13 ms·

Hospital creates bidding war by posting pricing online

868 points by nolanbrown23 13y ago

pdx 13y ago
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.
- eloisius 13y ago
  Prices get equalized at Medica{re,id} prices for the procedure. Those get set by a large conference of physicians and bureaucrats. In most other markets, we'd call it price fixing.
- showerst 13y ago
  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/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ 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 shot, not a fact related to transparent pricing.
  - fnordfnordfnord 13y ago
    Isn't this a recent development, like two months ago? http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?pagewanted=all http://www.nytimes.com/2013/05/08/business/hospital-billing-...
    - showerst 13y ago
      The specific provider data is recent, but the 'here's what we'll reimburse for what procedures' data has always been public, as far as I know. I think this is a link to it, but I'm not 100% sure - http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/physicianfeesched/ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment...
- showerst 13y ago
  Medicare and Medicaid pay less than the private insurers (usually), and far less than the (wholly insane) charges to the uninsured. Generally the government pays a standardized cost plus some set profit margin, which is usually less profitable per procudure It's very easy to do the accounting to make the government look very efficient and reasonable, or look like it requires a bankruptcy-inducing level of loss, depending on your politics and the field of medicine. What I _think_ this statement is really inferring is that they refuse to take medicare/aid and pay the government's lower rates, and thus raised their margins and bottom line, allowing for better care. This is a pretty standard conservative view of health care provisioning, and I'm surprised that it was allowed into a news story. The whole piece here reeks of being a politically slanted press release, which is embarrassing since it's actually an interesting story, and an editor could've just changed a few sentences to keep a more neutral POV.
HarryHirsch 13y ago
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.
- Vivtek 13y ago
  Sure. "Give me all your money or you die" is a guaranteed profit.
  - fnordfnordfnord 13y ago
    "Give me all your money AND you die" is also a popular scheme. I'm glad to see another chip in the the foundation of these business models.
- toomuchtodo 13y ago
  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).
  - HarryHirsch 13y ago
    How do you explain the fact that healthcare expenditures in the US are twice as high as in the rest of the Western world, and life expectancy is comparable?
    - wisty 13y ago
sixdimensional 13y ago
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/ 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).
EvanAnderson 13y ago
Their price for a procedure I had in 2000, today, is half of what I paid out-of-pocket back then. Wow. This is great, and I hope it's a sign of a trend.
etler 13y ago
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.
- homosaur 13y ago
  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.
ajiang 13y ago
So...let's create a reverse auction platform for self-pay surgeries? Not at all sure what the regulatory issues would be around that, but seems like it would make sense especially when you add in time and availability of specialist surgeons on certain days.
ambiate 13y ago
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.
- HarryHirsch 13y ago
  > 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?
  - crusso 13y ago
    The free market in medicine is plain weird Says you. Time and again, Lasik surgery and cosmetic surgeries not covered by insurance or hindered by over-regulation have shown us that transparent pricing and competition work to make those procedures more affordable -- just like these forces work in other markets. The State has perverted the medical market for more than half a century and you're just used to seeing it in its current screwed up state.
hcarvalhoalves 13y ago
The article uses the term "bidding war" like it's a race to the bottom. Isn't clear pricing supposed to be a good thing? Shouldn't it be actually enforced by law?
- tekromancr 13y ago
  I am not sure if mandating it is necessary. I think that hospitals should publish their pricing lists to differentiate themselves from their competition.
- muyuu 13y ago
  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. 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-health-care-costs-so-high/ http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...
tekromancr 13y ago
I don't care how transparent there pricing structure is. Letting Kevin Smith practice medicine at you is a bad idea. Chasing Amy was pretty good, tho.
systematical 13y ago
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.
- forgingahead 13y ago
  Related: http://www.moh.gov.sg/content/moh_web/home/costs_and_financing.html http://www.moh.gov.sg/content/moh_web/home/costs_and_financi...
djKianoosh 13y ago
Similarly, at least to me, Birthing Centers are offering a much lower cost alternative to the whole delivery process at hospitals. From experience, the price difference can be 10:1 which is just insane. 10 being what is billed to insurance, 1 what you'd pay directly. Still, comparing apples to apples, it's 3:1. Again, from recent experience. Bottom line, hospitals are big business and they can get away with billing insurance for a ton... and many times the extra "care" is unnecessary.
ChuckMcM 13y ago
