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Old Today, 05:56 AM
 
Location: Colorado Springs
4,416 posts, read 4,464,129 times
Reputation: 15630

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UCHealth tool shows patients what they’ll pay, but some say it’s not enough

https://www.csindy.com/coloradosprin...t?oid=17660570

"With a new online tool, UCHealth became one of the first hospital systems in the U.S. to show patients exactly what they can expect to pay for a given procedure. The tool allows the hospital system to use updated information from a patient’s insurance provider to determine individualized costs.

Patients can also select different hospitals to shop by location in the UCHealth system, which holds information for about 150 procedures so far, says Dan Weaver, UCHealth’s senior director of PR and communications.

UCHealth launched its new service shortly after the Centers for Medicare & Medicaid Services released its own, less-specific tool that shows average prices Medicare patients pay for procedures.

Also, the nonprofit Center for Improving Value in Health Care (CIVHC) recently released its “Shop for Care” tool, where patients can compare average prices for common procedures across Colorado. Though patients can’t see how much they’ll pay out of pocket, and physician fees aren’t included, still, says Cari Frank, CIVHC’s vice president of communication and marketing, it offers a good way to compare facilities."


I think this is a great idea. We really do need more transparency wrt health care costs.
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Old Today, 09:56 AM
 
20,431 posts, read 38,066,048 times
Reputation: 18267
The gist of this news article goes far beyond COLO SPGS, so I may move it to the Health Insurance sub-forum where it will probably get a lot of discussion.

The ability to see what something costs is a step forward and long needed. I gripe that hospital, doctor and services pricing is a game of smoke and mirrors; they bill Medicare or insurance $50k for a surgery but accept $17k as payment in full, yet they still make money. Same for prescription drugs and testing services. Insurance statements are a maze of numbers like "amount billed" and "amount authorized by Medicare" and "amount authorized by supplemental insurance" and "patient may owe" and other stuff. What the hell set of criteria is used to determine how much of a $158 charge is "authorized" by any of the players. The overhead costs must be huge to run all these monetary shell games, pay all the workers in the back room, the IT data costs, etc.

Just this week I was trying to find prices for a prostate test known as a 4KScore Panel and it took me some time to dig any data out of the internet, and then it was only one site that had even one bit of price data. Same for the cost of a prostate biopsy; try to find the "average cost" for ANY common procedure is like trying to pick fly poop out of pepper flakes while wearing boxing gloves.

My preferred solution to all these fun and games, to include drug prices, is to dump it all and go to a universal single payer (USP) system. I contend Medicare is a USP and I'm happy with how well it works for my wife and I. We pick any doctor and facility we wish and we go there for care. My docs don't have to bow and scrape before the almighty weasels at Kaiser for the okay to do testing procedures like I've seen my docs do in the past. Tens of millions of people have similar gripes and horror stories with how medical insurance works in this country.

I once saw stats that insurance typically reimburses ~44% of what is billed and Medicare reimburses ~25% of what is billed. If these stats are true it means something is very wrong in our healthcare fantasyland. Ironic that people used to say crooks keep two sets of books, one to show the IRS (how little money they make) and one to show themselves what they really were earning (and hiding for themselves).

Regarding COLO SPGS, here's something I recall from ten years ago regarding Memorial Hospital System (MHS) and its annual financial reports (AFRs). MHS once put AFRs on their website. I recall one very clearly (2005?) as it showed how badly overpriced health insurance really is. I'll recreate it from memory:

$650M (Income for 2005, from insurance payments and patients who paid out of pocket)
---------
$500M (Cost of services to insured patients and patients who paid out of pocket)
$125M (Cost of services to uninsured patients, indigent, etc, for which MHS was not paid)
$025M (Surplus at end of year, i.e., profits after all bills were paid)
----------

Read these numbers very carefully. MHS got $650M from our insurance firms but MHS only spent $500M to provide that service, thus our insurance was over billed by $150M. It is this $150M in over pricing that covered those patients who stiffed MHS ($125M) and also allowed MHS a surplus ($25M).

This proves what I've contended all along, that in order to stay in business, hospitals are forced to grossly overprice their services to cover the costs of those who cannot pay for care, i.e., the typical uninsured persons who walk into the ER because they don't have insurance or a family doctor.

It also proves what I've said all along, that no matter how we slice it, we ARE paying the healthcare costs for the uninsured. Sometimes that "free" care is paid by a local government but mostly it's paid via our inflated health insurance premiums. Either way, for damned sure WE are paying for it, and since we are paying for them why not just go the USP route and be done with it. Instead of shipping massive health care dollars to insurance firms who keep ~25% for their "overhead" why not shift those billions to Medicare who do a great job with an overhead cost of only ~5%. I contend the savings in overhead costs will pay for the uninsured and not cost us any extra.

