I wrote Hacking Healthcare for O'Reilly and I've spent the bulk of my career as a CEO and senior executive operating large health systems. It is a meaningful step forward to have most of this data in the public sphere but I think it is still early and that a lot of work has to continue to shape and analyze this information in a way that is more meaningful and practical for patients.<p>Appreciate the complexity of billing codes, these are not created by hospitals but by by the American Medical Association, Center for Medicaid/Medicare and a soup of other organizations. There are tens of thousands of procedure and drug codes (things that are done or given) and tens of thousands of diagnostic codes (reasons justifying the procedure), creating a space well into the quadrillions of possible routine combinations. That's a large restaurant menu.<p>There are a number of other comments comparing hospital pricing to retail type interactions. It is also important to consider that hospital interactions involve unexpected and unknown things that aren't easily captured in a pricing context before you get there.<p>From an instution standpoint there are some bad apples but a lot of organizations that are not complying are not complying because they are facing technology and operational issues that are stopping them from complying. From the trenches in my consulting practice one example is an institution whose has a core element of their billing system, that is largely a black box even to them, using technologies that are decades old. Why would someone continue to rely on that? Because it has direct integration with critical partners and counterparties that was set up decades ago and that continues to work.<p>Replacing it is underway but is costing 8 figures and taking years. The potential fines are small relative to that and there isn't much they can do to comply in the immediate term anyway.<p>For context understand that Medicare billing routinely involved actual physical dial-up modems somewhere in the chain (even if it was invisible to you) until late 2018.
I hope this succeeds. My daughter was born with many medical issues and understanding the billing was always near impossible. Nothing could be gleaned from the bills which would arrive 6 months to a year later (sometimes 2 years) from the insurance company. In what world can I not know the price of something before hand? If I go to a restaurant and see hamburgers cost 6000$, I wouldn't buy one. But with medical it is always a surprise.
Great idea!<p>I'm working on something similar, digitising my daughter's 213 pages of medical bills by building an app specifically for digitising printed medical bills. <a href="https://kingsley.sh/posts/2022/digitising-213-pages-of-medical-bills" rel="nofollow">https://kingsley.sh/posts/2022/digitising-213-pages-of-medic...</a><p>Everyone kept saying "make sure to check your statements", but when the statements came, they're 9pt font, 50-70 line items per page. 1 page, yes, 10, maybe, 213 is impossible.<p>In the middle of working on it last week, I got a $3000 medical bill, for my daughter who passed away 1.5+ years ago, for part of her 7 month ICU stay 2+ years ago.
I would suggest to now compare the prices for standard procedures in the US to the GOÄ[0,1], which is the German central medical fee list for anything medical as agreed between doctors and insurance companies.<p>Hilarity will ensue, since US pricing is an unbelievable rip-off.<p>Edit: In addition to procedures, there is a list for fixed drug cost [2]. The site hosts a PDF with pricing for any drug.<p>[0]<a href="https://de.wikipedia.org/wiki/Gebührenordnung_für_Ärzte" rel="nofollow">https://de.wikipedia.org/wiki/Gebührenordnung_für_Ärzte</a><p>[1]<a href="https://www.ottonova.de/en/expat-guide/health-wiki/medical-fee-schedule-goae" rel="nofollow">https://www.ottonova.de/en/expat-guide/health-wiki/medical-f...</a><p>[2]<a href="https://www.bfarm.de/EN/Medicinal-products/Information-on-medicinal-products/Reference-Pricing/_node.html" rel="nofollow">https://www.bfarm.de/EN/Medicinal-products/Information-on-me...</a>
The reality of is that for profit insurance companies want an opaque and high pricing structure. This allows them to charge higher premiums across their entire set of customers meanwhile the number of people that are getting seriously sick or injured is small allowing them to create huge profits.<p>So these higher prices, create higher premiums, which create higher profit, so there is no actual incentive for the insurance companies to get hospital prices down because the majority of their insured users are not going to be getting massive bills throughout the year and also they can still litigate or pass healthcare costs back to the customer due to coverage issues and let's not forget deductibles.
Just like the problems with pay transparency / publishing in job listings, what good is the publishing of hospital costs, if they inflate the rack rate prices to handle people who walk in without insurance, but discount everyone else to the Medicare rates? It doesn't give you any real comparable reference point between hospitals, does it?<p>As an example, you get a bill for $100k for a one-night hospital visit for an emergency, but it gets knocked down to $15,000 at Medicare reimbursement rates, and then you only pay $1,000. Which price should be shown? It is any use to show the $100k figure?<p>Or am I missing something that has changed? I mean, I'm all for these efforts but if there is no consistency / meaning behind the numbers being used, it's no good.