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.
- showerst 13y ago
  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. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ 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.
bengebre 13y ago
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.
- EvanAnderson 13y ago
  Same situation here. 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 13y ago
  > 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.
easyfrag 13y ago
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.
- jerf 13y ago
  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.)
- petermonsson 13y ago
  Does your current hospital show you these statistics?
- zdean 13y ago
  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.
- antitrust 13y ago
  Adding to your comment: There's a lot that cannot be quantified as well. For example, some doctors I trust more than others because I think their diagnostic skills, empathy, listening skills and ability to absorb case knowledge are superior to the generalized level of their peers' abilities in the same area. However, I wouldn't want someone to make an Excel spreadsheet with every patient's assessment of his/her doctor in the same way, since I think most patient's judgment skills will be on a similar standardized level that is below what I would need. It's sort of like martial arts fighters. We can measure number of wins/losses at tournaments, but we can't assess how well they'd do when approaching an unknown situation with assailants who do not play by the rules.
Kapura 13y ago
Oh man I want this to be the new norm so bad. The American health care system really needs to be shaken up. Republican dissent in Congress blocked that when Obama was championing it; perhaps the Republican's stated goal of a free market is going to be what affects the change. Where are the free market republicans supporting these practices? Why are they so upset about people coming to work in America but not the fact that hospitals are able to use the insurance system to gouge consumers? The cited $30,000 surgery costing a fifth of that at the centre makes it well worth the effort to fly from out of state to get your operation on. The old system of charging whatever you can get away with because the patient doesn't have options needs to die a horrible death.
- antitrust 13y ago
  > Where are the free market republicans supporting these practices? Yes, where? You'd think they and the Ron Paul fans would be all over this.
  - jessaustin 13y ago
    What, you think they'll schedule some elective surgery when they learn of this? People all over the political map have been complaining about healthcare for a long time. I'm surprised you haven't heard any of that. Seriously, political solutions to this sort of complex problem in the USA are very difficult. Blaming any particular political group for a lack of same is kind of dumb. If this Dr. Smith is improving the state of healthcare as most comments here seem to indicate, then you'll be scandalized by the Gustave de Molinari quote on his blog. It's more Ron-Paulian than Ron Paul.
  - pekk 13y ago
    They want the government to play less of a role, not more of one. Regulation of corporations is not something they want. They are mainly for moving power from the federal government to state governments.
- kasey_junk 13y ago
  Um, McCain ran on a platform that would encourage price transparency and insurance portability in 2008. Also last I checked Obama's health care plan passed and it is all about access to and quality of health insurance. There is no evidence that it will improve price transparency from the providers.
steveplace 13y ago
Some other techniques off the top of my head: -- 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 13y ago
  > 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 This sounds to me like an insurance premium, no?
  - steveplace 13y ago
    This particular hospital is catering to the high-deductible crowd, so that's why I put that one in there.
lifeformed 13y ago
Their pricing site should drop all the ".00" cents figures... it seems unnecessary and subconsciously makes the numbers look bigger than they are.
alexholehouse 13y ago
Great story but "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 13y ago
  By around the world I think they mean Canada :)
  - annnnd 13y ago
    I just spilled my morning coffee from laughing so hard... :-D
Apocryphon 13y ago
If the whole point of the current healthcare system is to embrace a free market, why isn't this SOP already? Why did no one do this previously?
plainOldText 13y ago
I really like their footer section :) "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/ http://www.surgerycenterok.com/
lostlogin 13y ago
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.
lettergram 13y ago
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.
rhuppert 13y ago
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.
will_brown 13y ago
FYI for all Florida patients, under the FL Patient Bill of Rights FL Statute 381.026(4)(c)(3): "A health care provider or a health care facility shall, upon request, furnish a patient, prior to provision of medical services, a reasonable estimate of charges for such services."
javert 13y ago
> 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. Obama, better close up that loophole! Wouldn't want people to find out that capitalism works in every. single. industry.
- kasey_junk 13y ago
  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.
  - javert 13y ago
