from these providers. But I assume this isn't for people with Medicare, since those people are covered with Medicare. I assume the dollar values don't have much relation to the reality that an uninsured individual would be billed, since Medicare negotiates pretty aggressively for prices that "normal" people or even normal insurance plans can't get.
I'm just not understanding what you learn from this other than what Medicare gets reimbursed. And I'm not understanding how knowing that is actionable in any way for the average person.
Even with insurance your coinsurance could be up to 20%. So, for complex procedures, it is very useful to see if you can get it done some place cheaper. First example of intracranial hemorrhage, price ranges from $9,540 - $234,913. Certainly gives a lot of input to make an appropriate decision. Very unlikely that without medicare negotiation, prices will magically converge to some middle point for all of them.
The issue is that if you have insurance, you're not paying the charge master rate or the Medicare rate, you're paying the negotiated (and likely non-public) rate for your insurer. The 20% co-insurance you pay is based on the negotiated rate.
Exactly. If this knew what my insurance company had negotiated for the procedure, and I could input my policy details to figure out what my personal cost would be then I can totally see the usefulness. But as a consumer I just have no idea at all what knowing the Medicare reimbursement prices tells me.
If I assume that the relative differences that Medicare has negotiated are similar to the relative differences my insurance company has negotiated (which I'm guessing is an invalid assumption), and if I accurately know what my policy will cover vs not cover (again, a nearly impossible thing to know given how complicated these things are), then maybe you can make a decision with this data. But the system is so complicated that I don't think that works at all by just using this dataset.
Yeah, unfortunately what CMS pays for procedures bears little relation as to what private insurers pay. It all depends on the local market for the provider. If most of the population goes to only a few providers, the providers have a lot of sway in negotiations. They will often ask for (and get) per-diem rates or percentage of charge.
If the population goes to a number of different providers, then the insurance company can play hardball and say "if you don't take this rate, you're out of our network, good luck with that". In those cases, they'll negotiate an MS-DRG + X% rate.
The reason why negotiated rates with private insurers are non-public is because it's a negotiating tool. If hospital A gets paid $5K for a heart attack and finds out hospital B a block away gets paid $7K for the same thing, the next round of negotiations will be very rowdy.
True re: negotiated rate. However, the whole premise here is that there is some correspondence between this rate and the negotiated rate. If the negotiated rate is the same across the country across all hospital systems ("the magical mid point price") then this chart is not useful. I doubt thats the case.
US Patients go to south america and Asia to get treated. I don't think shopping around the country hospitals to figure out a good option is going to be a big problem. This is a good first step.
the whole premise here is that there is some correspondence between this rate and the negotiated rate
That is a plausible but false assumption. Different providers negotiate different rates. In many cases, the negotiated rate for a given provider is lower than the "cash rate" that an uninsured person would pay, but in many cases the negotiated rate it is actually much higher(!). Maybe in these cases the insurer gets an end-of-year volume-based discount that the insured (me) never gets to see.
Source: my recent experience shopping for an MRI while on a high-deductible plan.
One factor that keeps these negotiated rates from becoming public is that a lot (actually, almost all) of these contracts signed between hospitals and insurers have a gag order of sorts built into the contract by the hospital. These gag orders prevent the insurer from making the hospital's rates public, and what's more, the terms of these contracts usually forbid insurers from even revealing the existence of these gag orders. Believe me, insurers would love to be able to steer policyholders towards cheaper and higher quality -- better value -- care, but these gag orders make it almost impossible for them to do so. It's an incredibly screwed up system all around, and everyone's complicit -- it's not just the insurers and other payers.
Luckily insurers have begun to find a way around this by selling bulk claim data to third parties who can analyze them and extrapolate the contracted rates on their own (a la Castlight, Change Healthcare, etc.).
Your point is a good one, but maybe a different procedure would be a better example- most people suffering from an intracranial hemorrhage aren't in a position to do a whole of of comparison shopping on where to have it taken care of.
I get your point, but people seem to have the ability to shop on quality!
Let's say you suddenly lose your ability to speak, you think it's a stroke, so you head to the closest clinic. They freak out because you need to go to a stroke center. People (or their family) often ask "What's the best stroke center around here? I want to go there!".
