PRICES

[RickyScott]

You can now look up charges at your local hospital. Good luck understanding them.

Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them.

Anyone looking up the costs for radiation?

MDACC charge lists: Price Transparency are they charging 7000$ for managment? numbers 890+ on spreadsheet
number 77371 (925 on spreadsheet) 54,000$ does that seem excessive?

I know these are not what they negotiate with insurance companies, but we are starting to see who is choosing wisely.


904 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77014 CT scan guidance for insertion of radiation therapy fields $591
905 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77280 Management of radiation therapy simulation, simple $932
906 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77285 Management of radiation therapy, simulation, intermediate $1,442
907 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77290 Management of radiation therapy, simulation, complex $1,900
908 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77293 Respiratory motion management simulation $917
909 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77295 Management of radiation therapy, 3D $4,576
910 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77300 Calculation of radiation therapy dose $679
911 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77301 Management of modulation radiotherapy planning $7,376
912 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77306 Radiation therapy plan $3,304
913 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77307 Radiation therapy plan $2,950
914 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77316 Radiation therapy plan $1,842
915 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77317 Radiation therapy plan $2,667
916 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77318 Radiation therapy plan $3,341
917 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77321 Radiation therapy total body port plan $1,177
918 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77331 Special radiation therapy planning $785
919 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77332 Radiation treatment devices, design and construction, simple $489
920 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77333 Radiation treatment devices, design and construction, intermediate $740
921 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77334 Radiation treatment devices, design and construction, complex $950
922 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77336 Radiation therapy consultation per week $647
923 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77338 Design and construction of device for radiation therapy $3,888
924 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77370 Radiation therapy consultation $1,115
925 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77371 Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session $54,723
926 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77373 Stereotactic body radiation therapy 1 or more lesions using imaging guidance $14,779
927 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77385 Radiation therapy delivery $2,168
928 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77386 Radiation therapy delivery $2,168
929 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77387 Guidance for localization of target delivery of radiation treatment $372
930 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77401 Radiation treatment delivery, superficial $471
931 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77402 Radiation treatment delivery $637
932 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77407 Radiation treatment delivery $678
933 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77412 Radiation treatment delivery $963
934 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77417 Therapeutic radiology port films $228
935 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77470 Special radiation treatment procedure $2,605
936 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77770 High dose brachytherapy , 1 channel $4,982
937 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77771 High dose brachytherapy , 2- 12 channels $6,348
938 RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - RADIATION THERAPY 77772 High dose brachytherapy , more than 12 channels $7,129

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[domestique]

These should be so called "chargemaster" prices so they are maximums. As you said, they do not reflect negotiated prices but are rather the starting point of such negotiations. Nobody is getting anywhere close to these figures.

 

[RickyScott]

These should be so called "chargemaster" prices so they are maximums. As you said, they do not reflect negotiated prices but are rather the starting point of such negotiations. Nobody is getting anywhere close to these figures.

True, but there is enormous divergence depending on leverage. That is why the actual paid costs twice as much to treat a patient in Northern vs Southern California, following hospital consolidations. There is every reason to believe that places like MDACC and MSKCC have a lot of leverage.

California hospital giant Sutter Health faces heavy backlash on prices

 

[domestique]

Of course they do. It has been a race to consolidate on both sides of the transaction for a while now (payer and provider orgs) for this exact reason and it will continue. Obviously some states' attorneys general are more activist than others at trying to slow it all down but it's a losing battle. And investment bank M&A groups have been back slapping for a decade plus in this environment. Everybody gets paid except docs and of course patients/society take it in p****r in terms of price. It's a fairly straightforward situation.

 

[scarbrtj]

Thanks President Trump.

 

[Shufflin]

People blame Trump for any bureaucratic issues even that have nothing to do with him. Intelligent.

Or how people blame their parents for bad things, but take personal credit for good things.

Or blame God for tragedies but for good things not a second thought about God.

CMS helps determine these rates - CMS is comprised of fellow doctors. Blame them.

