[HN Gopher] Open source hospital price database
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Open source hospital price database
Author : alecst
Score : 125 points
Date : 2023-06-13 20:41 UTC (2 hours ago)
(HTM) web link (www.dolthub.com)
(TXT) w3m dump (www.dolthub.com)
| tomrod wrote:
| So glad to see Dolthub got their DB up and running! We spoke a
| few times early in your process for insurance, looking forward to
| seeing that land.
| timsehn wrote:
| The insurance database (transparency in coverage) is here (also
| open data):
|
| https://www.dolthub.com/repositories/dolthub/transparency-in...
| hathawsh wrote:
| Hmm, that URL
| (https://www.dolthub.com/repositories/dolthub/transparency-
| in...) is giving a 404.
| hathawsh wrote:
| Related: I'd love an app or web site that lets me type in a
| medical procedure needed by someone close to me. After an AI chat
| conversation where I clarify the procedure and list any possible
| complications I'm aware of, the app would use databases (such as
| the database linked to this thread) to give me a list of
| estimated pricing nearby (and far away, if the prices are high.)
| All estimates would give a range (for example, $3500 +/- $1500.)
|
| Does such a thing exist? It seems possible with 2023 tech,
| although it probably needs to know health insurance details to do
| its job well. I think millions of US citizens would subscribe.
| brendanyounger wrote:
| It might exist soon. There are a few other companies working
| with the hospital (and much larger payer/insurer) price data,
| but it's a _very_ small community. It's been said that you need
| a screw loose to really enjoy digging into the data.
|
| Even beyond just collecting and organizing the disparate files
| (which Alec has been doing a yeoman's job of with an all-
| volunteer force), you quickly realize that many of the quoted
| prices are just flat out wrong, or, at best, misleading. Even
| people in the business struggle to make sense of them.
|
| An example: you look at a hospital MRF to see the cost for a
| knee surgery on a BCBS plan and it just happens to be exactly
| 3.5x the Medicare rate. Then you look at all their other quoted
| prices in the MRF and realize they're _all_ 3.5x Medicare.
| Someone in the billing department was really lazy putting
| together that MRF! Then you look at the BCBS MRF and see a rate
| which is 1x Medicare. Definitely not right. So you ask the BCBS
| affiliate what gives and they say the hospital you're looking
| at is on the ancient APC billing codes which means the HCPCS
| code you were looking at for the knee surgery would never be
| billed by this hospital and all the rates you just looked at
| are complete bunk. Now, take that knowledge and make a simple-
| to-use, mostly correct user-facing website! Because if you
| quote the wrong $ amount, the internet will roast you alive.
|
| As I said, it might exist sometime in the next few years, but
| it will take a lot of behind the scenes effort to make it work.
|
| Some of the folks working on this problem:
|
| https://turquoise.health/
|
| https://www.serifhealth.com/
|
| https://tynbil.com/
|
| https://www.healthcostlabs.com/
| thallium205 wrote:
| CMS publishes all their rates which is where almost all pricing
| is based off of (typically some multiple).
| breadwinner wrote:
| > _I think millions of US citizens would subscribe._
|
| And why would millions of US citizens be interested in such a
| service? If they have insurance, insurance pays most of the
| costs. And this is the reason medical costs are on an upward
| spiral in the US: consumers are not incentivized to shop
| around.
| wnolens wrote:
| Many many people have high deductible plans, or need to use
| out of network providers. We cannot shop around as it is.
| hathawsh wrote:
| A lot of US citizens have moved to "high deductible" health
| insurance plans, which means they pay for most medical
| procedures up to some yearly maximum (such as $10k.) The
| advantage is the monthly premium is significantly less. Those
| people are very incentivized to shop around.
| chatmasta wrote:
| This is pretty much the default option for your average
| person who doesn't have employer-provided healthcare. And
| the "significantly less" monthly premium is still in the
| range of hundreds of dollars. It's outrageous.
| nradov wrote:
| Most large medical insurance companies already have some sort
| of cost estimator tool for their plan members. You can log into
| the member portal and search for common procedures to get
| estimates of what different network providers typically charge.
| WaitWaitWha wrote:
| > Does such a thing exist? [...] I think millions of US
| citizens would subscribe.
|
| Yes, such thing exists.
|
| My friend just had an endoscopy & colonoscopy together. She was
| able to get a price estimate through her hospital's portal both
| with and without her insurance, prior to her procedures,
| requiring no special interaction besides picking the service
| she was interested in and if she wanted to see the price with
| or without insurance.