If they had the info available to them, why couldn't they include cost in that equation?
friend got a 2nd degree burn yesterday. she waited 2h to decide if she went to a hospital because she was out of insurance... so yeah, i think she would have used this site :)
Yes, in the short term. But in the long term, your insurance premiums are decided based on the cost of your health care. So if everyone spent wisely, the premiums would go down or stop rocketing the way they have been.
True, but because you don't foot the bill aside from a relatively small co-pay, hospitals/insurance companies can get by charging more and more. This ruins it for the ~50M Americans who don't have insurance.
You have a PPO plan so you pay a copay. Many people have HSA, High Deductible or Catastrophic plans where they pay out of pocket until their hit their deductible. So all of these people have an incentive to shop on price. You're just choosing to pay more in premiums for the benefit of not having to worry about the costs for care.
But this tool only includes Medicare data so it doesn't apply to any of those cases we just mentioned.
They actually correspond to two different slugs in our database. One that has higher price is pointed to the more complicated procedures that involved multiple complications, while the other one is simpler procedure without any complications.
I'd love to talk more about how this can be taken to the next step. Can't find your contact info in your profile--mind pinging me at:
neilsharma101 at gmail dot com
Excellent POC - Obamacare needs to pick this up and run with it, to provide the next level of detail, for all insurers.
Can you tell us about the technology under the hood? Ruby or Node (or whatever)? What APIs did you use? Programming-wise, what was easy and what turned out to be tricky?
Hey. The technology i used focused on speed of deployment. My DB and "backend" is all parse (I don't have a traditional backend). My hosting service is site44, which is simple dropbox hosting so i don't have to setup a server. The rest of it is just js/html/less files. I used bootstrap for the styling and jquery/google maps API for everything else.
I did do some pre-processing on the data in python to geocode the locations (ie: change the street addresses to long/lat coordinates). I used geopy to do that, and pandas to manage the data.
The total product took me three days to build and design
Incredibly useful if you're on medicare (what the price data is based on).
For the majority of us _not_ on medicare, castlighthealth.com is solving this. It's B2B for now, i.e. Tesla pays for castlight and then its employees can use castlight to find out how much things will cost.
I just met with Castlight this week. They have a really slick tool. Other companies like Change Healthcare and Healthcare Blue Book are trying to solve the problem too (with their own B2B solutions).
These are called cost and quality or transparency tools in the industry.
Many insurance companies have tools that can do this exact thing for their members AND apply it to your specific plan at the time of the inquiry. So you can choose based on the procedure cost and your actual cost based on your deductible and co-insurance. Not only that, the tools will also tell you about quality so you can compare based on the quality of service, cost of service and your actual cost at the same time.
Unless you can do all of these things at the same time with your tool, it leaves out critical factors for those actually searching for this type of information as it applies to them at any given time - most importantly when they are trying to make a decision.
Additionally, you only have access to negotiated rates for Medicare whereas an insurance company providing this information is going to provide as much information as they can for all of their members by displaying their negotiated rates specific to your plan.
As an HN reader, if you like this tool, go check with your insurance company and see what they already have and how specific it is for you.
Additionally, you only have access to negotiated rates for Medicare whereas an insurance company providing this information is going to provide as much information as they can for all of their members by displaying their negotiated rates specific to your plan.
This is important. Contracted network discounts may not align with Medicare reimbursement rates for providers so if you have insurance through a network you should look for a tool that can compare in-network rates for your plan as MJR suggests.
the link shows all the diagnoses that fall in that category of DRGs. (DRGs are the packages of procedures that Medicare pays a fixed price for, simply put. If you get that diagnosis, you submit that DRG. However in this case the map from diagnosis to DRG is one to many.) Some of the average costs are only from 20-30 discharges. Do you think that makes for good math or some sort of price guide?
It may highlight that the DRG is incorrectly applied by some hospitals (maybe?), but it has nothing to do with 'going down the street' for a better 'price'.
Bug: (FF 16.0.1 on OSX 10.8.5) When the "select a procedure" drop down box is expanded, wheel scrolling up/down seems to also zoom the map underneath it.
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[ 4.3 ms ] story [ 264 ms ] threadThe surgeons who take these patients may end up having terrible stats, but be the most skilled if only because their mortality rate is not pushing 100%.
Comparing this statistic the way people compare gas mileage is a disincentive for these surgeons to operate on patients that need help, but are high risk.