 

[RickyScott]

CMS helps determine these rates - CMS is comprised of fellow doctors. Blame them.

CMS rates are much less than these. Nothing to do with cms. These prices are set by the hospital, and depending how much leverage they have with the insurance company, the more they will recover.

 

[Shufflin]

CMS rates are much less than these. Nothing to do with cms. These prices are set by the hospital, and depending how much leverage they have with the insurance company, the more they will recover.

I mean that CMS sets the tone with Medicare rates, then hospitals respond however they wish but CMS sets the ballpark figures. But yes, I agree.

 

[scarbrtj]

People blame Trump for any bureaucratic issues even that have nothing to do with him. Intelligent.

Or how people blame their parents for bad things, but take personal credit for good things.

Or blame God for tragedies but for good things not a second thought about God.

CMS helps determine these rates - CMS is comprised of fellow doctors. Blame them.

I said "Thanks." I should have said "Honest to God, cross my heart, hope to die... Thanks President Trump."

 

[Shufflin]

I said "Thanks." I should have said "Honest to God, cross my heart, hope to die... Thanks President Trump."

Yes, that would have been marvelous.

 

[Mandelin Rain]

Biggest complaint about Affordable Care Act is that it did nothing to make care affordable.

 

[RickyScott]

unless you address prices, not going to make anything affordable, as far as I can tell. If your power or water company was pulling this kind of bs, none of us would accept it. Drug prices, which are an issue, but not as much as hospital costs, yet still the federal government is not allowed to negotiate prices.

Ultimately, I hope Trump and Congress pass legislation to mandate transparency for actual negotiated costs. I guarantee you that in radiation you will be sickened by what ASTRO instituitions are charging for hypofractionated treatments.

 

[Mandelin Rain]

unless you address prices, not going to make anything affordable, as far as I can tell.

Of course. That's what I was getting at.

 

[Gfunk6]

The entire apparatus of the US healthcare system - private insurance, executives, medical device companies, pharma/biotech, hospitals, healthcare lobbyists, researchers, physicians, physician extenders is predicated on high-cost care. It's what makes healthcare profitable with ever burgeoning prices and patient out of pocket unaffordability.

The system as it has evolved tries to wring out the maximum amount of revenue per patient and quality/safety are secondary concerns at best and then again only insofar as they relate to profit. With so many people and institutions getting fed from the teat (so to speak) there is no single process or maneuver that can produce meaningful change.

The entire system needs to be re-engineered from the ground up. It can be done but there will be a LOT of short-term pain which would likely cause an economic recession/depression in the name of long-term gain and sustainability. In our current political climate, that will not happen. I weep for future generations that will inherit this travesty.

EDIT: Kaiser has the right idea. They control the input (health insurance) and output (delivery of care). This heavily incentives them to focus on preventative care and limit expensive, futile care. They view hospitals as an expensive but necessary evil. Most non-Kaiser health care systems try to funnel all their work into hospitals to maximize profit.

 

[Mandelin Rain]

The entire apparatus of the US healthcare system - private insurance, executives, medical device companies, pharma/biotech, hospitals, healthcare lobbyists, researchers, physicians, physician extenders is predicated on high-cost care. It's what makes healthcare profitable with ever burgeoning prices and patient out of pocket unaffordability.

The system as it has evolved tries to wring out the maximum amount of revenue per patient and quality/safety are secondary concerns at best and then again only insofar as they relate to profit. With so many people and institutions getting fed from the teat (so to speak) there is no single process or maneuver that can produce meaningful change.

The entire system needs to be re-engineered from the ground up. It can be done but there will be a LOT of short-term pain which would likely cause an economic recession/depression in the name of long-term gain and sustainability. In our current political climate, that will not happen. I weep for future generations that will inherit this travesty.

EDIT: Kaiser has the right idea. They control the input (health insurance) and output (delivery of care). This heavily incentives them to focus on preventative care and limit expensive, futile care. They view hospitals as an expensive but necessary evil. Most non-Kaiser health care systems try to funnel all their work into hospitals to maximize profit.

