Trump Fought Secret Prices
On June 27, 2019, President Trump issued an Executive Order titled “Improving Price and Quality Transparency in American Healthcare to Put Patients First“
His order required hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items.
The American Hospital Association fought the ruling on first amendment rights and lost. It was one of the best things Trump accomplished in his term.
Hospitals Hide Pricing Data From Search Results
Most hospitals have partially complied with the transparency act but the penalty is so small that some haven’t.
Hospitals that published prices have a new tactic. They Hide Pricing Data From Search Results.
Hundreds of hospitals embedded code in their websites that prevented Alphabet Inc.’s Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.
“It’s technically there, but good luck finding it,” said Chirag Shah, an associate professor at the University of Washington who studies human interactions with computers. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”
Some hospitals that do post the data only do so partially. One tactic is to post only sticker prices, not prices paid to insurers. Others don’t post cash rates.
For example, Houston Methodist does not post negotiated rates. Houston Methodist claims that publishing negotiated rates would be confusing.
Allegedly hiding and distorting prices is not confusing.
How Data is Hidden
To identify webpages hidden from search results, the Journal wrote a program that read the contents of 3,190 disclosure pages whose addresses were provided by Turquoise Health Co., a startup working with the price-transparency data. The program searched for a tag in the pages’ background coding that instructs search engines not to index the page.
The Journal found 164 webpages hosting disclosure files for 307 hospitals that contained versions of that blocking syntax. Some pages include information for more than one hospital within a system. The code was removed from pages with data for 182 hospitals after the Journal contacted their owners.
UPMC, a 40-hospital system based in Pittsburgh, has placed the price lists on each hospital’s website, which can require seven clicks to reach from UPMC.com.
UPMC says the blocking code was in error and that it now only takes 3 clicks to find the data.
However, the Journal notes UPMC does not disclose negotiated commercial rates for insurers.
Blocking Hospitals
- HCA Healthcare Inc., HCA
- Universal Health Services Inc., UHS
- University of Pennsylvania Health System and NYU Langone Health.
- Some regional systems also had such code on their websites, including Michigan’s Beaumont Health and Novant Health in Winston-Salem, N.C.
Requirements and Penalties
Hospitals are required to post insurers’ prices and cash prices. They are also compelled to ensure the prices are “are easily accessible and without barriers.”
The penalty for noncompliance is “up to $300 a day”.
Given the extremely small penalties, hospitals have no real incentive to disclose prices other than to claim they have done so.
C-Section Can Cost Anywhere From $6,241 to $60,584
Please note that At One Hospital, a C-Section Can Cost Anywhere From $6,241 to $60,584
Given such pricing discrepancies, the $300 penalty for noncompliance is meaningless.
Mish
Hospitals Forced To Be More Transparent About Pricing. Will That Save You Money?
January 5, 2021
JULIE APPLEBY
AND
The 70 CMS-mandated services hospitals must post online next year
Alia Paavola – Thursday, February 13th, 2020
Here’s an example of how the medical establishment can screw with pricing. And this is the system that so many fought against as opposed to the “socialized” medicine plan put forth by Sanders/Warren in the last presidential campaign? STOOPID!
Her Doctor’s Office Moved 1 Floor Up. Why Did Her Treatment Cost 10 Times More?
March 26, 2021
For one Ohio Medicare patient, the same pain-relieving steroid shot that used to cost her about $30 went up to more than $300 just because her doctor started giving it in a hospital-affiliated clinic instead of her former office.
Kyunghee Lee’s right hand hurts all the time.
She spent decades running a family dry cleaning store outside Cleveland after emigrating from South Korea 40 years ago. She still freelances as a seamstress, although work has slowed amid the COVID-19 pandemic.
While Lee likes to treat her arthritis with home remedies, each year the pain in the knuckles of her right middle finger and ring finger increases until they hurt too much to touch. So about once a year she goes to see a rheumatologist who administers a pain-relieving injection of a steroid in the joints of those fingers.
Her cost for each round of injections has been roughly $30 the last few years. And everything is easier and less painful for a bit after each steroid treatment.
So, in late summer she masked up and went in for her usual shots. She noticed her doctor’s office had moved up a floor in the medical building, but everything else seemed just the same as before — same injections, same doctor.
Then the bill came.
….
If you have insurance, the rate will be capped by the insurance. If not, negotiate the price to something reasonable. In almost every case, it’s far cheaper for the hospital to settle.