Early next year, CMS will post healthcare quality metrics that it's collected from providers who bill to CMS. In 2015, hospitals will start getting reimbursed based on quality, which is a step in the right direction, however, it is chocked with problems (i.e. treating the best patients will advantage a hospital)
Fun fact: Dr. Oz is in there and it even looks like he might be one of the better performing surgeons too. Another fun fact: it can be hard to draw inferences about individual providers this way; check out just how wide some of the the 95% CIs for the RAMRs are, and a lot hinges on how good your risk adjustment model is (details on pg 13).
The system is so fundamentally out of whack, and not at all 'market driven' and yet somehow... my 'free market capitalist conservative republican' friends (I have a few) are really against "socializing" medicine/healthcare. As if, somehow, what we have now in the US is a bastion of free market enterprise.
The cynic in me thinks that the conservative elite really really really enjoy having a dependent class, and ensuring people are at the mercy of private health insurance companies vs the federal or state government helps ensure that dependency in a way they can still control. But... I'm overly cynical, it's late, and my words aren't coming out exactly as I think they should. :/
Insurance companies consider doctors a commodity. They only place where capitalism really applies is when patients are paying cash.
Source: I'm an MD. My specialties are forensic and child psychiatry. Interestingly, despite severe shortage of child psychiatrists, it is not reimbursed as well as some specialties that have a glut of providers (like cardiology). Not complaining, it's well reimbursed enough for me, but just making another point that it's not really capitalism.
Wow. I bet you could write an interesting book or three. (I hope you do.)
For fun I ask how much it is going to cost when going to my doctor. They refuse to tell me. They can't even make an estimate (tens? hundreds? thousands?) Even after seeing the doctor they can't. I pull out my card and say "I would like to pay now". I get told I have to wait for the bill. It is virtually impossible to find prices. Things are more complicated because the patient is often not the one paying directly due to the "insurance" that goes on.
This doesn't only apply for doctor visits/procedures, but even for labs where it is a known consistent product with little variability. http://www.rogerbinns.com/blog/gplus/the-first-rule-of-the-a...
A few years ago I had a ride to the emergency room. There was only one ambulance company and only one relevant hospital. The morphine in the ambulance was $27. At the hospital it was $129 plus another $75 fee to add it to the drip. Capitalism is not at play there.
Also did you know that if in most states you were going to open a hospital to lower costs you won't be allowed to? https://en.wikipedia.org/wiki/Certificate_of_Need
I couldn't understand this argument. Something seems to be wrong.
It is of course hogwash, but is a nice way for existing facilities to have a monopoly, prevent competition, and not have pricing pressure. Standard rent seeking/corruption that exists in the US.
Nice work. Where did you get the data for this? Is it publicly available?
The Obama Administration has tried to make pricing more transparent--this particular data set is publicly available. Here it is: https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
I'm not questioning your story, just genuinely curious what the extra costs are.
My mother is covered by Indiana's medicaid program, as she's at the poverty level but not old enough yet to qualify for Medicare. Her prescription buydown/deductible every month is $550, which I pay for. If you don't mind, I don't want to list specific medications, as it might make it easier to determine her identity. She takes medication for bone mineralization, hormone replacement due to a heart condition, a medication to reduce her blood pressure, as well as a Schedule I pain killer 3-4 times a day for pain management due to lower body nerve damage. She'll very likely have some nerves in her lower back severed in the next 6-12 months to relieve the pain.
So, her prescriptions alone cost around $5K-$6K/year. This is before her GP or specialist copays (very few providers will take Medicaid patients, so its hard to find and keep them), or a hospital visit or two. Her recent open MRI was completely out of pocket (luckily only $600 at a low-income clinic).
I guess my question is, what if a Medicaid patient in IN was truly destitute? There must be some mechanism for patients who can't afford those types of costs.
Seriously. An ER is required by law to treat anyone who comes in. If you really can't pay, go to the ER.
Some argue this is why healthcare costs so much because ERs have to be paid for.
http://newsroom.acep.org/index.php?s=20301&item=29928
They're basically allowed to make you "stable" and then send you out into the cold. They might do more but they don't have to.
