Ещё раз о стоимости медицины
Mar. 25th, 2025 12:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ny_quantСлучайно нашел незакрытую вкладку на заметку в НЙТ. На всякий случай скопирую целиком.
Thank goodness for urgent care centers. Last July my daughter was still limping a week after a bike injury, and we needed a quick X-ray to rule out a fracture. As a doctor, I knew we didn’t need an expensive emergency room for something this straightforward. We found an urgent care at the end of a strip mall in Chicago, and 20 minutes later we received the good news that there was only a sprain.
As the three employees closed up shop for the day, I reflected on how urgent-care centers filled a perfect niche between the overkill of an emergency room and the near impossibility of snagging an immediate orthopedic appointment.
But this is health care in America, and nothing ever closes up tidily. Two weeks later a bill arrived: The radiology charge from NorthShore University HealthSystem for the ankle and wrist X-rays was $1,168, a price that seemed way out of range for something that usually costs around $100 for each X-ray. When I examined the bill more closely, I saw that the radiology portion came not from the urgent care center but from a hospital, so we were billed for hospital-based X-rays. When I inquired about the bill, I was told that the center was hospital-affiliated and as such, is allowed to charge hospital prices.
It turns out that I’d stumbled into a lucrative corner of the health care market called hospital outpatient departments, or HOPDs. They do some of the same outpatient care — colonoscopies, X-rays, medication injections — just as doctors’ offices and clinics do. But because they are considered part of a hospital, they get to charge hospital-level prices for these outpatient procedures, even though the patients aren’t as sick as inpatients. Since these facilities don’t necessarily look like hospitals, patients can be easily deceived and end up with hefty financial surprises. I’m a doctor who works in a hospital every day, and I was fooled.
As of 2022, federal law protects patients from surprise bills if they are unknowingly treated by out-of-network doctors. But there is no federal protection for patients who are unknowingly treated in higher-priced hospital affiliates that look like normal doctors’ offices or urgent care clinics. Federal regulations are needed, at the very least, to require facilities to be upfront with their pricing scheme — and more ideally, to eliminate this price differential entirely. Otherwise patients
One study of pricing revealed that HOPDs charged an average of $1,383 for a colonoscopy, compared with the $625 average price at a doctor’s office or other non-HOPD settings. A knee M.R.I. averaged $900, compared with $600. Chemotherapy and other medications cost twice as much. Echocardiograms command up to three times as much. Much of these costs comes from tacked-on facility fees, which are rising far faster than other medical costs.
The American Hospital Association justifies these costs by arguing that patients seen in HOPDs are sicker than other outpatients. But that doesn’t typically make the procedures performed at these facilities any more complicated; an outpatient echocardiogram, for instance, is basically the same no matter who it’s for. If a patient’s illness does render a procedure more complicated, there are legitimate ways to account and bill for that.
Last December the health insurer Blue Cross Blue Shield released findings that HOPDs charged far more than doctors’ offices for certain procedures. (Prostate biopsies, for example, cost over six times as much.) HOPDs turn out to be an attractive business plan for hospitals that are aggressively acquiring doctors’ practices. When these acquisitions occur, prices often rise as patients are now seen in “hospital facilities.”
It’s difficult to quantify how many patients find themselves unknowingly getting higher-price care at HOPDs as we did. But news outlets have reported frustrations suffered by some patients receiving hospital-cost charges after a visit to walk-in care centers. There are also stories on Reddit and other platforms about new — and steep — facility fees at doctors’ offices appearing on medical bills and often not covered by insurance. One patient’s bill went up 10-fold for the same procedure after her doctor’s practice changed its classification of her appointment to a hospital-based designation. Another study of outpatient surgical procedures found an increase of more than 50 percent in facility fees over the course of six years, resulting in much higher out-of-pocket expenses for patients. Most patients find out only weeks later when the bill arrives.
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There’s a movement afoot to make so-called site-neutral payments the law, meaning that Medicare would pay doctors the same price for an outpatient procedure like an endoscopy, no matter what type of outpatient setting it’s performed in. Though at least 16 states have passed laws requiring transparency about facility fees, headwinds are still stiff. Congress inserted a site-neutral payment rule into the Bipartisan Budget Act of 2015, but ferocious lobbying from the hospital industry exempted nearly all existing HOPDs. The American Hospital Association vehemently opposes any legislation that equalizes HOPD payments or eliminates facility fees.