I think we will start to see more and more (consolidated) large systems offer their own insurance products to compete at the local level with the large national players.

 

[Chartreuse Wombat]

I think we will start to see more and more (consolidated) large systems offer their own insurance products to compete at the local level with the large national players.

I await the Buffett/Bezos/Dimon plan with Gawande at the helm. As GFunk6 points out there are lots of stakeholders whose livelihoods depend on high prices

 

[RickyScott]

Obviously for our field, the issue is that prices are inextricably intertwined with fractionation. ASTRO has being pushing hypofractionation as a surrogate for lower prices/resource consumption, which it clearly is not when it comes to large health care systems.

 

[medgator]

Obviously for our field, the issue is that prices are inextricably intertwined with fractionation. ASTRO has being pushing hypofractionation as a surrogate for lower prices/resource consumption, which it clearly is not when it comes to large health care systems.

ASTRO has changed their tune on bundles, but AFAIK, still does not support site neutrality with respect to payment amount, which would actually bring down hospital pricing significantly.

And why should they? They don't represent the freestanding community at an executive level. They want their high priced hospital - based toys like protons and Mri Linacs, which can't be paid for with lower freestanding reimbursement rates

 

[OTN]

ASTRO does not support site neutrality for payment, which completely invalidates their opinion when it comes to cost-saving measures, resource utilization, choosing wisely, etc. Hypocrites.

 

[fiji128]

ASTRO does not support site neutrality for payment, which completely invalidates their opinion when it comes to cost-saving measures, resource utilization, choosing wisely, etc. Hypocrites.

True, true.

 

[RickyScott]

My favorite hypocrisy right now is "We deliver protons at IMRT rates?"

Here is site where you can access major apcs for what hospitals bill medicare to get a sense of where radiation falls as a hospital outpatient service

American Hospital Directory - Hospital of the University of Pennsylvania (390111) - Free Profile

 

[Phantom1]

...

EDIT: Kaiser has the right idea. They control the input (health insurance) and output (delivery of care). This heavily incentives them to focus on preventative care and limit expensive, futile care. They view hospitals as an expensive but necessary evil. Most non-Kaiser health care systems try to funnel all their work into hospitals to maximize profit.

I second the Kaiser heavy incentives for preventative care, this is so critical and hands down the most efficent and effective use of health care dollars. However one downside of that model is that advanced or complicated procedures are disincentivised. All things considered it is very likely that the benefits of increased preventative care outweigh the decreased use of advanced heroic procedures, certainly without question when related to elderly/end of life situations.

I still cannot fathom how in this country some families cannot accept that their parent or grandparent will eventually die. Just need more sensability and less sensationalization.

 

[medgator]

I second the Kaiser heavy incentives for preventative care, this is so critical and hands down the most efficent and effective use of health care dollars. However one downside of that model is that advanced or complicated procedures are disincentivised.

Yup it is a balance Kaiser was actually sued a couple of decades ago for trying to keep complicated transplants in house rather than appropriately referring out and incurring higher costs.

Kaiser To Pay $2M In Transplant Mess

Transition of Kaiser Kidney Transplant Patients to UCSF Begins

 

[DoctwoB]

The entire apparatus of the US healthcare system - private insurance, executives, medical device companies, pharma/biotech, hospitals, healthcare lobbyists, researchers, physicians, physician extenders is predicated on high-cost care. It's what makes healthcare profitable with ever burgeoning prices and patient out of pocket unaffordability.

The system as it has evolved tries to wring out the maximum amount of revenue per patient and quality/safety are secondary concerns at best and then again only insofar as they relate to profit. With so many people and institutions getting fed from the teat (so to speak) there is no single process or maneuver that can produce meaningful change.

The entire system needs to be re-engineered from the ground up. It can be done but there will be a LOT of short-term pain which would likely cause an economic recession/depression in the name of long-term gain and sustainability. In our current political climate, that will not happen. I weep for future generations that will inherit this travesty.