EMTALA [0] requires the hospital to stabilize the patient, ie, make it so that it is no longer an emergency (the "E" in "ER"). If you "really can't pay" and it's not an emergency, you likely will find yourself in collections from the hospital.
[0] http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and...
If they are very poor, they should in theory be covered by Medicaid, which will then pay for treatment. But this requires them to actually be in a condition (mentally/physically/education-wise) to figure out how to sign up and be approved for it, since coverage isn't automatic. Afaik, even if the hospital is able to determine the person should be eligible, they can't just treat the person and then sign them up on their behalf; the person has to do it themselves, and be approved before seeking treatment.
This is one area that I think the U.S. lags behind many other developed countries in: assigning a social worker to help people in bad situations navigate the system. I've noticed that with an uncle of mine who has MS, is on SSI disability, and can't really take care of himself. If he didn't have a family member who was willing to accept power of attorney and file all sorts of paperwork and make phone calls on his behalf, he would have huge problems, because he isn't able to do that himself, and the state has not assigned a social worker to help him out.
This is a tough one. I have a disabled family member who would have never been able to do this themselves.
If you go into one of these hospitals looking like you have no money, you'll likely not be asked to pay anything.
People will gladly pay $500+ for an iphone but will not spend money on their own health. Yet they expect the hospital to be forced to take them even if the they can pay.
Are some hospital charges a ripoff. Oh yes. But they are also open 24 hours a day with highly trained staff ready to try and save your life even if you were doing something dumb. They are on stand by even though you pay them nothing to be waiting.
* For people with incomes above 150% FPL, copayments for non-preferred drugs may be as high as 20 percent of the cost of the drug. For people with income at or below 150% FPL, copayments are limited to nominal amounts.[1] *
[1]http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By...
Try here
http://www.pparx.org/en/prescription_assistance_programs/lis...
A green marker means its the cheapest price within the map's boundaries. Red means its the most expensive.
Thanks, I will make that more clear
What I think matters most for healthcare is not just price, but quality/cost. Quality is difficult to measure, but should factor in recovery speed, number of repeat-procedures, service, etc.
I think, when are showing some numbers, it looks much more perceivable when you have something to compare to, in our case, the top hospitals ranking from the US News.
Some more work will mostly likely be done soon to enrich the data we are showing.
I went back and checked the data. If you search for chest pain, and look at Cedar-Sinai Medical Center around Santa Monica,
we are showing this piece of information.
313 - CHEST PAIN,50625,CEDARS-SINAI MEDICAL CENTER,8700 BEVERLY BLVD,LOS ANGELES,CA,90048,CA - Los Angeles,229,43714.62445,5094.71179
In the PriceMaps we made, we are showing the last value, which is the 'Average Total Payments' for the operation.
Not exactly sure if the site mentioned in the HN is using the same data.
Paying more sometimes means better outpatient treatment (and sometimes lower readmittance rates), but it's not a guarantor.
The price spread is pretty crazy. Some hospitals have higher fixed costs or salaries depending on the geography. Also, if a hospital is more research-oriented, R&D funds are normally tacked onto the price (one of the reasons why Stanford's Hospital is really expensive).
It's hard to find quantifiable data on the breakdown of bills, but based on a great article in Time a few months ago, prices are almost entirely arbitrarily defined: http://swampland.time.com/2013/05/08/an-end-to-medical-billi...
If you want to know why costs vary so much, starting looking at reimbursement. Hospitals are incentivized to raise their list prices because many of them are paid a set percentage.
Also, from what I've learned about elderly care, Medicare reimburses a care center a fixed amount ($5000/mon/patient in California) regardless of the severity of the case. I'm assuming this number varies a bit too even in the same region.
As a side note, if you click on any of the prices in the map, it'll show you medicare's reimbursement rates too. Should've made that feature more clear--it's rather important.
I'm just not understanding what you learn from this other than what Medicare gets reimbursed. And I'm not understanding how knowing that is actionable in any way for the average person.
If I assume that the relative differences that Medicare has negotiated are similar to the relative differences my insurance company has negotiated (which I'm guessing is an invalid assumption), and if I accurately know what my policy will cover vs not cover (again, a nearly impossible thing to know given how complicated these things are), then maybe you can make a decision with this data. But the system is so complicated that I don't think that works at all by just using this dataset.
