Compare hospital charges, http://www.opscost.com/

by on May 19, 2013 at 4:11 pm in Medicine, Web/Tech | Permalink

The web site reads:

On May 8th, 2013, the federal government released data on list prices and medicare reimbursements for the 100 most common procedures at over 3,300 hospitals.

This tool allows users to easily search and compare hospital charges.

Shane M May 19, 2013 at 4:32 pm

For uninsured – it’d be nice just to be able to get the pre-negotiated rate without having to be a part of the group. I’ve wondered if there would be an insurance policy you could buy that pays _nothing_ on your bills – but comes with a set of pre-negotiated prices similar to what insured folks pay. I bet it’d sell.

mw May 19, 2013 at 5:50 pm

In more exotic parts of the world they call this “government price controls,” but I can see the ideological appeal of having a middle man do the price setting instead.

steve May 19, 2013 at 5:55 pm

As a provider, why would I want that deal? I am willing to cut rates for an insurer who promises to bring me a large number of patients and has the ability to pay. Why should I take that risk for an individual? Why should I offer the same low price w/o the accompanying volume?

Steve

Mike May 19, 2013 at 6:24 pm

A large group of people buying at pre-negotiated rates seems like an attractive market; potentially more attractive than insurance companies that are notorious for being hard to deal with and slow to pay.

mulp May 19, 2013 at 11:50 pm

As opposed to jobless poor people who have no insurance because they are both jobless and poor??

The hospitals and clinics that served them once got a predictable amount of money from the public because they were public institutions. The prices billed were high for the rich and low for the poor.

The conservatives argument that for-profit private institutions would be cheaper and offer better service has created the current bizarre situation where the wealthy get the low prices because they have insurers who drive down prices, while the poor get poor service with extremely high prices they go bankrupt trying to pay to get the bill collectors off their backs, or they have their wages and property attached.

Floccina May 20, 2013 at 11:07 am

@mulp those sorts of things make me wonder if charity is the best option in healthcare. People do not trust for profits to exclude treatments based on efficacy and net benefit but they do not truest government on these matter either. Perhaps they would trust mutual aid societies, their church or a charity to make such decisions.

Shane M May 20, 2013 at 3:13 am

I have limited experience with the health care system, but what I have seen is more than enough to let me know I have no idea what reasonable and correct charges would be, that negotiated rates can be far far less than uninsured, and that I’m likely to have no ability to research prices beforehand, or in some cases have no opportunity to research in emergency situations.

In any event, having somebody who knows what the prices “should” and to have that part taken care of would be nice- and would keep me from getting myself into a situation where I have to pay many multiples of what something would otherwise cost. Some folks might say “what the prices should be are whatever the provider wants to charge”, and I understand that viewpoint, but it really is hard to even begin to understand and shop in any informed way.

quadrupole May 19, 2013 at 4:42 pm

I’m pretty sure such a policy is illegal under the Affordable Care Act :(

Mike May 19, 2013 at 5:35 pm

Seriously? Why would that be case? Seems like a good idea to me.

Rich Berger May 19, 2013 at 5:49 pm

Think about it. Why would an anti-market law use market forces?

mw May 19, 2013 at 6:04 pm

For 1,000 points, name 5 features of a “market” that are present and functional in American healthcare. For extra credit, explain how those market features become less free as a result of a private health insurance exchange.

Mike May 19, 2013 at 6:26 pm

I guessing you’re used to not being taken seriously.

BC May 19, 2013 at 6:39 pm

Obamacare works at least in part by requiring some people to overpay for their own insurance and using that excess to subsidize others’ insurance, e.g., mandating that young, healthy people buy insurance at inflated prices (relative to their actuarially expected claims) so that older people and people with pre-existing conditions can buy insurance at subsidized prices. The law prevents insurance companies from charging some consumers “too little” relative to other consumers regardless of relative differences in their fair (actuarial) cost of insurance.

That’s the same reason for opposing Medicare vouchers, although voucher opponents don’t state it that way. They say that insurance companies will “cherry-pick” the best customers. Of course, that’s nonsense since insurance companies don’t get to unilaterally pick their customers — the customers have a say in which policies they buy. So-called “cherry-picking” really means that insurance companies, due to competition, will offer lower-priced policies to actuarially cheapest to insure customers so that those customers will benefit from their lower actuarial cost. In doing so, we will not be able to force these customers to subsidize those that politicians deem worthy of subsidization.

Obamacare needs to make certain policies illegal — e.g., low-priced, catastrophic-only, Shane M’s suggestion, etc. — precisely because they *are* good ideas, so good that people will want to buy them and, hence, deprive the architects of Obamacare from forcing those people to subsidize others’ insurance.

The transparent way to provide subsidies, to those with pre-existing conditions for example, would be to just use tax money. But, Obamacare proponents didn’t want to admit that Obamacare required either raising taxes or increasing the debt. Thus, they *effectively* taxed some people by mandating that they buy more insurance than necessary at inflated prices. Since this effective tax is disguised as insurance premium, it doesn’t count as a tax; it just has the same effect as a tax — a tax on the healthy rather than a tax on the wealthy.

ThomasH May 20, 2013 at 6:51 am

“The transparent way to provide subsidies, to those with pre-existing conditions for example, would be to just use tax money.”

Why DID the Administration resist all that Republican pressure for using higher taxes to more transparently subsidize health insurance for those who do not have it?

Bender Bending Rodriguez May 20, 2013 at 5:05 pm

I’m guessing it had something to do with elections having consequences.

