[dpayonk]

There is obviously a ways to go to create a system where price transparency is feasible, but I’m very interested in how the community might think it would affect the value based healthcare industry with respect to total cost of care management and bundled services? You cannot always look at a service in isolation because of complications on episodes like joint replacements or the impact of chronic conditions over the longitudinal total cost.

[topspin]

"You cannot always look at a service in isolation because..."

The medical industry is adept at excuse making and impeding change. If we wrap ourselves around every conceivable axle then nothing will be achieved. As it is providers and payers already employ elaborate coding systems to represent work and ascribe costs. Step one is to kick open that door and make this transparent. Should the result prove inadequate to sufficiently represent every imaginable nuance then the medical industry can engage in the necessary rework under that pressure.

[q-rews]

You’re right, my estimate for a short surgery in a private Thai hospital last Monday was “10k/11k THB excluding fees.” I walked out of the hospital 2 hours later having paid 9.1k THB (270 USD) painkillers included.

Estimates are fine, it’s just that they don’t benefit US hospitals. Stop justifying them, they’re scamming you.

[leetcrew]

sure. any given procedure has a happy path and many different ways it could go wrong and become much more expensive. you can't really predict what it will cost for an individual. but after performing the same procedure hundreds or thousands of times, the hospital ought to be able to figure out a standard rate that (statistically) covers its costs. I don't see a good reason why a large organization with tons of cashflow shouldn't be able to quote a price up front after taking any pre-existing conditions into account.

of course, we might not like the prices they quote if forced to do this, but it would at least be better than rolling the dice every time.

[dpayonk]

This is what bundled payments are attempting to accomplish. These bundles take into account the procedure (cot codes) in addition to transmissions and rehab costs generally. Disclaimer: not an expert on this specifically.

[peterangular]

> You cannot always look at a service in isolation

But in the American system it's setup that you must. This is the whole "coding" thing that you hear people refer to which is taking a procedure and breaking it into individual codes that can be used in billing you/your insurance.

This was addressed in the "Methodology" section of the article:

> Data was collected for three services, determined by specific codes.

---

> I’m very interested in how the community might think it would affect the value based healthcare industry with respect to total cost of care management and bundled services?

You mean... releasing pricing for individual codes.....? Finally showing that hospitals will bill different prices for the same code based on the patient's insurer...?

I read the article and all I got was that hospitals are releasing pricing information under the Trump mandate. I'm not sure what you're positing for an "effect" here as the effect is literally just transparency in hospital billing?

[nradov]

The US healthcare system is slowly moving away from the fee-for-service model and towards a value-based care model. Under that model, providers bear much of the financial risk. They might receive a single bundled payment for a joint replacement including all follow-up care, with penalties for failing to meet clinical quality measures. Or they might receive a flat per-patient per-month fee to completely care for people.

[OrvalWintermute]

>Under that model, providers bear much of the financial risk.

Actually, practices currently bear the risk already, because they are subject to reimbursements unless they are cash-paying. Remember, the patients are regularly not the bill payors - the Payors are actually insurance companies/medicare/or, rare HMOs out of the area.

> They might receive a single bundled payment for a joint replacement including all follow-up care, with penalties for failing to meet clinical quality measures

Certain medical interventions like cancer treatment or joint replacement may require a long tail of treatment, counseling, physical therapy, aftercare, global periods, etc.

The applicability of that is fairly limited since many things do not trigger a global, and don't fit into this definition.

[peterangular]

Good faith - not trying to be a bastard...

I've heard rumblings of this too but every time I've interacted with healthcare it's still the same coded system that you see in regards to the chargemasters etc... even as recent as-of a few weeks ago this was the system in a modern hospital in a large west coast city.

So, two things:

1. I think we're on the coded system indefinitely, or at least that's only what I can expect given recent experience

2. Even if we were to implement this, providers and insurers will still fight like cats and dogs because there's just too much money to be made here that I can't imagine the same problems won't manifest itself in a "bundled payment" system. I would actually expect this to make matters worse. Often when you bundle something it obfuscates and confuses the value of the individual "things" in the bundle - the middlemen will do everything they can to extract margin from this. I'd personally like to stay with codes to maintain transparency through having an auditable receipt of known services directly tied to a fair price.

[nradov]

Procedures will always be coded using a terminology system like CPT4 / HCPCS / SNOMED CT regardless of the payment model. The issue isn't coding but rather who bears the risk.

Bundled payments give providers the freedom and financial incentive to find innovative ways to efficiently deliver high quality care. No one benefits when hospitals have a separate line item charge every time a nurse administers a pain killer over the course of a hospital stay.

[peterangular]

> Bundled payments give providers the freedom and financial incentive to find innovative ways to efficiently deliver high quality care

Until someone financially incentivizes a higher quality of care I don't expect to receive it, especially by a bundled pricing model.

> No one benefits when hospitals have a separate line item charge every time a nurse administers a pain killer over the course of a hospital stay.

And as someone who's been billed insane amounts for things like OTC painkillers I disagree with this so hard. I have zero, and I mean zero, confidence that they will not continue to overcharge me. When everything is individually coded then at least a patient can go back and "look at the receipt"...

In my adult life I realize that almost everything is weaponized against me (the patient) in healthcare. I cannot expect in good faith that removing the line items from the receipt will help me in any way. In America, I can only expect this to hurt me or I'd be an idiot.

Sorry to disagree, but there is no way that bundled pricing is going to serve the patient better as it makes auditing services rendered much much harder. As someone who's had to get into the weeds on this stuff between insurer, hospital billing, etc. I can only imagine that bundled pricing would have made my life more difficult as it really did come down to the codes.....

[dpayonk]

Bundled payments still help stablize the cost for an outcome. The bundled payment should make it easier to purchase a “knee replacement” as a consumer because you won’t need the clinical knowledge to understand the professional details of how. It has downsides as you mentioned above, but it can make consumer choice easier. Complexity is one of the fundamental challenges of paying for healthcare today.