    > true competition can exist. True competition can always exist unless force is used against someone to stop it (in 99.9% of cases, that's done via government regulation). > the justice system The justice system isn't an industry, it's a proper function of government. > emergency service providers (think fire/hazmat etc) As someone who has been screwed over by government emergency service providers, I beg to differ. > Lets not let the bizarre state of the US medical industry act as some sort of straw man to support some ultra libertarian viewpoint. Actually, lets. The US medical system is a total clusterfuck and is only getting worse. It is hard to get good medical care in the US. There is only one way this complete nightmare could have come about, and that's because people aren't free to act in their own interest. We could never remotely approach this nightmare in any non-highly-regulated industry. In fact, practically all non-highly-regulated industries make amazing advances over time, whereas healthcare delivery has seen amazing regress in the last few decades. This is not an appeal to some ideology that is divorced from reality. The empirical evidence is all on my side, plus a causal explanation for the results. But liberals are covering up their ears and shouting, "We can't (won't) hear you!". As a result, my lifespan and those of my loved ones will likely be significantly curtailed.
bobo13579 13y ago
An Orbitz for healthcare procedures is sorely needed. Does one exist?
pbreit 13y ago
Price transparency is a key part of Obamacare and is apparently beginning to work. For example, insurance companies in Oregon reduced premiums after seeing competitor prices [1]. 1: http://www.oregonlive.com/health/index.ssf/2013/05/two_oregon_insurers_reconsider.html http://www.oregonlive.com/health/index.ssf/2013/05/two_orego...
- prostoalex 13y ago
  Insurance price transparency != hospital price transparency. It's actually easy to avoid insurance price transparency by manipulating deductibles, co-pays, and lists of supported medications.
verelo 13y ago
Healthy people can work and be productive. When progressive startups say things like "We want you to work, and not worry about your income, so we're trying to pay you a salary that allows you to do just that" we all respect that, right? Why can we not do the same with healthcare and just say its "free" (aka paid by our pseudo-employer - the Government) so we can all be productive and contribute to making the country/world a better place. Plain and simple...
jnardiello 13y ago
While i know how health-care is working in the US, every time i read something about it i'm astonished and incredibly sad. How broke can a system be to put a price on health? And everybody cheering that someone is doing it in a trasparent way. Woooow. I wonder how you will all react if you'll find out, in future, that the surgery/procedure you actually need is too expensive for your pockets and not covere by the insurance (if you are elegible/have one). Sorry to say this but: This whole system is a shame. And i just can't understand why the people in the US just don't realize it.
- vidarh 13y ago
  Not so broke, as it turns out, as the US pays more per capita in health care than pretty much every other country on the planet... It's not about being broke, it's about being dysfunctional.
DigitalSea 13y ago
When you think of upfront pricing it just makes sense. Recently someone posted a breakdown of their surgery here on HN (don't remember the kind of surgery it was, but it totalled about $30k), I don't understand how a hospital with the same medically trained staff as any other hospital (with exception of specialists of course which would vary) can be 4 times the price as this hospital is offerng to do it for and most likely the same level of care. I encourage everyone to read this Harvard Business Review article here which gives some insight into just how the American healtrh system runs: http://hbr.org/web/extras/insight-center/health-care/why-innovation-in-health-care-is-so-hard http://hbr.org/web/extras/insight-center/health-care/why-inn...
nazgulnarsil 13y ago
Well this is a shot across the bow of the AMA. Let's see what they do.
- 11Blade 13y ago
  This really has very little to do with the AMA. This is hospitals vs outpatient centers(who can do the easy stuff much cheaper than hospitals can)
dmd149 13y ago
So, I've had this idea for a while and I'm wondering why no one has done it yet: An Expedia for health care services. You pop in your zip code, the service you need (if you know it), and out comes a list of hospital and doctors with prices for that particular service. I imagine you could start very simple: call 50-100 clinics and ask how much they would charge for a simple checkup, upload it, see how many people start booking doctor visits via your site. Check out Zoomcare: http://www.zoomcare.com/info/services-prices http://www.zoomcare.com/info/services-prices I went there in Portland and service was great! I loved the transparency. I just wonder why more independent clinics aren't trying this. Is there some major legal obstacle I'm not seeing?
locusm 13y ago
Thats quite a bit cheaper than Australia for a Tonsillectomy at least, 3k vs 5k.
mrharrison 13y ago
So who on this thread has already started coding a kayak for hospitals?
- alok-g 13y ago
  Am waiting for the day when it shows up!
caycep 13y ago
"hospital" may be a misnomer - these may be private facilities set up to do high-volume "day surgeries" that don't require ICU's or CCU's that tertiary care hospitals provide. They aren't expected to offer the full suite of hospital services, i.e. emergency, trauma, in-house pharmacy, etc.
prostoalex 13y ago