The House recently passed the Lower Costs, More Transparency Act, which would enforce site-neutral payments for one narrow slice of health care — physician-administered medications. The Senate has yet to take up any such legislation.
I was so livid about being charged hospital rates for two simple X-rays that I filed a formal complaint with the Illinois attorney general’s office, which concluded that the billing was legal under federal law. When I asked for on-the-record comments about my contention that the charges seemed excessive and that the system felt deceptive, a representative for NorthShore University HealthSystem (now Endeavor Health) offered only a general statement that read, in part: “We understand that navigating the health care landscape, including billing, can be complex.”
It’s time for Congress to protect patients from both unfair pricing schemes and health care deception. MedPAC, the nonpartisan Medicare Payment Advisory Commission, recently recommended to Congress a basic set of site-neutral policies. It would apply site-neutral payments to a handful of low-risk procedures — some imaging, medication injections, simple office procedures — and this would apply to all HOPDs.
After six months of fighting the cost, the hospital quietly canceled our bill. I’m sure it calculated that this was the simplest way to get rid of a pesky patient — but that wasn’t what I was after. I wanted to untangle this loophole that catches patients unaware and saddles them with exorbitant bills. Congress should tune out hospital lobbying and enact these common-sense measures to protect patients.
Thank goodness for urgent care centers. Last July my daughter was still limping a week after a bike injury, and we needed a quick X-ray to rule out a fracture. As a doctor, I knew we didn’t need an expensive emergency room for something this straightforward. We found an urgent care at the end of a strip mall in Chicago, and 20 minutes later we received the good news that there was only a sprain.
As the three employees closed up shop for the day, I reflected on how urgent-care centers filled a perfect niche between the overkill of an emergency room and the near impossibility of snagging an immediate orthopedic appointment.
But this is health care in America, and nothing ever closes up tidily. Two weeks later a bill arrived: The radiology charge from NorthShore University HealthSystem for the ankle and wrist X-rays was $1,168, a price that seemed way out of range for something that usually costs around $100 for each X-ray. When I examined the bill more closely, I saw that the radiology portion came not from the urgent care center but from a hospital, so we were billed for hospital-based X-rays. When I inquired about the bill, I was told that the center was hospital-affiliated and as such, is allowed to charge hospital prices.
It turns out that I’d stumbled into a lucrative corner of the health care market called hospital outpatient departments, or HOPDs. They do some of the same outpatient care — colonoscopies, X-rays, medication injections — just as doctors’ offices and clinics do. But because they are considered part of a hospital, they get to charge hospital-level prices for these outpatient procedures, even though the patients aren’t as sick as inpatients. Since these facilities don’t necessarily look like hospitals, patients can be easily deceived and end up with hefty financial surprises. I’m a doctor who works in a hospital every day, and I was fooled.
As of 2022, federal law protects patients from surprise bills if they are unknowingly treated by out-of-network doctors. But there is no federal protection for patients who are unknowingly treated in higher-priced hospital affiliates that look like normal doctors’ offices or urgent care clinics. Federal regulations are needed, at the very least, to require facilities to be upfront with their pricing scheme — and more ideally, to eliminate this price differential entirely. Otherwise patients
One study of pricing revealed that HOPDs charged an average of $1,383 for a colonoscopy, compared with the $625 average price at a doctor’s office or other non-HOPD settings. A knee M.R.I. averaged $900, compared with $600. Chemotherapy and other medications cost twice as much. Echocardiograms command up to three times as much. Much of these costs comes from tacked-on facility fees, which are rising far faster than other medical costs.
The American Hospital Association justifies these costs by arguing that patients seen in HOPDs are sicker than other outpatients. But that doesn’t typically make the procedures performed at these facilities any more complicated; an outpatient echocardiogram, for instance, is basically the same no matter who it’s for. If a patient’s illness does render a procedure more complicated, there are legitimate ways to account and bill for that.
Last December the health insurer Blue Cross Blue Shield released findings that HOPDs charged far more than doctors’ offices for certain procedures. (Prostate biopsies, for example, cost over six times as much.) HOPDs turn out to be an attractive business plan for hospitals that are aggressively acquiring doctors’ practices. When these acquisitions occur, prices often rise as patients are now seen in “hospital facilities.”