If the population goes to a number of different providers, then the insurance company can play hardball and say "if you don't take this rate, you're out of our network, good luck with that". In those cases, they'll negotiate an MS-DRG + X% rate.
The reason why negotiated rates with private insurers are non-public is because it's a negotiating tool. If hospital A gets paid $5K for a heart attack and finds out hospital B a block away gets paid $7K for the same thing, the next round of negotiations will be very rowdy.
US Patients go to south america and Asia to get treated. I don't think shopping around the country hospitals to figure out a good option is going to be a big problem. This is a good first step.
A hospital with a cost of $20K for a procedure might only get paid $5K, while one with a $10K cost might get paid $8K!
In fact, the same hospital can get paid very differently between different insurance companies.
That is a plausible but false assumption. Different providers negotiate different rates. In many cases, the negotiated rate for a given provider is lower than the "cash rate" that an uninsured person would pay, but in many cases the negotiated rate it is actually much higher(!). Maybe in these cases the insurer gets an end-of-year volume-based discount that the insured (me) never gets to see.
Source: my recent experience shopping for an MRI while on a high-deductible plan.
Let's say you suddenly lose your ability to speak, you think it's a stroke, so you head to the closest clinic. They freak out because you need to go to a stroke center. People (or their family) often ask "What's the best stroke center around here? I want to go there!".
If they had the info available to them, why couldn't they include cost in that equation?
Btw, nice work :)
We'll see how Obamacare deals with it though.
But this tool only includes Medicare data so it doesn't apply to any of those cases we just mentioned.
Me and my friend Anders made a bit better version of this, at
http://pricemaps.betterdoctor.com/#/
Check it out!
They actually correspond to two different slugs in our database. One that has higher price is pointed to the more complicated procedures that involved multiple complications, while the other one is simpler procedure without any complications.
http://pricemaps.betterdoctor.com/
I'd love to talk more about how this can be taken to the next step. Can't find your contact info in your profile--mind pinging me at: neilsharma101 at gmail dot com
We tried to compare the hospital quality with the prices.
Disclaimer: I am not a lawyer or a doctor.
Can you tell us about the technology under the hood? Ruby or Node (or whatever)? What APIs did you use? Programming-wise, what was easy and what turned out to be tricky?
I did do some pre-processing on the data in python to geocode the locations (ie: change the street addresses to long/lat coordinates). I used geopy to do that, and pandas to manage the data.
The total product took me three days to build and design
For the majority of us _not_ on medicare, castlighthealth.com is solving this. It's B2B for now, i.e. Tesla pays for castlight and then its employees can use castlight to find out how much things will cost.
Many insurance companies have tools that can do this exact thing for their members AND apply it to your specific plan at the time of the inquiry. So you can choose based on the procedure cost and your actual cost based on your deductible and co-insurance. Not only that, the tools will also tell you about quality so you can compare based on the quality of service, cost of service and your actual cost at the same time.
Unless you can do all of these things at the same time with your tool, it leaves out critical factors for those actually searching for this type of information as it applies to them at any given time - most importantly when they are trying to make a decision.
Additionally, you only have access to negotiated rates for Medicare whereas an insurance company providing this information is going to provide as much information as they can for all of their members by displaying their negotiated rates specific to your plan.
As an HN reader, if you like this tool, go check with your insurance company and see what they already have and how specific it is for you.
This is important. Contracted network discounts may not align with Medicare reimbursement rates for providers so if you have insurance through a network you should look for a tool that can compare in-network rates for your plan as MJR suggests.
http://www.cms.gov/icd10manual/fullcode_cms/P0136.html
the link shows all the diagnoses that fall in that category of DRGs. (DRGs are the packages of procedures that Medicare pays a fixed price for, simply put. If you get that diagnosis, you submit that DRG. However in this case the map from diagnosis to DRG is one to many.) Some of the average costs are only from 20-30 discharges. Do you think that makes for good math or some sort of price guide?
https://en.wikipedia.org/wiki/Diagnosis-related_group
It may highlight that the DRG is incorrectly applied by some hospitals (maybe?), but it has nothing to do with 'going down the street' for a better 'price'.
nice interface though.
Bug: (FF 16.0.1 on OSX 10.8.5) When the "select a procedure" drop down box is expanded, wheel scrolling up/down seems to also zoom the map underneath it.