Not a hospital, but I patronize this medical group partially because they have a list of cash prices posted online http://www.caduceusmedicalgroup.com/cash-prices/cash-prices.html http://www.caduceusmedicalgroup.com/cash-prices/cash-prices.... Even though I never needed it, having insurance through my employer, it's the transparency that I liked.
dr_ 13y ago
"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 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.
orblivion 13y ago
Posting your prices is revolutionary? It's about time for this sort of thing, but damn the medical market must be in an unhealthy state.
mathgladiator 13y ago
The great thing about this is that could enable me to be my own insurance company. If I know how much things cost, then I can budget appropriately and invest in an index fund to store my health fun. If bad things happen, then I'm covered. If they don't happen, then I get a boat.
hremid 13y ago
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. [1] http://usatoday30.usatoday.com/News/health/2005-03-02-doctor-shortage_x.htm http://usatoday30.usatoday.com/News/health/2005-03-02-doctor... [2] http://www.ama-assn.org/resources/doc/PolicyFinder/policyfiles/HnE/H-305.968.HTM http://www.ama-assn.org/resources/doc/PolicyFinder/policyfil... [3] http://www.clintonlibrary.gov/assets/storage/Research%20-%20Digital%20Library/jennings-hsa/Box%20046/647904-hsa-congressman-gingrich-AMA-deal.pdf.pdf http://www.clintonlibrary.gov/assets/storage/Research%20-%20...
deleted 13y ago
[deleted]
timedoctor 13y ago
It should be the law that they must provide the pricing online and via an API so that it can be easily collated and compared with every other hospital. Imagine the type of apps you could create with this information.
Shalle 13y ago
I can't really see how charging this much to ease people's suffering is humanly possible. Sure Surgery Center was a lot cheaper than the rest, but even that is still expensive. For example, if I want to gosurgery center and get an brain/heart surgery, I'd be looking at possibly $500 in overnight fees but not really anything else. How is anyone inhumane enough to start a business like these hospitals? Any medical care should be available to everyone. Breaking a finger shouldn't cost $2805 either. Countries like USA think they're superiour but yet they do not help their fellow citizens. If they would drop the war on the rest of the world(incl their own) they would probably afford to provide free medical care as well.
contingencies 13y ago
It's called medical tourism, and it's absolutely rife in Asia. http://en.wikipedia.org/wiki/Medical_tourism http://en.wikipedia.org/wiki/Medical_tourism (I guess Oklahoma is the new Mexico, or something.)
11Blade 13y ago
This article is a bit misleading. An outpatient surgery center has the luxury of "skimming" the easy uncomplicated same-day surgeries while leaving the hospitals to do the heavy lifting. It is not a hospital Surgery centers do not have the cost of carry of a pharmacy(24/7), a fully functioning diagnostic lab(24/7), an emergency room(24/7), 200-1000 beds, ICU,CCU, radiology department(24/7) etc and an infrastructure that is impressively expensive. Its very very very easy to offer these surgeries at a cheaper price than a hospital but when you need a complicated surgery or an emergency that surgery center will not be there for you. I like the idea of pricing transparency but it should be hand in hand with outcome and quality statistics and comparisons should be fair. I did not see Oklahoma surgery center compare themselves to other surgery centers which are likely very close in price. One last thing. In healthcare - price is not everything (its an important issue) but as we drive down the price, we must not sacrifice but rather improve outcome measurement and quality.
yaix 13y ago
> The move is revolutionizing medical billing in Oklahoma and around the world. Around the world? Not really.
dgudkov 13y ago
Will we ever see a search engine for hospital quotes? Why not a startup idea.
bobwyman 13y ago
At hospitals in the US, every payer is charged a different price. Large insurers and HMO's negotiate large discounts which shifts costs onto smaller insurers who get smaller discounts and thus pay part of the costs of their larger competitors. The non-poor uninsured, who often can least afford to pay, are charged the most -- often 5X, 10X or more than what Medicare or a large insurer would pay. In all states other than Maryland, which has state-wide "all-payer" pricing, what you are charged depends more on who you are and how much negotiating power you have than what was done for you. The solution is to let the "free market" work. Of course, that means we need to regulate the market to fix the existing "market failure." Free markets are regulated markets. (Although not all regulated markets are free.) All states should pass laws saying that hospitals are free to charge what they want but that their prices must be posted and apply to "all-payers" without discounting. Additionally, states should develop all-payer databases like those advocated by: http://www.apcdcouncil.org/ http://www.apcdcouncil.org/ Much has been said about Medicare in the comments here that isn't quite accurate. The reality is that Medicare ignores hospital charges (except in Maryland) and pays according to their own calculations of hospitals' costs. In most cases, that means they pay much less than they are charged. However, in some cases, it means that they pay more. For some additional background on this issue, from a New York perspective, see my PDF on the subject linked to at: http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html
ultim8k 13y ago
Hospitals and medication MUST be free for everyone! fsck companies and money. Health doesn't have a price!