EDIT: Kaiser has the right idea. They control the input (health insurance) and output (delivery of care). This heavily incentives them to focus on preventative care and limit expensive, futile care. They view hospitals as an expensive but necessary evil. Most non-Kaiser health care systems try to funnel all their work into hospitals to maximize profit.

And yet kaiser health insurance isn’t any cheaper then a standard PPO. In fact, for most employer sponsored plans Kaiser is a premium option, meaning the premiums are higher then the other employer offered options. Most people I know with Kaiser are quite happy with it and it has many benefits as an integrated system, but cost saving (at least to the consumer) it is not.

 

[medgator]

And yet kaiser health insurance isn’t any cheaper then a standard PPO. In fact, for most employer sponsored plans Kaiser is a premium option, meaning the premiums are higher then the other employer offered options. Most people I know with Kaiser are quite happy with it and it has many benefits as an integrated system, but cost saving (at least to the consumer) it is not.

Where is that extra savings going? Executive salaries/compensation?

 

[DoctwoB]

Where is that extra savings going? Executive salaries/compensation?

I’m sure that’s part of it, but the bigger issue is just that there isn’t that much in the way of savings. The reason Kaiser survived when so many HMOs didn’t is that they don’t act too much like an hmo in terms of denying or rationing care, meaning the biggest potential saving of limiting less necessary care isn’t realized because they have to respond to customer demand. While there are undoubtedly efficiencies in being a closed system (no billing insurance, etc), Some of those savings are eaten up by being a humongous, beaurocratic conglomarate. For example in my field (urology) Kaiser jobs are generally known for being pretty cush with fewer patients per day then a typical private practice.

 

[Gfunk6]

And yet kaiser health insurance isn’t any cheaper then a standard PPO. In fact, for most employer sponsored plans Kaiser is a premium option, meaning the premiums are higher then the other employer offered options. Most people I know with Kaiser are quite happy with it and it has many benefits as an integrated system, but cost saving (at least to the consumer) it is not.

In Northern California, Kaiser plans are cheaper than all comparable alternatives. In fact, if they dropped the rates a few percent more, they would completely price everyone out of the market. However, they don't have the capacity to do this.

I agree that the monetary savings that they achieve is by limiting care. I've seen more than a few people abandon Kaiser after Kaiser balked at high-cost care. Of course, this is a win for Kaiser as they were able to extract the premiums for the patient for all those years and then do not have to pay the cost of care.

 

[seper]

I wonder if anyone has ever been a straight-employed Kaiser RadOnc and can share experience.

 

[nkmiami]

I have close colleagues who speak very positively about the Northern California Kaiser both in radiation and other fields. However, everything must be highly standardized and this may not be everyones cup of tea, depending how its organized. I was told South CA Kaiser at one point was organized such that you would see the department's sims one day, on treats the next, etc so there was not really "continuity of care. " I am not sure if this is case anymore.

 

[medgator]

I have close colleagues who speak very positively about the Northern California Kaiser. However, everything must be highly standardized and this may not be everyones cup of tea, depending how its organized. I was told South CA Kaiser at one point was organized such that you would see the department's sims one day, on treats the next, etc so there was not really "continuity of care. " I am not sure if this is case anymore.

Sounds awful imo and a great way to introduce errors into the system

 

[seper]

Agree, but that's how a lot of large, hospital-based RadOnc Departments operate nowadays. Communal patients shared by covering attendings.

Sounds awful imo and a great way to introduce errors into the system

 

[Neuronix]

Agree, but that's how a lot of large, hospital-based RadOnc Departments operate nowadays. Communal patients shared by covering attendings.

This way it's easier to have high efficiency practices with easily replaceable rad oncs...

Agree also that it's not that conducive to high quality care. But let's not confuse things like reputation, revenue, and quality of care. Correlations between any of those three things are pretty weak.

 

[RickyScott]

More news on prices, not utilization as main driver of health care costs.

Hospital price growth driving healthcare spending

https://www.healthaffairs.org/do/10.1377/hblog20190206.305164/full/