|
| The system seem to show her anything and everything she needed,
| from a routine office visit, these procedures, to delivering a
| baby. It not only includes the price at that facility but also
| a range from low to high, and where the facility fits. It also
| gives breakdown of the fees, although not deep enough.
|
| The service seems to be by a company called Epic
| (www.epic.com), based in Wisconsin.
| HDThoreaun wrote:
| There's a reason medical providers refuse to tell you the cost
| before a procedure. They honestly do not know, there are just
| so many complications and unforeseen events that can happen.
| While the Trump executive order forced some consolidation of
| medical codes there's still a massive difference between
| providers, so you can't even compare the lists of two hospitals
| since they're not charging for the same things.
| maxerickson wrote:
| If they can't predict a complication, shouldn't they be
| setting an ahead of time fee that will on average cover it?
| Why does the provider get to push the unpredictable risk onto
| the patient who has less control than they do?
|
| Like I shouldn't be billed extra if my surgeon is hungover
| and things don't go smoothly.
| moneywoes wrote:
| Would they pay for it?
| hathawsh wrote:
| If that app works reliably, then yes, because it would
| regularly save people thousands of dollars under the current
| US health care system.
| gurleen_s wrote:
| This is so insanely dystopian. You shouldn't have to figure out
| where care is cheapest, especially in an emergency.
| loeg wrote:
| Everyone wants this for non-emergency scenarios.
| alecst wrote:
| I meant to submit this from my work account and not my personal
| one, but oh well.
|
| I helped make this. AMA or email me at alec@doltub.com.
| adunsulag wrote:
| What the is the code you are using in your data. Is it SNOMED?
| CPT4? Something else?
| tdstein wrote:
| CDM codes and REV codes are listed, both of which are a
| different coding system than SNOMED or CPT, specifically
| built for billing purposes.
|
| https://en.m.wikipedia.org/wiki/Chargemaster
| throwaway8689 wrote:
| If you are curious to compare with a foreign single payer system,
| England's NHS tariff is published at
|
| https://www.england.nhs.uk/pay-syst/national-tariff/national...
| nhinck2 wrote:
| 13k vs 35k for a defib implantation, yikes.
| lannisterstark wrote:
| I mean, it's just the 'cost.' Not necessarily the 'cost to
| the patient.'
|
| I understand that it's helpful to see for people who are
| under/uninsured, but for most of the people it'll just max
| out at out of pocket/annual deductible max (which for example
| is like $250 per annum for me).
|
| Further, what hospitals charge to insurance is not
| necessarily the rate insurance pays either. My counselor
| charges my insurance $400 an hour, but insurance negotiates
| it to like $80, of which I pay $0.
|
| The counseling office charges people who do _not_ have
| insurance like $96 per session.
|
| What hospitals charge is not necessarily cost to patient is
| all I'm saying.
| maxerickson wrote:
| If they continue to accept the rate that the insurance
| company reimburses at, it is not reasonable to describe
| them as charging some other rate. They know what the
| insurance is gonna pay when they provide you the service.
| peteradio wrote:
| Wtf is that $400 price for them?
| me-vs-cat wrote:
| > Wtf is that $400 price for then?
|
| Insurance: "Look how much we saved you! (Don't question
| our value.)"
|
| And maybe even the medical provider being able to write
| off the difference as a business loss or being able to
| say: "Look how much we discounted your service!"
| lannisterstark wrote:
| This only matters to end user if they actually pay for
| insurance themselves. If their employer covers it (as
| mine does), I don't think they care that much how much
| their insurance 'saved' them if the net cost ends up
| being $0.
| xp84 wrote:
| Using insane prices and then marking them down to
| reasonable levels "as an insurance discount" only has a few
| possible purposes and none of them are good:
|
| 1. Ripping off anyone without insurance who doesn't realize
| they may be able to negotiate it 2. Misrepresenting the
| true cost of healthcare for anyone who goes off the
| "original price" 3. Establishing that insurance companies
| _have_ to push for deep, 90%+ discounts on everything,
| meaning _nobody_ can offer sane pricing because the
| insurance company will say "But <HOSPITAL> gives us 95%
| off!"