868 points by nolanbrown23 13y ago

pdx 13y ago

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.

eloisius 13y ago
Prices get equalized at Medica{re,id} prices for the procedure. Those get set by a large conference of physicians and bureaucrats. In most other markets, we'd call it price fixing.
showerst 13y ago
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/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ 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 shot, not a fact related to transparent pricing.
- fnordfnordfnord 13y ago
  Isn't this a recent development, like two months ago? http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?pagewanted=all http://www.nytimes.com/2013/05/08/business/hospital-billing-...
  - showerst 13y ago
    The specific provider data is recent, but the 'here's what we'll reimburse for what procedures' data has always been public, as far as I know. I think this is a link to it, but I'm not 100% sure - http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html?redirect=/physicianfeesched/ http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment...
showerst 13y ago
Medicare and Medicaid pay less than the private insurers (usually), and far less than the (wholly insane) charges to the uninsured. Generally the government pays a standardized cost plus some set profit margin, which is usually less profitable per procudure It's very easy to do the accounting to make the government look very efficient and reasonable, or look like it requires a bankruptcy-inducing level of loss, depending on your politics and the field of medicine. What I _think_ this statement is really inferring is that they refuse to take medicare/aid and pay the government's lower rates, and thus raised their margins and bottom line, allowing for better care. This is a pretty standard conservative view of health care provisioning, and I'm surprised that it was allowed into a news story. The whole piece here reeks of being a politically slanted press release, which is embarrassing since it's actually an interesting story, and an editor could've just changed a few sentences to keep a more neutral POV.

HarryHirsch 13y ago

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.

Vivtek 13y ago
Sure. "Give me all your money or you die" is a guaranteed profit.
- fnordfnordfnord 13y ago
  "Give me all your money AND you die" is also a popular scheme. I'm glad to see another chip in the the foundation of these business models.
toomuchtodo 13y ago
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).
- HarryHirsch 13y ago
  How do you explain the fact that healthcare expenditures in the US are twice as high as in the rest of the Western world, and life expectancy is comparable?
  - wisty 13y ago

sixdimensional 13y ago

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/ 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).

EvanAnderson 13y ago

Their price for a procedure I had in 2000, today, is half of what I paid out-of-pocket back then. Wow. This is great, and I hope it's a sign of a trend.

etler 13y ago

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.

homosaur 13y ago
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.

ajiang 13y ago

So...let's create a reverse auction platform for self-pay surgeries? Not at all sure what the regulatory issues would be around that, but seems like it would make sense especially when you add in time and availability of specialist surgeons on certain days.

ambiate 13y ago

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.

HarryHirsch 13y ago
> 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?
- crusso 13y ago
  The free market in medicine is plain weird Says you. Time and again, Lasik surgery and cosmetic surgeries not covered by insurance or hindered by over-regulation have shown us that transparent pricing and competition work to make those procedures more affordable -- just like these forces work in other markets. The State has perverted the medical market for more than half a century and you're just used to seeing it in its current screwed up state.

hcarvalhoalves 13y ago

The article uses the term "bidding war" like it's a race to the bottom. Isn't clear pricing supposed to be a good thing? Shouldn't it be actually enforced by law?

tekromancr 13y ago
I am not sure if mandating it is necessary. I think that hospitals should publish their pricing lists to differentiate themselves from their competition.
muyuu 13y ago
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. 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-health-care-costs-so-high/ http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...

tekromancr 13y ago

I don't care how transparent there pricing structure is. Letting Kevin Smith practice medicine at you is a bad idea. Chasing Amy was pretty good, tho.

systematical 13y ago

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.

forgingahead 13y ago
Related: http://www.moh.gov.sg/content/moh_web/home/costs_and_financing.html http://www.moh.gov.sg/content/moh_web/home/costs_and_financi...

djKianoosh 13y ago

Similarly, at least to me, Birthing Centers are offering a much lower cost alternative to the whole delivery process at hospitals. From experience, the price difference can be 10:1 which is just insane. 10 being what is billed to insurance, 1 what you'd pay directly. Still, comparing apples to apples, it's 3:1. Again, from recent experience. Bottom line, hospitals are big business and they can get away with billing insurance for a ton... and many times the extra "care" is unnecessary.

ChuckMcM 13y ago

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.

showerst 13y ago
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. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/ 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.

bengebre 13y ago

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.

