CMS Releases Hospital Cost Data

[RayNY]

If rates were published and available for comparison, I'm convinced the TRUE ECONOMIC COST of healthcare would plummet (opposed to the "my premium is less" savings the Obamacare law hopes to create).

There are no market forces in play in the health industry.

Coming from a state that requires restaurants to publish the caloric values of everything on the menu (down to ketchup packets), I find it strange no one ever stood up and though "hey, we should pass a law that gives people the ability to find out how much they will be charged for medical services beforehand. You know, like any other service or product available today."

 

[leevena]

Most cost figures (if not all) have always been available, just not made public. Medicare providers are required to submit their cost information to CMS. There are quite a few companies who market their services to self-funded groups to help them negotiate lower out-of-network costs by using such data. For example, if a hospital were to charge $20,000 and their CMS cost data migh show a cost of $7,000, the service would automatically assume the $7,000, add an additional % and send it out as payment in full.

Part of the problem for individuals or smaller groups was that it was next to impossible to collect this data.

 

[AllenChicago]

If rates were published and available for comparison, I'm convinced the TRUE ECONOMIC COST of healthcare would plummet (opposed to the "my premium is less" savings the Obamacare law hopes to create).

There's no doubt that we'll have more public disclosure as the low-deductible plans are replaced by the ObamaCare compliant plans. When citizens have to pay the first $5,000 of their medical care, they go shopping.

I experienced this last year with a $5,000 deductible HSA plan client. He needed a Computed Tomography scan. His doctor referred him to a big Naperville, IL. hospital. Before undergoing the procedure, he asked the cost. Response: "It will cost you $7,200 Mr. Sucka.". Mr. Rose walked out and found the exact same test at a local stand-alone MRI center for $425.

My family of 4 is on a Zero Deductible Blue Cross group plan. I haven't been to a private physician in awhile, but my wife and kids just use it with abandon. I expect this to change when the teacher contract is renegotiated again.
-ac

 

[Crabcake Johnny]

A lot has to change. With my kidney stone, they tried to write me a prescription for 4 meds. Being on a HSA, I heavily questioned each med. I left with a prescription for 1.

My wife went for a back issue. They, again, wrote out several prescriptions but when she come home we researched them. One turned out to be a med for depression, so she called back. Doc said it would help "relax" her; relieve her back pain.

We ended up getting none filled. Health care costs can come down significantly if we are educated, well informed and have price transparency. Then all of a sudden, that $10,000 procedure winds up being $3,000. Let's make it competitive.

 

[Ann H]

Clearly a lack of transparency is one of the main drivers of rising costs. I'm a great proponent of transparency in medical billing. Some say you can't know all the procedure codes, but it's not that hard in non-emergency situations. If you plan to have arthroscopic knee surgery, the surgi center already knows all the codes, all the associated providers you will need, added costs for possible complications that happen quite often, and the cost for meds post-surgery. It is not that hard to look up those costs and budget for them. But not getting a bill until you've had the service makes it hard to budget and hard to control consumption when you've already consumed.

Of course, the providers will tell you these prices cover cost-shifting because of non-payers and low-payers. And then that brings us to the shocking fact that the lowest payers are Medicaid and Medicare.

 

[stuy119]

How much more difficult this will become with an extra 80,000 codes is unreal.

 

[somarco]

Transparency doesn't work in health care once you get beyond the basics.

 

[Crabcake Johnny]

Well lack of transparency certainly doesn't work so let's give full transparency the good ole college try.

 

[dgoldenz]

Well it's about damn time...

 

[RayNY]

Glad we all agree on transparency.

And I'm sure we all recognize, it won't happen.

In the words of hospitals "We don't actually expect anyone to pay what's on their bills, it just serves as grounds for negotiating."

I wish I could get away with that at my side job. Send a bill for $2,000 to put a radio in a car. "What!? I can't afford that!" "Talk to billing, they can put you on a plan and reduce it to $5 payments for 14 months."