Some Hospitals Charge Up to 10 Times More for Medical Scans Than Others, Study Finds

[fiji128]

No surprises here but I imagine the magnitude of the price spreads seen here are probably the same in rad onc.

I hadn't seen before that fine for not releasing prices is going up from $109,500/year to $2,000,000/year, which is still a rounding error for the MDACC of the world.

https://pubs.rsna.org/doi/10.1148/radiol.2021211948

Some Hospitals Charge Up to 10 Times More for Medical Scans Than Others, Study Finds

The report, based on once-secret pricing data and published in the journal Radiology, found that thousands of hospitals didn’t report their prices despite a new federal requirement.

www.wsj.com

Hospitals Face Steeper Fines for Shunning Federal Price-Disclosure Rules

Under a new U.S. government rule, large hospitals could pay as much as $2 million annually if they don’t make prices public, which some haven’t done despite federal requirements.

www.wsj.com

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[RickyScott]

No surprises here but I imagine the magnitude of the price spreads seen here are probably the same in rad onc.

I hadn't seen before that fine for not releasing prices is going up from $109,500/year to $2,000,000/year, which is still a rounding error for the MDACC of the world.

https://pubs.rsna.org/doi/10.1148/radiol.2021211948

Some Hospitals Charge Up to 10 Times More for Medical Scans Than Others, Study Finds

The report, based on once-secret pricing data and published in the journal Radiology, found that thousands of hospitals didn’t report their prices despite a new federal requirement.

www.wsj.com

Hospitals Face Steeper Fines for Shunning Federal Price-Disclosure Rules

Under a new U.S. government rule, large hospitals could pay as much as $2 million annually if they don’t make prices public, which some haven’t done despite federal requirements.

www.wsj.com

2 million could be thought of as small part of the advertising/pr budget. well worth it vs quasi delegitimization.

 

[Mandelin Rain]

Of all the **** CMS does, why don't they just stop paying hospitals that refuse?

 

[Gfunk6]

Since ObamaCare mandates have been loosened over the last several years, I am seeing more and more patients who are under- or uninsured. I had a situation sometime ago where a patient had a symptomatic vestibular schwannoma and a "fly by night" catastrophic insurance plan.

She did some research and wanted to pursue single fraction SRS. Got a quote at the local academic medical center -$70,000.

Saw me - we offered Medicare rates with a discount for cash payment which was about x10 fold less than above.

 

[fiji128]

I wonder what prices for rad onc services would be in a competitive market if consumers where sensitive to and aware of prices. Would centers be advertising all in prostate and breast RT for $5,000? It would be interesting to see what the true market rate for our services would be.

 

[TheWallnerus]

Since ObamaCare mandates have been loosened over the last several years, I am seeing more and more patients who are under- or uninsured. I had a situation sometime ago where a patient had a symptomatic vestibular schwannoma and a "fly by night" catastrophic insurance plan.

She did some research and wanted to pursue single fraction SRS. Got a quote at the local academic medical center -$70,000.

Saw me - we offered Medicare rates with a discount for cash payment which was about x10 fold less than above.

But Dr Gfunk many in academics say that IMRT in your center will be more financially toxic than SBRT in the academic center.

 

[Gfunk6]

But Dr Gfunk many in academics say that IMRT in your center will be more financially toxic than SBRT in the academic center.

Well unlike MSKCC, we cannot open non-profit foundations and solicit donations from the community to contribute to a pool of money to mitigate their own financial toxicity. Most of the time, a patient would much rather opt for a $70,000 treatment with $0 co-pay vs a $7,500 treatment with $200 co-pay. All they care about is their out of pocket costs - it is society that pays the price.

