Washington State has had that for a decade or more. It's not hard to find the data for many other states.
- It may still prove to be confusing to consumers, since standard rates are like list prices and don’t reflect what insurers and government programs pay.
That's straight bullshit and PBS should feel bad. If an insurer pays less than the fee schedule they're guilty of fraud and will get kicked off the medicare provider roster. We take six different kinds of medicare plans and they all pay the fee schedule to the penny. You bill as if it's medicare, you get paid as if it's medicare.
For many of the services the rates aren't great (for many of the services the rates are less than the cost of providing the services) but if we could just get a reasonable-profit fee schedule for everything we do we'd be done.
We'd also be able to discontinue two different contractors who pickaxe fees out of insurance companies on a percentage basis.
Wait, maybe I'm not understanding your claim correctly, but insurance companies and government medical programs regularly negotiate prices that are different and often much lower than the listed price. And I have yet to see any major medical procedures or items that weren't being sold at a profit, or, if they weren't being sold at a profit to the public, they were being subsidized by the government to make up for the discrepancy. Can you please direct me toward information that says otherwise? Or are you talking about something else?
- but insurance companies and government medical programs regularly negotiate prices that are different and often much lower than the listed price.
No. Medicare schedules are protected by law. If Medicare has a price, that is the Medicare price. If you are contracted with Medicare, that's the price you get. Full stop.
- And I have yet to see any major medical procedures or items that weren't being sold at a profit,
Well, clearly. In the United States, medicine is a for-profit industry. Medical providers are not public employees. Profits provide wages provide living expenses allow for there to be medicine.
- Can you please direct me toward information that says otherwise? Or are you talking about something else?
You're replying to a comment with two links in it. Both of those links are to fee schedules. From the first link, here's an XLS of the fee schedule for hospice care in Washington State. That's what Washington State pays for hospice care. To everyone. Sunrise, sunset. Per county.
Hi. Nice to meet you. Welcome to Hubski. We aren't Reddit. Allow me to direct you to a part of my statement:
- We take six different kinds of medicare plans and they all pay the fee schedule to the penny. You bill as if it's medicare, you get paid as if it's medicare.
When you call someone's personal testimony into question, and demand evidence to back them up, you are calling that person a liar. When you call that person a liar without bothering to click on the links they provided, you're indicating that you don't think enough of them to observe their evidence before you call them a liar.
And it makes them cranky.
Now - did you mean to make me cranky? Or are you just acting as if you're on Reddit?
Because in either case, kindly desist.
I see what you are saying, and it is correct at that level, but I think you have confused the listed price they are talking about with the Medicare/Medicaid schedules. They are being required to list the prices they actually charge at a hospital level, in an online format, not what Medicare is willing to pay out for patients (which may or may not be fully covered or relevant to patients covered by other insurers). The fee schedule IS the negotiated lower price and represents what they will pay out for a specific service. Those with other insurance plans, or no insurance at all, are often charged a different rate, that rate is the often listed price they are talking about or the insurance companies negotiated price.
Also, asking for evidence isn't calling someone a liar, it's just that, asking for evidence to support their claim. Especially if the other parties understand the situation differently.
And thanks for welcoming me to Hubski.
You're in that ugly place where you don't know what you don't know, and you're lecturing someone who does. Once more with feeling: those listed prices are what my medical facility - the one I built, the one my wife runs - is allowed to claim for Medicare patients. They were negotiated by our trade organization working in concert with the state. They are the official contracted prices that all Medicare assignees must pay. This is why they are publicly available. Yes. It is the "negotiated lower price" and is "what they will pay out for a specific service." "Those with other insurance plans, or no insurance at all, ARE NOT ON MEDICARE. They are not relevant to this discussion. For any given ICD10 code we are contracted to be paid about twelve different prices depending on the insurance provider... but five of those insurance providers are Medicaid and they all pay the same. They all pay the agreed, published rate.
Let's back up a minute: you're speaking in abstracts. I'm speaking in concretes. Those rates put food on my family. They pay for my kid to go to gymnastics. They are things I know, live and breathe, not things I've thought about once or twice to win an Internet argument. So when you tell me I'm wrong, when you imply that I don't have my facts straight, when you demand to see proof, you are calling me a liar. You may not think you're calling me a liar, but I'm here to tell you: you're calling me a liar. You're insulting me. If you didn't mean to insult me, you need to ask the question differently. But then, if you're asking for evidence directly underneath a statement linking to two forms of evidence, you shouldn't ask. The polite thing to do, by the way, would have been to apologize for missing those links and acknowledge they were there all along.
The polite thing to do now would be to apologize.
"Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday." - From the article.
As someone who has handled medical payments, the rate differentiation is extremely wide between what the standard pricing is and what Medicare recipients and others pay. And the article is about all patients and standard rates, not just Medicare recipients. Medicare is just pushing for more transparency industry wide to help people make more informed decisions.
It sounds like you and your wife have built and run an exceptional institution that is very morally and ethically centered, especially to insist on standardized pricing, but I know from experience that this isn't the norm in the United States. I'm glad that people like you are out there to do it.
It's a good thing, but it isn't going to do much. People can only comparison-shop if a) they know what they are looking for b) it's non-emergency and c) there are multiple facilities nearby.
This seems like a good idea for consumer welfare. It might encourage competition at the margins between hospitals and bring down prices somewhat.