EvanAnderson 13y ago
Same situation here. 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 13y ago
> 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.

easyfrag 13y ago

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.

jerf 13y ago
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.)
petermonsson 13y ago
Does your current hospital show you these statistics?
zdean 13y ago
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.
antitrust 13y ago
Adding to your comment: There's a lot that cannot be quantified as well. For example, some doctors I trust more than others because I think their diagnostic skills, empathy, listening skills and ability to absorb case knowledge are superior to the generalized level of their peers' abilities in the same area. However, I wouldn't want someone to make an Excel spreadsheet with every patient's assessment of his/her doctor in the same way, since I think most patient's judgment skills will be on a similar standardized level that is below what I would need. It's sort of like martial arts fighters. We can measure number of wins/losses at tournaments, but we can't assess how well they'd do when approaching an unknown situation with assailants who do not play by the rules.

Kapura 13y ago

Oh man I want this to be the new norm so bad. The American health care system really needs to be shaken up. Republican dissent in Congress blocked that when Obama was championing it; perhaps the Republican's stated goal of a free market is going to be what affects the change. Where are the free market republicans supporting these practices? Why are they so upset about people coming to work in America but not the fact that hospitals are able to use the insurance system to gouge consumers? The cited $30,000 surgery costing a fifth of that at the centre makes it well worth the effort to fly from out of state to get your operation on. The old system of charging whatever you can get away with because the patient doesn't have options needs to die a horrible death.

antitrust 13y ago
> Where are the free market republicans supporting these practices? Yes, where? You'd think they and the Ron Paul fans would be all over this.
- jessaustin 13y ago
  What, you think they'll schedule some elective surgery when they learn of this? People all over the political map have been complaining about healthcare for a long time. I'm surprised you haven't heard any of that. Seriously, political solutions to this sort of complex problem in the USA are very difficult. Blaming any particular political group for a lack of same is kind of dumb. If this Dr. Smith is improving the state of healthcare as most comments here seem to indicate, then you'll be scandalized by the Gustave de Molinari quote on his blog. It's more Ron-Paulian than Ron Paul.
- pekk 13y ago
  They want the government to play less of a role, not more of one. Regulation of corporations is not something they want. They are mainly for moving power from the federal government to state governments.
kasey_junk 13y ago
Um, McCain ran on a platform that would encourage price transparency and insurance portability in 2008. Also last I checked Obama's health care plan passed and it is all about access to and quality of health insurance. There is no evidence that it will improve price transparency from the providers.

steveplace 13y ago

Some other techniques off the top of my head: -- 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 13y ago
> 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 This sounds to me like an insurance premium, no?
- steveplace 13y ago
  This particular hospital is catering to the high-deductible crowd, so that's why I put that one in there.

lifeformed 13y ago

Their pricing site should drop all the ".00" cents figures... it seems unnecessary and subconsciously makes the numbers look bigger than they are.

alexholehouse 13y ago

Great story but "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 13y ago
By around the world I think they mean Canada :)
- annnnd 13y ago
  I just spilled my morning coffee from laughing so hard... :-D

Apocryphon 13y ago

If the whole point of the current healthcare system is to embrace a free market, why isn't this SOP already? Why did no one do this previously?

plainOldText 13y ago

I really like their footer section :) "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/ http://www.surgerycenterok.com/

lostlogin 13y ago

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.

lettergram 13y ago

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.

rhuppert 13y ago

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.

will_brown 13y ago

FYI for all Florida patients, under the FL Patient Bill of Rights FL Statute 381.026(4)(c)(3): "A health care provider or a health care facility shall, upon request, furnish a patient, prior to provision of medical services, a reasonable estimate of charges for such services."

javert 13y ago

> 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. Obama, better close up that loophole! Wouldn't want people to find out that capitalism works in every. single. industry.

kasey_junk 13y ago
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.
- javert 13y ago
  > true competition can exist. True competition can always exist unless force is used against someone to stop it (in 99.9% of cases, that's done via government regulation). > the justice system The justice system isn't an industry, it's a proper function of government. > emergency service providers (think fire/hazmat etc) As someone who has been screwed over by government emergency service providers, I beg to differ. > Lets not let the bizarre state of the US medical industry act as some sort of straw man to support some ultra libertarian viewpoint. Actually, lets. The US medical system is a total clusterfuck and is only getting worse. It is hard to get good medical care in the US. There is only one way this complete nightmare could have come about, and that's because people aren't free to act in their own interest. We could never remotely approach this nightmare in any non-highly-regulated industry. In fact, practically all non-highly-regulated industries make amazing advances over time, whereas healthcare delivery has seen amazing regress in the last few decades. This is not an appeal to some ideology that is divorced from reality. The empirical evidence is all on my side, plus a causal explanation for the results. But liberals are covering up their ears and shouting, "We can't (won't) hear you!". As a result, my lifespan and those of my loved ones will likely be significantly curtailed.