It’s difficult to quantify how many patients find themselves unknowingly getting higher-price care at HOPDs as we did. But news outlets have reported frustrations suffered by some patients receiving hospital-cost charges after a visit to walk-in care centers. There are also stories on Reddit and other platforms about new — and steep — facility fees at doctors’ offices appearing on medical bills and often not covered by insurance. One patient’s bill went up 10-fold for the same procedure after her doctor’s practice changed its classification of her appointment to a hospital-based designation. Another study of outpatient surgical procedures found an increase of more than 50 percent in facility fees over the course of six years, resulting in much higher out-of-pocket expenses for patients. Most patients find out only weeks later when the bill arrives.
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There’s a movement afoot to make so-called site-neutral payments the law, meaning that Medicare would pay doctors the same price for an outpatient procedure like an endoscopy, no matter what type of outpatient setting it’s performed in. Though at least 16 states have passed laws requiring transparency about facility fees, headwinds are still stiff. Congress inserted a site-neutral payment rule into the Bipartisan Budget Act of 2015, but ferocious lobbying from the hospital industry exempted nearly all existing HOPDs. The American Hospital Association vehemently opposes any legislation that equalizes HOPD payments or eliminates facility fees.
The House recently passed the Lower Costs, More Transparency Act, which would enforce site-neutral payments for one narrow slice of health care — physician-administered medications. The Senate has yet to take up any such legislation.
I was so livid about being charged hospital rates for two simple X-rays that I filed a formal complaint with the Illinois attorney general’s office, which concluded that the billing was legal under federal law. When I asked for on-the-record comments about my contention that the charges seemed excessive and that the system felt deceptive, a representative for NorthShore University HealthSystem (now Endeavor Health) offered only a general statement that read, in part: “We understand that navigating the health care landscape, including billing, can be complex.”
It’s time for Congress to protect patients from both unfair pricing schemes and health care deception. MedPAC, the nonpartisan Medicare Payment Advisory Commission, recently recommended to Congress a basic set of site-neutral policies. It would apply site-neutral payments to a handful of low-risk procedures — some imaging, medication injections, simple office procedures — and this would apply to all HOPDs.
After six months of fighting the cost, the hospital quietly canceled our bill. I’m sure it calculated that this was the simplest way to get rid of a pesky patient — but that wasn’t what I was after. I wanted to untangle this loophole that catches patients unaware and saddles them with exorbitant bills. Congress should tune out hospital lobbying and enact these common-sense measures to protect patients.
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no subject
Date: 2025-03-25 05:18 pm (UTC)no subject
Date: 2025-03-25 05:32 pm (UTC)В прошлом году, мне назначили какой-то тест, кажется сонограмму живота. В принципе, страховка показывает цены на своем сайте, но в данном случае не показала. Позвонил провайдерам, они мне сказали, что точной цены назвать не могут. Наученный горьким опытом в прошлом, позвонил в страховку и попросил их позвонить от моего имени. Им тоже не сказали. Написал жалобы - никто не ответил. В итоге плюнул и пошел в темную (у провайдера хорошая репутация) и действительно всё обошлось в пределах разумного. Но могли и вздуть.
Но в принципе я согласен, конечно должна быть maximum possible disclosure and price transparency.
no subject
Date: 2025-03-25 06:55 pm (UTC)no subject
Date: 2025-03-26 07:56 am (UTC)no subject
Date: 2025-03-26 02:17 pm (UTC)no subject
Date: 2025-03-27 01:13 am (UTC)а если у него нет страховки? может он отказаться платить постфактум?
no subject
Date: 2025-03-27 01:40 am (UTC)no subject
Date: 2025-03-27 01:44 am (UTC)no subject
Date: 2025-03-25 07:20 pm (UTC)Очень странно читать про госпитального врача, случайно узнавшего про существование hospital outpatient departments. Я понимаю, что страна большая и бывает всякое, но вокруг меня, например, все известные мне outpatient radiologies прикреплены к одному из множеств местных госпиталей. И я себе с трудом могу представить существующую в наши дни частную медицинскую практику со своим CT Scan, ultrasound, X-ray, etc., которая может потянуть расходы на содержание этого всего без поддержки госпиталя. В 90е, емнип, такое еще было, но их уже всех, кмк, скупили на корню.
no subject
Date: 2025-03-25 07:25 pm (UTC)no subject
Date: 2025-03-25 07:51 pm (UTC)Да, согласен, но мне кажется их все равно ставят в такие условия, что они вынуждены примкнуть к кому-то. Это вообще общий тренд сейчас, по-моему, ближайший к нам госпиталь был последний из могикан в нашем районе, независимый со дня открытия 100 лет назад, а с 1 апреля становится частью Penn Medicine.