 

[TheWallnerus]

All they care about is their out of pocket costs

As an aside, the burden of travel for radiation therapy is a totally made up thing. Allows for a kind of virtue signaling in the hypofractionation era (HE). Before the HE, *no one* talked about fractionation minimization to reduce travel burdens. If we all were truly concerned about travel burden we would have long since been exploring novel models (an MSKCC Radiotherapy Uber Service e.g!), advocating on Capitol Hill to allow free transport for Medicare patients, that sort of thing. I mean we could put our heads together, and a fraction of our profits together, and eliminate travel burdens overnight no matter the RT fraction number. It's so damn frustrating when a place like MSKCC gets to talk about their care and concern for the poor patients' travel burden and how MSKCC alleviates that burden. The real travel burden in MSKCC's eyes is when the patient travels and gets RT a place that isn't MSKCC. Any place that talks about fraction reduction reducing patients' travel burden, this is their real ulterior motive: "Make sure you travel to us for treatment."

 

[RickyScott]

Well unlike MSKCC, we cannot open non-profit foundations and solicit donations from the community to contribute to a pool of money to mitigate their own financial toxicity. Most of the time, a patient would much rather opt for a $70,000 treatment with $0 co-pay vs a $7,500 treatment with $200 co-pay. All they care about is their out of pocket costs - it is society that pays the price.

Nailed It. Focusing on out of pocket patient costs plays well to the public, but is a red herring. The real damage is when places like MSKCC/MDACC charge the teacher's union 300k for proton partial breast (topped off with a couple Gs for the EKGs).

 

[Ray D. Ayshun]

Nailed It. Focusing on out of pocket patient costs plays well to the public, but is a red herring. The real damage is when places like MSKCC/MDACC charge the teacher's union 300k for proton partial breast (topped off with a couple G for ekgs before and after)

We not uncommonly just write off the out-of-pocket. It's all a bull**** shell game.

 

[jondunn]

'As an aside, the burden of travel for radiation therapy is a totally made up thing.'


ummmm really? made up? what? who are your magical patients and magical families of patients?

speak for yourself and the region you live in.

 

[Mandelin Rain]

'As an aside, the burden of travel for radiation therapy is a totally made up thing.'


ummmm really? made up? what? who are your magical patients and magical families of patients?

speak for yourself and the region you live in.

What he is saying is that it never mattered before. Suddenly, someone decided it mattered out of the ether. Likely not of purely altruistic reasons.

 

[jondunn]

What he is saying is that it never mattered before. Suddenly, someone decided it mattered out of the ether. Likely not of purely altruistic reasons.

just because you think it didnt matter doesnt mean it didnt matter!

literally think about it for one second

 

[jondunn]

'back in the 90s no one cared about homophobia. it's a totally made up thing. allows for virtual signaling in the woke era. Before the woke era, you never heard people talking about this stuff. it was a total non-issue, homophobia didnt exist'

 

[Mandelin Rain]

just because you think it didnt matter doesnt mean it didnt matter!

literally think about it for one second

No, I understand. I think it matters. It's a big issue for patients and their families. I also took 2 seconds to understand his point and agree with the spirit of his post, because I don't take everything written here as entirely literal. Plenty of tongue in cheek commentary. But my guess is you knew that already.

EDIT: Your faux outrage is cute though.

 

[TheWallnerus]

'back in the 90s 80s no one cared about homophobia intersectionality. it's a totally made up thing. allows for virtual signaling in the woke era.

speak for yourself and the region you live in.

What he is saying is that it never mattered before. Suddenly, someone decided it mattered out of the ether.

Region? Not region so much as spacetime.

I don't recall MSKCC talking about travel burden when they were having prostate patients come in the department for almost a whole Spring, Summer, Fall, or Winter (9.5 weeks of tx) in the 2000s. Come 2021 if you can get better or equal reimbursement by having patients come in for a week, and get better reimbursed for that week of tx versus the community guys, now you get to talk about travel burden. If we as a field were really concerned about travel burden, then every department in the 1990s would have had a doctor, physicist, dosimetrist, therapist, nurse, and patient driver. And in the present we would be developing mobile linacs mounted in Tesla Semis.

