This week the government released a massive survey of hospital charges across the the country, showing how much hospitals charge Medicare for a variety of different procedures. If, like me, you were interested in seeing the information on your area hospitals, you might have tried downloading and opening the file. If you got that far, you would have discovered that the data were arrayed in a huge Excel spreadsheet. I took one look at it and concluded I didn’t have the patience to dig out the information I wanted on local hospitals, much less figure out how to get it into a more readable user-friendly format.
Fortunately the busy worker bees at the New York Times solved the problem with a giant interactive map. It still doesn’t let you do a side-by-side comparison of figures — Hospital A vs. Hospital B — but at least you can easily look up specific hospitals and their prices on a list of procedures. Chances are the specific procedure you’re interested in won’t be included; the list isn’t very long. But you can still get a good idea of which hospitals charge more or less compared to others in your area. And you can be appropriately horrified by the price tags on even the cheapest procedures.
I do not see how to “look up specific hospitals and their prices’. Where is that?
I sent the following email to HHS [ “Salcido, Dori (HHS/ASPA)” ],
I got back a polite note that said she would forward it up the chain, but no hint that there’s a plan to get what the public really needs. This is a toe in the water and what we need is a bath.
Thanks for the link, PT. I hope this takes off, somehow.
Go to the NYT story. At the end of the brief story you can enter you city or ZIP code to get to a large map of your area, where each hospital is a dot. Click on the dot to see information for that hospital. Or you can simply click on the map to zoom into an area and procede from there.
Yes, I saw that. Joplin has exactly two hospitals and all it tells me is that they are both coded “blue”, meaning categorized as in the lowest of three, count-’em, three, levels of chargemaster. It has zero use as far as I’m concerned, unless I want to go out of state for a new knee or something. What I need and want is a way to make our two hospitals compete.
I got curious and looked at some of the red dot hospitals in NY. It was obvious immediately that there were many more procedures listed for them than for Denver-area hospitals. It was disappointing to see the information was far more complete for some hospitals than for others. As for making your two hospitals compete with each other or with out-of-state hospitals, they probably already know what the other guy charges and make whatever adjustments they feel is appropriate. I don’t know if publicizing their prices would make a difference because I don’t think people price shop on health care the way they do for cars or lawnmowers or anything else that can be returned or exchanged. Would you want the best knee surgery you could afford, or simply the cheapest?
Those long price lists weren’t the prices you wanted to see?
Oh PT. When you say, “Would you want the best knee surgery you could afford, or simply the cheapest?”, you are falling right into the trap. The whole point of Steven Brill’s Time Magazine essay, Bitter Pill, was that price in healthcare has no relation whatsoever to quality. None. The “chargemasters” have NO basis. And I can’t open the price lists – the spreadsheet is too big.
What I meant to say and obviously didn’t was would you seek out the best available doctor, or would you just shop by price and pick the cheapest one? I don’t worry about comparative pricing or the charge master because it’s totally unrelated to whether my doctor is the best, most qualified doctor I can find.
I would do both, PT, if I had the time of course.
What criteria would you use in shopping for healthcare? In my experience, people use two:
1. Recommendation of a referring doctor.
2. Hearing of a positive experience of another patient.
These are better than random, but not much, and neither justifies ignoring price when the difference is thousands or tens of thousands of dollars. “Bitter Pill” documents that quality can be, and often is, higher for a lower price. Counter-intuitive, I know.
Physician recommendation and the positive experience of others are probably where I’d start. I’d also check with the state medical board for any disciplinary actions, license suspensions, etc. (in some states this information is more difficult to obtain than it ought to be). I’d do an online search for anything I could turn up — age, CVs, academic (teaching/publishing) credentials, professional affiliations, years of experience, speciality and subspecialty, medical school attended, hospital(s) where he/she has admitting privileges, CME, etc. If surgery were anticipated, I’d want to know how many times the doctor has done the procedure and how recently. I’d want an MD, not a DO. I’d want an allopathic, not homeopathic physician. I’m not sure how much weight I’d give the charge master at the doctor’s hospital(s) unless I were trying to decide between two equally qualified doctors.
Yet, after all that, I’d still be limited to those doctors and hospitals that would accept my insurance. Even if I were willing and able to pay cash, they probably wouldn’t accept me unless they liked the cut of my insurance company’s jib. Boy, insurance companies have gotten waaaaaay too big for their britches.
btw, Salcido’s email is Dori.Salcido@hhs.gov
We will all drown in paper work and fall in the battles between hospitals and insurance companies. I am so tired of insurance companies saying “Oh, we want you to take this medicine despite your doctor wants this one” repeatedly.
Would prefer we all go back to patients paying for services/ making arrangements then going to insurance company for their share…hospital costs would go down a great deal – less padding – less paperwork – and you would only pay for what YOU use – not for the other patients who don’t pay their bills.
Absolutely. The tail is wagging the dog now. Used to be the insurance companies didn’t get involved or even know what was going on until after the fact when a claim was submitted and they paid their agreed-upon percent. I’m not even sure anymore how we managed to devolve from that to our current situation.