Our medical system is totally screwed up, but the absence of prices is one of the biggest problems. Credit to LP candidate Gary Johnson who was ahead of the curve on this, calling for transparency in medical pricing before Trump. I remember Gary using an analogy it was like going to the grocery store and trying to shop with no prices on anything. You just get a mystery bill at the end.
Clear price signals are essential for functioning markets. If you don’t have effective price competition, you don’t have capitalism.
Why not simply require hospitals to present their pricing for the services to be rendered to the particular patient on a particular occasion? Just like for any other product or service that you can shop around for. For example, you want a tree removed from your property … you get N different prices from N different contractors and make your choice based on price and any other factors that matter to you.
Pricing of individual “procedures”/”items” simply does not allow the consumer to even know what “procedures”/”items” will be necessary for a given outpatient or inpatient “encounter”.
Of course there might always be opportunity for “additional emergency items required for unforeseen circumstances”, legitimate or otherwise, that hospitals would milk as much as possible … but make all of that public information and it would eventually become part of the information a person could use to make decisions. After all, accurately estimating what you will be charging for your services is something that should be available for the consumer to consider as well.
Yeah, I know … pipe-dreaming anyplace crony capitalism is inevitable king … anyplace ruled by caveat emptor as its second “golden rule” just below “those with the most gold make the rules”
Here’s a real life example. Back in Feb, I had an EMG (nerve health) test done for my left arm in prep for an elbow operation (Ulnar nerve relocate and repair tendon tear).
That perhaps 30 minute test was billed to Medicare as 5 separate codes:
Description Billed Allowed
Total $2,531 $583.84
Medicare allowed about 23% of the gross billing. I was potentially responsible for about $112 but that is picked up by the supplement plan. Since this wasn’t an office visit, I don’t believe I will owe anything at all out-of-pocket.
Point is, imagine trying to price this out on your own. Would you have to know all the codes that go into this one procedure and would you have to then add them together yourself? How are you going to determine those codes that go into a procedure? What if you chose the wrong codes and were grossly wrong?
The only way knowing medical prices work is if they were to classify the procedures as something like (in this case), “EMG, forearm”, but there are probably 20 different ways they could go about performing the tests and each way would cost different.
And I haven’t seen the cost for the operation yet. I imagine that the provider and hospital (good old Sutter) will bill that at something like $30-40k and Medicare will then likely pay in total something like $5k. Which is almost funny because if you’ve been in surgery lately, you know that there are a minimum of 10 people involved in the process in the hospital from the check-in to the pre-op, to the 8 or more people in the operating room (doctor, assistant, anesthesiologist, their assistant, a technician or two monitoring the machines, a nurse and then the recovery room nurse, etc. Surgery is quite labor intensive!
I have a hunch hospitals will be appealing to the Biden administration to repeal or just simply ignore this requirement
Won’t some 3rd party find and tabulate all the data, and then publish it where it can be found?
It was tried years ago but the insurance companies fudged the data.
There was a lawsuit where the insurers were ordered to find a neutral 3rd party entity to accumulate data.
It never happened.
Knew a guy who wrote a book on medical billing. Minimum of 3 prices:
He explained the reasons for all 3. It was such a … weird … explanation that my mind refused to remember it. Strangest effect.
Oh. Just to keep things simple, Medicare, et al, won’t pay more than anyone. Medicare effectively controls actual pricing in the USA. And care. If you don’t have a “code” (for a treatment), you ain’t getting the treatment. Since they can’t bill you without a “code”.
Love this posting@Mish . Especially the robots.txt thing. What’s amazing is you don’t need a fax machine to see the provider web pages!
Medicare does not control pricing, nor does it control the “codes “
There are two main codes you use to bill ANY insurer: CPT, which the code for the procedure or service provided and ICD, which is the condition for which services wetr rendered.
The federal government granted a monopoly on these codes to the AMA, which is worth millions of dollars. That’s why you’ll never see the AMA take a hard stand against government policy.
Thanks for the clear clarification on codes. Yep. I got really sloppy there. Should also have said, “Over-simplifying” rather than “Just to keep things simple”. Or, better, just left out the whole thing.
The whole US health system is criminal racketeering. No surprise that they choose to not to be honest.
There are 4 major systems of insurance hospitals use so there are 4 pricing systems. This is why prices remain not only high but secret.
They can’t publish every price for every person. My insurance might have a negotiated rate of $100 for a given service while yours might have a rate of $110.
What they CAN do is check your insurance benefits, how much of your deductible you’ve used, what your co-insurance is, and give you a pretty good estimate of what your out of pocket expense will be.
Be careful because the hospital isn’t the only entity that will bill you. Obviously there will be professional fees as well as unanticipated additional services.