 

[jondunn]

'If we as a field were really concerned about travel burden, then every department in the 1990s would have had a doctor, physicist, dosimetrist, therapist, nurse, and patient driver.'

okay double down on ridiculous premises. since you were around before hypofrac was a thing, you also Im sure remember all of the concerns about it and the safety of it (we see much of it to this day!) and im sure you also remember a time when the technology made it much harder.

despite that, people were clearly interested back then. people didnt do it widely before data existed for it. then it did exist. then people did it.

america last at every step, of course, as we do.

 

[jondunn]

it is true that patients have become more discerning and more likely to question 'i really have to come in for 7 weeks?' -my older partner is close to retirement and he often comments on this - 'back in the day people just came to get their cancer treated and didnt ask questions about convenience!'

we are certainly a more entitled populace


but you also said none of your patients have trouble coming in twice a day, so you clearly have a unique population.

 

[Ray D. Ayshun]

It's pretty obvious wallnerus is having trouble reconciling the move by academic rad onc to simultaneously preach travel burden while doing their best to put rural rad onc outta business. I think we all recognize travel burden is a thing, it's just now become convenient to talk about.

 

[TheWallnerus]

'back in the day people just came to get their cancer treated and didnt ask questions about convenience!'

I think you just said what I am saying strangely enough. Both the patient people and the doctor people... all the people... didn't ask questions.

 

[TheWallnerus]

'back in the 90s no one cared about homophobia. it's a totally made up thing. allows for virtual signaling in the woke era.

I think we all recognize travel burden is a thing, it's just now become convenient to talk about.

Very convenient!

 

[jondunn]

Very convenient!

lol i dont always click every link (you post a lot of them!) but this was good

 

[OTN]

'If we as a field were really concerned about travel burden, then every department in the 1990s would have had a doctor, physicist, dosimetrist, therapist, nurse, and patient driver.'

okay double down on ridiculous premises. since you were around before hypofrac was a thing, you also Im sure remember all of the concerns about it and the safety of it (we see much of it to this day!) and im sure you also remember a time when the technology made it much harder.

despite that, people were clearly interested back then. people didnt do it widely before data existed for it. then it did exist. then people did it.

america last at every step, of course, as we do.

whoops:

 

[jondunn]

you're not making the point you think you are making though. never said we were the only ones that did FFS pay.

 

[OTN]

oops:

The British seem less likely to get cancer than Americans but are also less likely to survive. Why?

But we also need to look at cancer mortality rates.

qz.com

 

[radiation]

As an aside, the burden of travel for radiation therapy is a totally made up thing. Allows for a kind of virtue signaling in the hypofractionation era (HE). Before the HE, *no one* talked about fractionation minimization to reduce travel burdens. If we all were truly concerned about travel burden we would have long since been exploring novel models (an MSKCC Radiotherapy Uber Service e.g!), advocating on Capitol Hill to allow free transport for Medicare patients, that sort of thing. I mean we could put our heads together, and a fraction of our profits together, and eliminate travel burdens overnight no matter the RT fraction number. It's so damn frustrating when a place like MSKCC gets to talk about their care and concern for the poor patients' travel burden and how MSKCC alleviates that burden. The real travel burden in MSKCC's eyes is when the patient travels and gets RT a place that isn't MSKCC. Any place that talks about fraction reduction reducing patients' travel burden, this is their real ulterior motive: "Make sure you travel to us for treatment."

Wasn't "quad shot" in the 80s born because of convenience issues?

Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502) - PubMed

The crude late complications rate is 6%. Actuarial analysis using cumulative incidence shows 6.9% by 18 months. This represents a significant decrease in late complications from 49% seen with higher dose per fraction (10 Gy x 3) piloted by Radiation Therapy Oncology Group (7905) for a similar...

pubmed.ncbi.nlm.nih.gov

"This schedule has significant logistic benefits and has been shown to produce good tumor regression and excellent palliation of symptoms."