no subject
Date: 2025-03-25 08:04 pm (UTC)Хотя, может он удивился, что подобное существует внутри Urgent Care? Тогда я неправ. Ближайший ко мне офис Urgent Care пишет, что у них рентген (up to 2 views) стоит $75.
no subject
Date: 2025-03-25 07:59 pm (UTC)no subject
Date: 2025-03-26 07:26 am (UTC)А в чем там расходы? У нас множество Radiology по городу Брисбен раскидано, ultrasound уж точно можно где угодно делать. Да и рентген сейчас у каждого стоматолога. У нас я видел интересную идею внутреннего разделения точек в одной сети — в каких-то амбарах вам сделают очень базовые тесты, а где-то оно будет интегрировано в госпиталь. И соответственно, когда вы с ними связываетесь в зависимости от процедуры будут предоставлять разные локации.
no subject
Date: 2025-03-26 02:29 pm (UTC)Это просто мои догадки, но мне кажется, что у такого бизнеса очень большие overhead expenses. Дорогое оборудование, дорогие работники.
no subject
Date: 2025-03-26 02:42 pm (UTC)Работники там медсестры, рентген снимать полноценный врач не нужен. Оборудование на фоне зарплат недорогое. Всякие простые рентгены и ультрасаунды делают уже давным давно, ноу хау не надо. Есть поток пациентов — те же узи для беременных и травмы. Основное объяснение почему оно не доступно — регулирование или нечестная конкуренция.
no subject
Date: 2025-03-26 04:05 pm (UTC)Нет, не медсестры, а radiology techs, со средней зарплатой ~$96K, у ultrasound techs чуть меньше, но если у них специализация, типа obstetric sonographer, то и побольше будет, ~$110K. Естественно к этой зарплате прилагаются медицина, отпуска, итд, итп. Медсестры, кстати, у нас тоже совсем не дешевые, у моей младшей в госпитале зарплата $52 в час, $87 за овертаймы, плюс надбавки за работу по выходным, праздникам, плюс все бенефиты и 36-часовая рабочая неделя. И это она работает первый год после университета, через несколько месяцев будет еще больше.
no subject
Date: 2025-03-26 11:25 pm (UTC)>>> The radiology charge from NorthShore University HealthSystem for the ankle and wrist X-rays was $1,168, a price that seemed way out of range for something that usually costs around $100 for each X-ray.
>>> One study of pricing revealed that HOPDs charged an average of $1,383 for a colonoscopy, compared with the $625 average price at a doctor’s office or other non-HOPD settings. A knee M.R.I. averaged $900, compared with $600.
Не совсем понятно, что автор имеет в виду, doctor's bill или конечную стоимость для пациента, но если первое, то это настолько сильно отличается от реальности, с которой я знаком, что напоминает старый анекдот "хочу в СССР".
X-rays за $100? MRIs, которые стоят меньше, чем четырехзначные суммы? Colonoscopy за полторы тысячи? Colonoscopy bill, который я видел недавно, был 8 с лишним тысяч. Паршивую эхокардиограмму оценили в $2,700. Ну, и так далее.
Где та чудесная небесная Америка, в которой обитает автор, и как туда попасть? Альтернатива: наверное, я как-то неправильно живу.
Всякий раз, когда комментаторы ругают страховые компании и радуются отстрелу insurance executives, у меня возникает вопрос: а стоимость медицины вас не смущает?
no subject
Date: 2025-03-27 01:17 am (UTC)Как неоднократная жертва колоноскопии, могу подтвердить, что она мне стоила меньше $1,000 каждый раз.
X-rays за $100 вполне соответствует ощущениям. Иногда больше, иногда меньше, но порядок правильный.
Короче, у вас какие-то секулярные проблемы.
no subject
Date: 2025-03-27 01:30 am (UTC)>>> Как неоднократная жертва колоноскопии, могу подтвердить, что она мне стоила меньше $1,000 каждый раз.
"Она мне стоила" - Вы платили? Или doctor's bill? Насчет рентгенов имею такой же самый вопрос.
>>> Короче, у вас какие-то секулярные проблемы.
Напомните, пожалуйста, что нынче означает русское слово "секулярный"? Это не то же самое, что secular, да?