Tangentially related, Russ Roberts of econtalk had a good interview a few years ago with the founder of a free market hospital in Oklahoma. Super interesting.<p><a href="https://www.econtalk.org/keith-smith-on-free-market-health-care/" rel="nofollow">https://www.econtalk.org/keith-smith-on-free-market-health-c...</a>
Direct link to the hospital price database > <a href="https://www.dolthub.com/repositories/onefact/paylesshealth" rel="nofollow">https://www.dolthub.com/repositories/onefact/paylesshealth</a>
Thank you for doing this. It's good to know that this information is publicly available. I was not aware of the 2019 legislation and it would be helpful to know what the name of the law is.<p>I went to urgent care back in 2021 to have a few different tests run, pretty standard stuff. I asked for a price quote and they refused to give it to me. There is no other industry where sleazy practices like this are accepted.
My first job out of college was creating long term facility software, like Epic if you're familiar with that world.<p>After my second or third major project to support ICD-10 codes, I knew this was an industry I really didn't want to create software for, but also that it was an industry that definitely could use some quality solutions.
This law was insanely helpful for my wife as she tried to establish pricing for her own small business. Going from a drone to your own boss, it's hard to wrap your head around how much more you should be charging. It's a lot. Like, multiples.
This seems very cool.<p>But, at the risk of seeming extra dumb: is there a way to contribute to this project for people who don't know how to work with SQL?
This is cool and, I believe, a necessary step.<p>I know that some hospital price data has been previously available for years on govt websites listed by billing code. You could, for example, see the price differential between getting a procedure done in Alabama vs. Oregon. This article states that hospital data was only available after 2019. Is the distinction that the previous data was only based on Medicare/Medicaid reimbursements? Or that they weren't itemized lists?
Now what is needed to get data on outcomes as well? I would likely choose to pay more for a increased chance of success. (Recall the recent coverage in HN of the professional musician for whom retaining ability to play saxophone was of great importance.) I recognize that some hospitals either serve more impaired populations or take on more high risk cases, so the comparison is not at all easy.
I hope this succeeds.<p>A single MRI can take up to 200 gb of storage space. The health system has about 7.5 petabytes of data in storage arrays alone, all of which is active and separate from backups.<p>About one petabyte of that data is unstructured (which includes MRIs and other imaging data), and that’s the type of data that’s growing quickest.<p>This is being done on purpose to obfuscate the pricing scheme. A shame on the industry. I have hope that, together, we can succeed and crack this.<p>[1] <a href="https://www.itprotoday.com/file-storage-and-block-storage/how-healthcare-giant-uses-data-storage-tiers-pbs-data" rel="nofollow">https://www.itprotoday.com/file-storage-and-block-storage/ho...</a><p>* not sure how reliable this one source is, there isn't much information out there to verify against.
"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community"
I've gotten hospital bills and other medical bills with a date and a dollar amount, but never to details. With all the other health care regulations, how is that legal?<p>The system favors the insurance companies and the healthcare providers, but puts its thumb on the scale for anyone else. And that system is slow to change for exactly that reason. That is, the status quo is quite happy printing money. Anyone else? Not so happy.<p>If only health care was about health and care.
While I'm sure the transparency is a good idea, I'm guessing is only important because US hospitals mostly charge individuals rather than health insurance providers / healthcare provider organizations ("sick funds") - and thus people are surprised by exorbitant fees and hospitals have a motivation to overcharge, rather than the fees being negotiated and agreed in bulk.
Is it possible you've already been beat to the punch here? Seems this site actually has pricing data:<p><a href="https://www.ahd.com/free_profile/010001/Southeast_Health_Medical_Center/Dothan/Alabama/" rel="nofollow">https://www.ahd.com/free_profile/010001/Southeast_Health_Med...</a>
How were you able to do this if billing codes are copyrighted? Where did you get all of the billing codes? Also, isn't this pointless as the final pricing is highly dependent upon one's insurance policy? Also, the price differs if you pay cash versus with insurance.
It sounds like a lot of people are encouraged by this work. I’m taken aback by the name, though. I looked around their site and couldn’t find an explanation.
Why is AI necessarily for this?<p>> One Fact to feed these files into their artificial intelligence pipeline and figure out how much hospitals charge for different procedures