Also, when the they tested all the different head and neck treatment schedules in RTOG 9003 the UF bid arm won but never fell into favor presumably because of travel issues (and/or bid bias that still exists today)

 

[TheWallnerus]

Wasn't "quad shot" in the 80s born because of convenience issues?

Late effect of multiple daily fraction palliation schedule for advanced pelvic malignancies (RTOG 8502) - PubMed

The crude late complications rate is 6%. Actuarial analysis using cumulative incidence shows 6.9% by 18 months. This represents a significant decrease in late complications from 49% seen with higher dose per fraction (10 Gy x 3) piloted by Radiation Therapy Oncology Group (7905) for a similar...

pubmed.ncbi.nlm.nih.gov

"This schedule has significant logistic benefits and has been shown to produce good tumor regression and excellent palliation of symptoms."

Also, when the they tested all the different head and neck treatment schedules in RTOG 9003 the UF bid arm won but never fell into favor presumably because of travel issues (and/or bid bias that still exists today)

Quad shot, a convenient bid regimen; hyperfractionated H&N RT (and bid for SCLC?), an inconvenient bid regimen. I wouldn't hesitate to hyperfractionate a bulky superglottic sans chemo. The Apostle Paul wrote "For all have sinned and come short of the glory of God." TheWallnerus writeth "For all have made their dose prescriptions too lengthy and come short of the glory of minimal patient travel burden."

 

[Mandelin Rain]

When the money was in fractions, the talk was about efficacy and safety.

When the money is in patient throughput, the talk is about travel burden and non inferiority.



I know what is a better focus but the thing that is constant is the money. That is what actually matters.

 

[elementaryschooleconomics]

I have a difficult time believing these numbers reflect reality. The more and more I read these financial/healthcare economics papers, look at the mandated "price transparency" documents provided by hospitals, and hear from my own patients how much they're paying (or, at least, how much they see on a bill), the more I question if anyone has an idea of what's going on in this country on an individual level. On a macro scale, sure, but not on an individual level.

I guess this is as good a measure as any?

 

[ramsesthenice]

I guess this is as good a measure as any?

Anyone remember the Bristol Stool Scale? That’s what these things make me think of. Except it at least has quantifiable real world applicability.

 

[RickyScott]

When the money was in fractions, the talk was about efficacy and safety.

When the money is in patient throughput, the talk is about travel burden and non inferiority.



I know what is a better focus but the thing that is constant is the money. That is what actually matters.

Definitely has been a shift in the primary mission of some of these large “nonprofits” to be solely focused on profit/expansion over past 20 years. no shareholders or “owners”, but profit motivates and fuels an expanding “administrative class”.

 

[jondunn]

Definitely has been a shift in the primary mission of some of these large “nonprofits” to be solely focused on profit/expansion over past 20 years. no shareholders or “owners”, but profit motivates and fuels an expanding “administrative class”.

capitalism, baby

 

[Mandelin Rain]

capitalism, baby

State and federally subsidized. Being the little guy in America, is the wrong guy to be.

 

[OTN]

State and federally subsidized. Being the little guy in America, is the wrong guy to be.

Exactly. Regulatory capture has fueled crony capitalism, which is distorting the market to a severe degree. We need less government regulation to allow the market to function properly.

 

[medgator]

Exactly. Regulatory capture has fueled crony capitalism, which is distorting the market to a severe degree. We need less government regulation to allow the market to function properly.

Not sure it's regulatory problem, sounds more like crony capitalism. If we wanted govt out of the system altogether, it would essentially be necessary to abolish CMS, something neither side would ever agree to. Democrats created CMS but you'd never know that looking at how much republicans talk about protecting Medicare for seniors

Deregulation sounds great on theory until you have a winter storm in Texas and the free market charges you and arm and leg per KwH when most of the power plants seize up.

The straightforward answer would be to abolish the two different payment systems altogether as well as the PPS exempt handout and pay all sites of service the same payment