Я уже понял, что неправильно живу, теперь осталось понять, как именно.
no subject
Date: 2025-03-27 01:38 am (UTC)Оффис привычно выставляет счет на много тысяч, но они в контракте со страховкой, которая тут же обрезает счет до $800, который я плачу из кармана, т.к. у меня high deductible plan. Т.е. роль страховки в тут сводится только к ограничению цен, что как по мне очень неплохо.
То же касается и всех остальных видов мед. услуг, но особенно тестов, где нашего брата стараются вздуть по самые гланды.
Это то же самое, что secular, но не в религиозном смысле. Означает - локализованные в вашем подпространстве.
Как жить - найти хорошую страховку. Только не спрашивайте как.
no subject
Date: 2025-03-27 01:43 am (UTC)no subject
Date: 2025-03-27 04:35 am (UTC)Так-то оно понятно, у меня тоже high deductible plan (хуже, чем у Вас, btw), поэтому плачу по милости страховой компании. И благодарен, что они не дают врачам требовать полной оплаты по их странным непонятным для простого человека расценкам.
no subject
Date: 2025-03-27 02:07 pm (UTC)Все же, по сравнению с 108К из предыдущей записи, даже официальные цены на колоноскопию довольно скромные.
no subject
Date: 2025-03-27 10:24 pm (UTC)Понятно, что оно интересует больше, но интересны и потенциальные риски. И тут схема — счет зависит от того как страховая решила договорится с госпиталем выглядит офигенно ненадежной.
no subject
Date: 2025-03-27 11:01 pm (UTC)no subject
Date: 2025-03-27 11:29 pm (UTC)Проблема не в том, что цену нельзя узнать. Проблема в том, что нельзя легко узнать рыночную цену. Ведь между врачом/госпиталем и страховой свои непрозрачные отношения и вопрос, и ответить на простой вопрос "а сколько рыночная цена cнимка x-ray" довольно нелегко.
Ценообразование сделано максимально непрозрачным. Так обычно мошенники работают:)
no subject
Date: 2025-03-28 01:36 am (UTC)Indeed.
no subject
Date: 2025-03-28 01:25 pm (UTC)Тем не менее, я могу пойти на сайт своей страховки, и сделать поиск на назавание интересующей меня процедуры. Мне покажут всех провайдеров в заданном радиусе и их цены. Это м.б. не настоящая рыночная цена, но это она в доступной мне части рынка.
no subject
Date: 2025-03-28 01:40 pm (UTC)А цена будет индивидуально для вас или для всех пользующихся услугами этой страховой. И могу ли я не имеющий ни одной страховки и выбирающий из них посмотреть какие будут цены в разных случаях?
no subject
Date: 2025-03-28 02:19 pm (UTC)Если кто-то не поленится сделать для вас какой-то web-crawling tool, то и вы смогли бы - при условии прозрачности цен, которой нет. Такие существуют для рынков life insurance and travel insurance. Для health insurance такого, видимо, нет т.к. провайдеры не обязаны вывешивать цены для всеобщего ознакомления. Если вы клиент страховки, с которой у провайдера контракт, то обычно можно узнать, но и то не всегда.
Тем не менее, сдвиги есть. Некоторые вывешивают цены хоть и не обязаны, как показал г-н полковник.
no subject
Date: 2025-03-28 01:25 am (UTC)no subject
Date: 2025-03-27 06:08 pm (UTC)***Где та чудесная небесная Америка, в которой обитает автор, и как туда попасть?***
Да вот же она (https://www.afcurgentcare.com/conshohocken/resources/no-insurance-self-pay-pricing/). :)
no subject
Date: 2025-03-28 01:38 am (UTC)Не обманул, значит, доктор из NY Times.
no subject
Date: 2025-03-28 01:46 am (UTC)Я тоже удивился таким низким ценам, потому что держать в штате radiology tech недешево. Но если на них возлагают и другие функции, типа, patient intake, то может и ничего.
no subject
Date: 2025-03-29 03:51 am (UTC)no subject
Date: 2025-03-29 07:24 pm (UTC)no subject
Date: 2025-03-29 08:34 pm (UTC)no subject
Date: 2025-03-29 09:10 pm (UTC)no subject
Date: 2025-03-30 12:31 am (UTC)Бывает и интереснее, у друзей сын на двух страховках был и они в некий момент обе заявили, что они secondary и поэтому платить за дорогое лечение не будут. В итоге из кармана выложили десятку, потому что лечились у врача с индивидуальной практикой, тут не забалуешь, ну и вообще неудобно.