Boonton May 21, 2013 at 10:30 am

Obamacare works at least in part by requiring some people to overpay for their own insurance and using that excess to subsidize others’ insurance, e.g., mandating that young, healthy people buy insurance ..blah blah blah

Errr news flash, who exactly do you think pays? The entire premise of insurance is that those who aren’t making claims are paying for those who do. Put it to the test, try starting a homeowners insurance company whose premise is that people who don’t have housefires pay nothing but those who do pay for their costs. See how far that gets you.

Mario Rizzo May 19, 2013 at 6:15 pm

Why does the Medicare patient care about this? (Assuming he understands the unfriendly data presentation.) Suppose I am diligent and search for the best quality-adjusted deal. Does Medicare or supplementary insurance give me a rebate? If they did, I might search.

mulp May 20, 2013 at 12:50 am

After the deductible, Medicare only pays 80% of the allowed charge, which is the lower of the lowest rate a provider charges anyone, or the regional customary and proper rate, with a Congress mandated discount.

So, if you can find a lower rate than the maximum Medicare allowed, you will get to keep 20% of the lower price.

Insurers who offer a fixed copay require you use their preferred provider network where they have selected only providers with the right mix of low prices. However, if you need to go out of network, the price matters because you will pay 20% typically.

Dale May 19, 2013 at 7:10 pm

This is an area where some institutional knowledge is critical. First, there is no reason to shop Medicare prices – they are fixed by policy (they do vary by hospital according to set criteria, such as patient mix, geography, etc.). Second, the prices that can be searched only apply to uninsured people, not on Medicare or Medicaid. Even within this group, it only applies to people who don’t know they can negotiate their own prices with hospitals – not an empty set, but likely to be quite small.

On the other hand, the most relevant prices would be the negotiated prices with insurers. These may bear no relation to the list prices (we don’t know, since those are not available). In fact, it is possible that the negotiated prices vary little while the listed prices vary a great deal (again, we don’t know). The question that has always puzzled me is why the insurers don’t make such data available. They have the data and if available to patients, the patients search (inadequate though it might be) would save both the insurer and patient money.

mulp May 20, 2013 at 12:07 am

Insurers don’t public their contract prices because they believe they can get lower prices – if all the hospitals knows an insurer will publish, they know every other insurer will expect the same prices, or lower if they offer more business. It is basically the same reason employers don’t want wages published.

The question better asked is why the providers don’t publish all the prices they pay, especially when coerced by what is effectively trust price dictates. But that is probably the same reason workers don’t reveal their wages to everyone.

orthodoc May 20, 2013 at 1:28 pm

True reimbursement numbers can’t be publicized because to do so would violate Federal anti-trust law. It’s the same reason that doctor A can’t find out what doctor B charges.

Ekrem Tufan May 19, 2013 at 7:39 pm

Health can not be traded. It is a human right. Please have a look to subject also in this way.

anon May 19, 2013 at 8:33 pm

A doctor’s time to perform a triple-bypass surgery can be traded though…

lambert strether May 19, 2013 at 8:54 pm

1. Who are they?

No match for “WWW.OPSCOST.COM”.
>>> Last update of whois database: Mon, 20 May 2013 00:52:02 UTC <<<

2. I don't see an About page. How do I know the provenance of the data?

3. There are only ~100 operations in the dropdown. Where does that taxonomy come from, and why those 100?

OpsCost May 20, 2013 at 9:57 pm

Hi Lambert,

This is the 2011 Medicare IPPS dataset released by the CMS. The raw spreadsheet is available here: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

According to that site, “The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.”

We’re a data and analytics company based in SF that built this site as a side project. We’re not in the whois database yet because we literally just set this up over the weekend. Hope that answers your question.

Regards,

OpsCost

lambert strether May 19, 2013 at 9:02 pm

Adding, yes, the site says 100 most common. But sez who?

Rachel Soloveichik May 20, 2013 at 10:24 am

Dental insurance is often just pre-negotiated prices. There are plenty of companies that offer “insurance” plans for <$10 a month per family with no underwriting or limits on pre-existing conditions. To the best of my knowledge, there are no health insurance plans with similar rules. Even when they were legal, they just didn't exist. My strong guess is that there's not much market demand.

Shane M May 20, 2013 at 12:05 pm

Thanks Rachel, I can understand why I or someone might be uninsurable – but signing up for a list of pre-negotiated prices seems logical. It’s just a small step of difference from a catastrophic plan except not everyone qualifies for the catastrophic plan. For the folks who don’t qualify for the catastrophic plan it would gives at least some reassurance that the prices on the bill are reasonable.

Instead of turning me or someone down for insurance would there not be incentive to provide an option to sign up for their pricing list and contribute to their volume negotiating power? I understand demand for this may be low, but I don’t see the incentives to turn someone down when you could possibly make some money from them without any risk.

Or perhaps an option like this would be chosen “too often”, hurting both overall revenue and profitability for the insurance carrier. I can’t discount that possibility.

Dale May 20, 2013 at 12:09 pm

Most dental “insurance” plans are not insurance in any meaningful sense, but pre-payment plans. With an annual max of $2000 (or less), the majority of these plans cover routine care – cleanings, X rays, exams, and the occasional filling. Given that, it is fairly easy to predict payouts and negotiate prices with providers. I don’t see these circumstances as applying to health insurance, however. In fact, were it not for the pre-tax treatment of dental benefits, these plans would probably hardly exist at all.

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