That's my take on it. Tons of data is being hidden by all players as they guard their rice bowls.
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Old Today, 10:38 AM
Status: "And now for something completely different." (set 4 days ago)
 
Location: Aurora, CO
6,218 posts, read 9,596,032 times
Reputation: 9004
I'm intimately familiar with the patient cost estimation process because I worked for a company that provides a product that does exactly this, and as the article states it's not easy. Lots of moving parts. Coordination of benefits (which plans cover what). Order of reimbursement (facilities, primary provider(s), professional group(s)). Carriers with multiple health plans, each with potentially different coverage parameters. Some procedures require prior authorization from the carrier. Throw in Medicare and you also get crap like Medical Necessity, ABNs and HINNs.

Their software could generate an accurate estimate down to the penny. It's been around for years, but unfortunately it's not directly customer-facing. It's used by the revenue cycle management team to generate estimate letters beforehand.
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Old Today, 10:58 AM
 
20,431 posts, read 38,066,048 times
Reputation: 18267
Quote:
Originally Posted by bluescreen73 View Post
I'm intimately familiar with the patient cost estimation process because I worked for a company that provides a product that does exactly this, and as the article states it's not easy. Lots of moving parts. Coordination of benefits (which plans cover what). Order of reimbursement (facilities, primary provider(s), professional group(s)). Carriers with multiple health plans, each with potentially different coverage parameters. Some procedures require prior authorization from the carrier. Throw in Medicare and you also get crap like Medical Necessity, ABNs and HINNs.

Their software could generate an accurate estimate down to the penny. It's been around for years, but unfortunately it's not directly customer-facing. It's used by the revenue cycle management team to generate estimate letters beforehand.
Thank you a ton for that view from the inside. You describe what seems a horror of complexity, so much slicing and dicing of what's authorized at which levels and then the focus is lost on patient care itself. The "system" becomes the patient; care and feeding of the system becomes the focus.

All those moving parts, multiple plans, nuances between different companies, etc, all adds up to a level of complexity which seems headed for collapse like the economy in 2008 when all the financial complexities sank the world into a great recession.

As an outsider I don't get to peek into the secretive backrooms of health care where I envision an army of clerks entering data into coding systems for every visit, pill, procedure and gauze pad while over in a corner is a wizard of oz guy furiously shaking a row of levers to make it rain money. Everything works until one day it stops and everything comes to a screeching halt...kind of like Brexit. I'm afraid health care is getting near that point.
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Old Today, 11:08 AM
Status: "And now for something completely different." (set 4 days ago)
 
Location: Aurora, CO
6,218 posts, read 9,596,032 times
Reputation: 9004
Quote:
Originally Posted by Mike from back east View Post
Thank you a ton for that view from the inside. You describe what seems a horror of complexity, so much slicing and dicing of what's authorized at which levels and then the focus is lost on patient care itself. The "system" becomes the patient; care and feeding of the system becomes the focus.

All those moving parts, multiple plans, nuances between different companies, etc, all adds up to a level of complexity which seems headed for collapse like the economy in 2008 when all the financial complexities sank the world into a great recession.

As an outsider I don't get to peek into the secretive backrooms of health care where I envision an army of clerks entering data into coding systems for every visit, pill, procedure and gauze pad while over in a corner is a wizard of oz guy furiously shaking a row of levers to make it rain money. Everything works until one day it stops and everything comes to a screeching halt...kind of like Brexit. I'm afraid health care is getting near that point.
There is a lot of complexity involved, but TBH the most arduous part of using the system is contract management. The company literally has a team of people who do nothing but enter insurance plan contract details into the system all day. I'd go postal if I had to do that.

It's actually a pretty cool product because it also uses historical data to generate the estimate. For example - you're going to Dr. Smith to have your gallbladder removed. Based on the last x cholecystectomies Dr. Smith has done the system knows what supplies he typically uses, what the typical recovery time is, what the provider(s) typical billed costs are, etc. All that stuff gets automatically added to the estimate.
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Old Today, 09:12 PM
 
Location: Colorado
694 posts, read 365,200 times
Reputation: 796
Two points:
1. You’re right Mike about moving this thread. Way bigger than COS.
2. Already a fair amount of misinformation about a remarkably complicated and unfixable issue.
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