One gotcha is that although the facility might be in-network the anesthesia group might not. That can be very expensive since they’re billing out of network. I’ve seen bills where the anesthesia cost more than the surgery.
It takes a lot of skill and arcane knowledge to navigate this, much more than 99.9% of patients will ever be able to grasp.
Is your argument that its a good idea fo hospitals to hid their prices? Last time I checked that’s the opposit of a “market system” oh well
Too stupid to merit more than a token reply
That’s a load of crap. Of course there are ways to do it! There’s a surgery center in Oklahoma City that provides true transparent pricing for all their services. The government needs to up the penalty from $300 to one half the pre tax profits in the most recent fiscal year. That would get compliance. Better yet, include mandatory minimum prison sentences for hospital administrators if a court finds that they have willfully tried to avoid full compliance in good faith. And if they are determined to pay different prices to different parties, then they should be required to post the lowest price charged and be bound by it to whomever requests it. Many years ago, the auto repair industry made very similar excuses about why it could not quote one transparent price for its services before it did the job. Congress ignored their complaints and, guess what, it turned out they could do it after all. So can the hospitals. These hospitals are financial predators without enough market competition to keep them honest, and they need to be treated like predators.
This is typical consumer ignorance. The SCO compares their high prices with the absurd chargemaster prices that hospitals use. It’s a marketing sleight of hand. SCO still charges what i would consider very high prices.
Like most people you don’t even know when you’re being scammed.
I’m happy I am on Medicare and don’t have to worry about any medical pricing crap now.
Do you understand Medicare billing rules? If not they can still gouge you.
Here’s a simple challenge:
I’m on Medicare. I did an online telemedicine visit to refill my BP meds.
The practice charged me $255. Of this, Medicare paid about half and the practice billed me for the rest.
Tell me what’s wrong with this and what the bill should have been.
Shouldn’t need a doctor’s appointment for BP prescription refills. This is simply a refill. This is medicare fraud on the part of the practice.
What the scammers do is require an office visit to see if you “still need” the prescription, then they bill as an actual office visit, which they are allowed to do under telemedicine rules. You get hit with the co-pay/deductible and they get easy $$ for a 5 minute conversation.
Yeah it seems to me there is a lot of such nonsense. You have to see your general to get referred to a specialist .
And this is why an integrated system is better off. I’ve lived in states where there were no integrated systems like Cleveland Clinic or Kaiser. Those are higher cost when the hospital, doctors and insurance are all separate companies with their own markups. It is ironic that the example Mish pointed out for a baby delivery is Sutter Medical Foundation. They got exposed several years ago as the highest cost system in the state of California and since then they have started hiring doctors directly for all subspecialties like Kaiser in order to reduce overhead and payments to doctors.
I would just tell them I have a recorded conversation with them and will send to CMS as Medicare fraud if they told me I needed an appointment for a simple refill. That is a clear cut case of fraud. The only way they need an appointment is if there is a change in condition requiring a change in the RX. A refill doesn’t fall under that. Changes in RX can happen at checkups if there is data to back it up.
Oh really? You expect unlimited lifetime refills without a visit?
And you’re wrong about telemedicine visits. In the situation i described above I inferred that i was billed for a level 4 visit. Medicare pays $114 for that in my area.
A level 4 visit, among other things requires a detailed physical examination, which is impossible to do by phone.
They didn’t include any relevant codes regarding CPT, ICD, or place of service (POS) either.
The POS code is not the same for telemedicine as for a physical office visit.
As a specialist doing telemedicine i happen to know that Medicare pays about $44 for a specialist telemedicine visit. Did you know that? I doubt it.
So these guys can gouge you without you even knowing it.
I wrote back to the collection agency that I’d be happy to discuss this with the OIG for CMS. No reply.
Do you have the knowledge or skills to pick up on that ripoff? I sincerely doubt it.
You don’t know what you don’t know.
It’s not fraud. It’s good medical practice to check on your patients at reasonable intervals.
Well, I also have a supplement Plan N, which covers everything that Medicare doesn’t except for a $20 office visit fee. All together I pay about $280/month for the Medicare and supplement plan.
DRs routinely force patients to have an appointment before issuing a refill. They can just say they have to check for side effects. Many will force blood work to measure blood levels.
Publishing their prices is a good first step, one of the few Trump actions I agreed with. The next steps will take time. Insurance companies will be the driver since they pay most of the bills I think
I think it is difficult to publish prices when insurance is involved. If you want true pricing if you have to get rid of insurance.