bobo13579 13y ago

An Orbitz for healthcare procedures is sorely needed. Does one exist?

pbreit 13y ago

Price transparency is a key part of Obamacare and is apparently beginning to work. For example, insurance companies in Oregon reduced premiums after seeing competitor prices [1]. 1: http://www.oregonlive.com/health/index.ssf/2013/05/two_oregon_insurers_reconsider.html http://www.oregonlive.com/health/index.ssf/2013/05/two_orego...

prostoalex 13y ago
Insurance price transparency != hospital price transparency. It's actually easy to avoid insurance price transparency by manipulating deductibles, co-pays, and lists of supported medications.

verelo 13y ago

Healthy people can work and be productive. When progressive startups say things like "We want you to work, and not worry about your income, so we're trying to pay you a salary that allows you to do just that" we all respect that, right? Why can we not do the same with healthcare and just say its "free" (aka paid by our pseudo-employer - the Government) so we can all be productive and contribute to making the country/world a better place. Plain and simple...

jnardiello 13y ago

While i know how health-care is working in the US, every time i read something about it i'm astonished and incredibly sad. How broke can a system be to put a price on health? And everybody cheering that someone is doing it in a trasparent way. Woooow. I wonder how you will all react if you'll find out, in future, that the surgery/procedure you actually need is too expensive for your pockets and not covere by the insurance (if you are elegible/have one). Sorry to say this but: This whole system is a shame. And i just can't understand why the people in the US just don't realize it.

vidarh 13y ago
Not so broke, as it turns out, as the US pays more per capita in health care than pretty much every other country on the planet... It's not about being broke, it's about being dysfunctional.

DigitalSea 13y ago

When you think of upfront pricing it just makes sense. Recently someone posted a breakdown of their surgery here on HN (don't remember the kind of surgery it was, but it totalled about $30k), I don't understand how a hospital with the same medically trained staff as any other hospital (with exception of specialists of course which would vary) can be 4 times the price as this hospital is offerng to do it for and most likely the same level of care. I encourage everyone to read this Harvard Business Review article here which gives some insight into just how the American healtrh system runs: http://hbr.org/web/extras/insight-center/health-care/why-innovation-in-health-care-is-so-hard http://hbr.org/web/extras/insight-center/health-care/why-inn...

nazgulnarsil 13y ago

Well this is a shot across the bow of the AMA. Let's see what they do.

11Blade 13y ago
This really has very little to do with the AMA. This is hospitals vs outpatient centers(who can do the easy stuff much cheaper than hospitals can)

dmd149 13y ago

So, I've had this idea for a while and I'm wondering why no one has done it yet: An Expedia for health care services. You pop in your zip code, the service you need (if you know it), and out comes a list of hospital and doctors with prices for that particular service. I imagine you could start very simple: call 50-100 clinics and ask how much they would charge for a simple checkup, upload it, see how many people start booking doctor visits via your site. Check out Zoomcare: http://www.zoomcare.com/info/services-prices http://www.zoomcare.com/info/services-prices I went there in Portland and service was great! I loved the transparency. I just wonder why more independent clinics aren't trying this. Is there some major legal obstacle I'm not seeing?

locusm 13y ago

Thats quite a bit cheaper than Australia for a Tonsillectomy at least, 3k vs 5k.

mrharrison 13y ago

So who on this thread has already started coding a kayak for hospitals?

alok-g 13y ago
Am waiting for the day when it shows up!

caycep 13y ago

"hospital" may be a misnomer - these may be private facilities set up to do high-volume "day surgeries" that don't require ICU's or CCU's that tertiary care hospitals provide. They aren't expected to offer the full suite of hospital services, i.e. emergency, trauma, in-house pharmacy, etc.

prostoalex 13y ago

Not a hospital, but I patronize this medical group partially because they have a list of cash prices posted online http://www.caduceusmedicalgroup.com/cash-prices/cash-prices.html http://www.caduceusmedicalgroup.com/cash-prices/cash-prices.... Even though I never needed it, having insurance through my employer, it's the transparency that I liked.

dr_ 13y ago

"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 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.

orblivion 13y ago

Posting your prices is revolutionary? It's about time for this sort of thing, but damn the medical market must be in an unhealthy state.