Too much opportunity for double billing, fraud – and even billing an insurance company you haven’t been with for over 3 years and had already filled in all the forms for the new insurance company also years ago. Ooopsie doesn’t really explain it
(And since hospitals get to buy in bulk and get discounts, why does a single Tylenol cost so much?)
It all drives me totally crazy
I’ve long thought that hospitals figure “Hey, if the insurance company will pay $30 for a Tylenol tablet, why not charge that much? It’s like getting free money.” How long would you keep charging $1 for your product if you knew someone would pay $10?
Pied: I’ve long thought that hospitals figure “Hey, if the insurance company will pay $30 for a Tylenol tablet, why not charge that much? It’s like getting free money.” How long would you keep charging $1 for your product if you knew someone would pay $10?
Exactly!!!
What if (contrary to conditions prior to government medical handouts [Medicare, Medicaid, Etc.]) hospitals realized that they can charge and receive some kind of payment for procedures they perform on anybody? What if (in the absence of any means to pay) patients realized that they could get procedures performed that they could not ordinarily afford?
Like P. J. O’Rourke says: If you think medical care is expensive now, just wait till it’s free.
It’s an evil, greedy game the providers and insurers are playing, with their profits, not our health, the objective.
Very depressing indeed PT, but at least the giant interactive map is cool! 🙄
Maybe it was easy for a smart programmer to make a giant database display as an interactive map, but I appreciate it nonetheless. I couldn’t make heads or tails of the spreadsheet, especially on a 15″ laptop screen.
Goes to show that health care should not be for profit. End of story.
I’m still not ready to accept the idea of my doctors being government employees.
I didn’t say government. They should be not-for-profit.
Would you incur hundreds of thousands of dollars in debt and devote a minimum of 7-8 years to postgrad education and training just to work non-profit?
True.
I couldn’t help but catch the implication here that “non-profit” in hospitals might translate to lower pay. Here’s what “pay.com” says about this:
The truth is, “non-profit” hospitals are just as hungry for money as the “for-profits” and have chargemasters that are just as wild. The principal difference is that for-profits have shareholders and the non-profits plow their earnings back into infrastructure and salaries.
Sounds as though “not-for-profit” hospitals have nothing to offer the consumer by way of savings. Nice if the doctors still get the compensation they want, I suppose.
Sorry, make that salary.com
Why not, PT? What’s wrong with doctors being government employees? To pose this question, I think, requires thinking outside the box. If your fear is Orwellian, that put’s it in a category that ought to preclude having government prevail in all kinds of functions and you would then be simpatico with ImaLibertarian. I talked with our family doctor the other day and he is frustrated that his employer, a not-for-profit hospital, is pressuring him to increase through-put. He feels he can’t devote enough time to each patient, can’t be thorough. Why should that be? It can only be that the driver is not long-term patient welfare but the almighty dollar. Non-profit is a sham, it’s all about the money and raising salaries. Only in a single-payer government system can we get the priority changed – I’m convinced of it. And I truly believe that the best doctors, those who have humanitarianism in their souls ahead of riches, would be happy with the change.
Being a doctor’s daughter and having worked for the medical association for so long, I have a really tough time thinking outside that box. Inside that rather dusty old box, the doctors called the shots, not the government, not the insurance companies, and not for-profit corporations that owned chains of hospitals. While I’ve come around to believing single-payer insurance is probably the best way out of the existing insurance debacle (since lawmakers won’t regulate the companies back into submission), I’m still wrestling with the idea that doctors should subjugate their instincts and training to the wishes of government or corporate overlords. Medical training is long, difficult, and very expensive. If the net result is nothing but government work, would-be doctors will choose other careers and the current doctor shortage will get much, much worse. And without doctors, there will be no health care.
I do respect your experience as a doctor’s daughter, but that said I would speculate that generational impressions can be misleading. I’ve corresponded with Canadians on this subject and get no impressions of the problem you fear, micromanagement by bureaucrats. Quite the contrary, in fact. Being freed of the profit motive and having the goal of long-term care can give a doctor the freedom to practice medicine with only the patient in mind.
Did you ever read a book called “Not As A Stranger” by Morton Thompson? Published in 1954 when I was a high-school junior, it was a best-seller and it made a huge impression on me. It was a great fiction story about the career of a doctor, but also dealt with medical ethics in a very serious way. I am convinced there are many, many doctors who would love to practice medicine the way I describe, and they would not be impoverished in the process. (Thompson was a journalist too, by the way.)
Oh, I agree that generational impressions can be misleading. I realize that in many ways my background is a hindrance, a barrier to understanding and accepting the present-day paradigm. All I can do is keep trying. I see what you’re saying about Canadian doctors, but it is, literally and figuratively, very foreign to me. Wish I could sit down and have some long talks with today’s doctors, both American and Canadian.
I don’t think I ever read “Not As a Stranger,” but the title is so familiar I’m sure I saw the movie at some point. I don’t remember much about it though.