|
| I recently had a genetic test done. They told me that if my
| cost after insurance was more than $200 they'd notify me
| ahead of time so I could decide how to proceed, one option
| was a simple pay-cash option for $250. Turns out the
| "Amount billed" to insurance was $ 25,000, which was then
| "discounted" by about $ 24,600 and they were paid $400 or
| something. So, this is a service the lab is happy to
| provide for $250 -- and they make money at that price, yet
| in some fantasy universe, $ 25,000 is in play. This is why
| people want to burn the US health system to the ground.
| rqtwteye wrote:
| "What hospitals charge is not necessarily cost to patient
| is all I'm saying."
|
| It is cost to the patient in the form of ever rising
| insurance premiums and deductibles (mine is $3000 and a lot
| of people have even higher deductibles).
|
| Your counselor example also shows the insanity of US
| healthcare pricing. $400 vs $80 vs $96. How is anybody
| supposed to make economical decisions with such crazy
| pricing differences? There should be a regulation that
| providers charge the same price for the same procedure, no
| matter if they are insured or not or what insurance they
| have.
| Faaak wrote:
| And for Switzerland, which has a somewhat private (although
| regulated), but mandatory healthcare: for example
| https://browser.tartools.ch/#/tarmed_kvg/data/L/37.0700 (the
| real data is an MBD file, but less readable)
| TX81Z wrote:
| This is just Medicare data that's already freely available.
| MPSimmons wrote:
| If you just want to see the prices with the things, this is a
| more abbreviated query:
|
| SELECT `hospital_id`, `row_id`, `line_type`, `description`,
| `payer_category`, `payer_name`, `standard_charge` FROM `rate`
|
| Adding an 'order by' clause makes the query time out.
|
| "CC" in many of the descriptions seems to mean "complications and
| comorbidity". "MCC" is Major Complication or Comorbidity. Some
| other abbreviations can be looked up here:
| https://www.asha.org/practice-portal/professional-issues/doc...
| thumbuddy wrote:
| This is awesome. Lot of social good here. Kudos to you
| andrewstuart wrote:
| A friend just went to hospital in Queensland, Aus with pain in
| his hand.
|
| The booked him in to stay the night and did surgery the next day
| and he stayed for two more days then went home.
|
| Without a bill.
|
| Thank goodness for Australia's healthcare system. It's far from
| perfect, but when it works, it really works well.
| peteradio wrote:
| 3 days in hospital bed for hand surgery?!
| alluro2 wrote:
| It depends on the type of surgery, op room schedule, doctor
| availability, any kind of needed prep for the patient, etc -
| but 2 nights is not that unexpected. (Am also not a doctor,
| but stayed in hospital for 2 months, so seen people
| undertaking various surgeries in that time).
| dietr1ch wrote:
| If it's free I guess you'd prefer even staying a week instead
| of working months to pay it with your fun budget.
|
| And the clarification comment says only ~8h were wasted
| waiting to be seen. The rest of the 3 days was probably
| justified (might be surprising if you are expected to be at
| work unless you die).
| andrewstuart wrote:
| He arrived around lunchtime, had to wait 9 hours or so to be
| seen, they scheduled him for surgery the next day and booked
| him in that night, then two days post surgery (general
| anesthetic) to keep an eye on him. I'm not a doctor, don't
| know the details.
| zapdrive wrote:
| 9 hours to be seen? I thought only Canada was fucked up. I
| think all the countries with "free" healthcare end up with
| having absurd waiting times. I had some issue with harmones
| and the family physician referred me to endocrinologist. I
| called his office and guess what? There was a 6 month
| waiting period. They gave me an appointment 6 months away.
| Luckily I was traveling to Mexico in a couple weeks. I saw
| an endocrinologist there (no appointment, just walk in). He
| told me if i had waited 6 months, it would have taken a
| drastic irreparable toll on my health.
| Solvency wrote:
| Darn. I really want to sort this by highest price to lowest, but
| it times out.
| [deleted]
| timsehn wrote:
| If you clone the database locally it will work. It takes a long
| time to clone though.
| pessimizer wrote:
| I think it's important that people around the world can see this,
| know that we suffer, and feel proud of their own countries'
| health systems.
| [deleted]
| tempnow987 wrote:
| Some timeouts filtering by hospital for me:
|
| 'SELECT * FROM `rate` where hospital_id = "XXXXXX" ORDER BY
| `hospital_id` ASC, `row_id` ASC LIMIT 200;'
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(page generated 2023-06-13 23:00 UTC)