mathgladiator 13y ago

The great thing about this is that could enable me to be my own insurance company. If I know how much things cost, then I can budget appropriately and invest in an index fund to store my health fun. If bad things happen, then I'm covered. If they don't happen, then I get a boat.

hremid 13y ago

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. [1] http://usatoday30.usatoday.com/News/health/2005-03-02-doctor-shortage_x.htm http://usatoday30.usatoday.com/News/health/2005-03-02-doctor... [2] http://www.ama-assn.org/resources/doc/PolicyFinder/policyfiles/HnE/H-305.968.HTM http://www.ama-assn.org/resources/doc/PolicyFinder/policyfil... [3] http://www.clintonlibrary.gov/assets/storage/Research%20-%20Digital%20Library/jennings-hsa/Box%20046/647904-hsa-congressman-gingrich-AMA-deal.pdf.pdf http://www.clintonlibrary.gov/assets/storage/Research%20-%20...

deleted 13y ago

[deleted]

timedoctor 13y ago

It should be the law that they must provide the pricing online and via an API so that it can be easily collated and compared with every other hospital. Imagine the type of apps you could create with this information.

Shalle 13y ago

I can't really see how charging this much to ease people's suffering is humanly possible. Sure Surgery Center was a lot cheaper than the rest, but even that is still expensive. For example, if I want to gosurgery center and get an brain/heart surgery, I'd be looking at possibly $500 in overnight fees but not really anything else. How is anyone inhumane enough to start a business like these hospitals? Any medical care should be available to everyone. Breaking a finger shouldn't cost $2805 either. Countries like USA think they're superiour but yet they do not help their fellow citizens. If they would drop the war on the rest of the world(incl their own) they would probably afford to provide free medical care as well.

contingencies 13y ago

It's called medical tourism, and it's absolutely rife in Asia. http://en.wikipedia.org/wiki/Medical_tourism http://en.wikipedia.org/wiki/Medical_tourism (I guess Oklahoma is the new Mexico, or something.)

11Blade 13y ago

This article is a bit misleading. An outpatient surgery center has the luxury of "skimming" the easy uncomplicated same-day surgeries while leaving the hospitals to do the heavy lifting. It is not a hospital Surgery centers do not have the cost of carry of a pharmacy(24/7), a fully functioning diagnostic lab(24/7), an emergency room(24/7), 200-1000 beds, ICU,CCU, radiology department(24/7) etc and an infrastructure that is impressively expensive. Its very very very easy to offer these surgeries at a cheaper price than a hospital but when you need a complicated surgery or an emergency that surgery center will not be there for you. I like the idea of pricing transparency but it should be hand in hand with outcome and quality statistics and comparisons should be fair. I did not see Oklahoma surgery center compare themselves to other surgery centers which are likely very close in price. One last thing. In healthcare - price is not everything (its an important issue) but as we drive down the price, we must not sacrifice but rather improve outcome measurement and quality.

yaix 13y ago

> The move is revolutionizing medical billing in Oklahoma and around the world. Around the world? Not really.

dgudkov 13y ago

Will we ever see a search engine for hospital quotes? Why not a startup idea.

bobwyman 13y ago

At hospitals in the US, every payer is charged a different price. Large insurers and HMO's negotiate large discounts which shifts costs onto smaller insurers who get smaller discounts and thus pay part of the costs of their larger competitors. The non-poor uninsured, who often can least afford to pay, are charged the most -- often 5X, 10X or more than what Medicare or a large insurer would pay. In all states other than Maryland, which has state-wide "all-payer" pricing, what you are charged depends more on who you are and how much negotiating power you have than what was done for you. The solution is to let the "free market" work. Of course, that means we need to regulate the market to fix the existing "market failure." Free markets are regulated markets. (Although not all regulated markets are free.) All states should pass laws saying that hospitals are free to charge what they want but that their prices must be posted and apply to "all-payers" without discounting. Additionally, states should develop all-payer databases like those advocated by: http://www.apcdcouncil.org/ http://www.apcdcouncil.org/ Much has been said about Medicare in the comments here that isn't quite accurate. The reality is that Medicare ignores hospital charges (except in Maryland) and pays according to their own calculations of hospitals' costs. In most cases, that means they pay much less than they are charged. However, in some cases, it means that they pay more. For some additional background on this issue, from a New York perspective, see my PDF on the subject linked to at: http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html

ultim8k 13y ago

Hospitals and medication MUST be free for everyone! fsck companies and money. Health doesn't have a price!