ControlsFreak
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User ID: 1422
ControlsFreak
7mo ago
Don't care what you think about the relevance of the number. That is not your job. I care about the number. It is not even for the reason you think it is. In fact, you did not even respond to the stated reason I gave. You made some other irrelevant claim. Give me the information. Stop being morally evil.
ControlsFreak
7mo ago
It informs me as to the likely costs of various options, allowing me to proceed in deliberation and/or discussion about priorities and tradeoffs. This is straightforward stuff.
It has relevance to me. I'm telling you that it has relevance to me, and I can only tell you that so many times. (Vastly more so if I had access to the information at the appropriate time.) You cannot hear me, because you are lying to yourself and to me. You do not get to determine what has relevance to me. That is not your job. You are not god. You are not Stalin. You are not the sole arbiter of what information has relevance to others. Especially when you have an insane conflict of interest. (EDIT: Remember the snippet of the NYT op-ed; you can just be wrong sometimes about what has relevance to others. Fundamentally, you are not them; you do not know their situation or what is of interest/relevance/value to them, the same as how auto mechanics, no matter how artistic, no matter how well-educated, no matter how perfectly they know their craft compared to their customers, do not know the situation of or what is of interest/relevance/value to their customers, so they likewise do not get to unilaterally determine that things like price information are not relevant to them.)
I am usually very mistake-theory. Smart, good-natured people can simply be mistaken about things. They could just not have been challenged ever or just not thought things through. At this point, though, when it's clear that all of your other excuses were total trash and you're resting on pure assumption of power to determine for yourself what has relevance to others, even when they're disagreeing, I start feeling left with few other options. I start feeling that either you managed to hide being surprisingly low IQ long enough to get a medical degree and you honestly struggle to understand... or you're basically just morally evil, on par with the communists, who took power upon themselves to decide what was of relevance/value to others to a similarly insane degree.
(Further Edit: It would be insane if this was your job. I really don't think you want to adopt a rule that actually makes it your job to truly understand every patient's situation/interests/values/relevance and have standards by which you are required to determine whether pricing information is relevant to them and their particular situation. It is much much easier for you to just tell them and let them think for themselves, and decide whether or not to consent to the costs/benefits. Would you really support a conceptual schema that said that auto mechanics didn't give you a price; they were instead required by some fiduciary duty to try to understand everything about you personal situation, financial and otherwise, what your interests are, what your values are, etc., and make some determination (probably according to some objective standards, probably subject to lawsuits if they're wrong in their assessment) as to whether or not they think certain pricing information is "relevant" to you?! You want to reduce administrative grief; you do not want that. Forget CoI issues; you don't want that on your own terms. It would be a nightmare compared to just giving people the price.)
Further Further Edit: To the extent that you think you are doing something like this as part of your job, I am telling you that your profession is failing. I can only tell you so many times that I have personally experienced times where having even EOB-type information at the time of decision could have mattered. You have failed. This failure is probably part of why there is so much outrage, so much clamoring for additional regulation and such.
ControlsFreak
7mo ago
It's far too late at that point, because you've been lying and hiding the price from me at the time that it could have mattered. Probably the biggest way it alters my decision making is that seeing one reminds me to distrust people like you who are lying and hiding things from me, only to have it spring up later in a possible huge surprise.
ControlsFreak
7mo ago
You have not used the proper terminology. You've babbled about fruit.
EOBs are fine. They do, indeed, give relevant information. Why can't you even do that much?
ControlsFreak
7mo ago
You're babbling. Incoherently. Please use actually relevant words. Aren't you supposed to know something about this topic, at a technical level? How come you can't even use the proper terminology?
ControlsFreak
7mo ago
ControlsFreak
7mo ago
It does, indeed, have meaning to the patient. It can matter, as you have already agreed. They even see the same numbers on their Explanation Of Benefits, which they currently get, just after it's too late for them to consent. They have meaning there, too. Have you never read an EOB?
ControlsFreak
7mo ago
Your charge and the negotiated rate are both denominated in US dollars in the US. (So are all of the other terms in their health insurance policy.) US legal tender laws are a hell of a drug, so unless you're extremely transparent up front about your pricing structure being in terms of oranges (in which case, you are probably transparent enough as it is... and you certainly don't work with any US-based insurance companies), yours is denominated in US dollars, too.
I mean, this is how silly you've gotten. Wow. I hope you're really good at medicine, because I'm starting to get the impression that you just don't understand how any other aspect of the world works.
ControlsFreak
7mo ago
Patients want to know what they will pay
You're ignoring what I've written time and time again. I am asking you to simply inform your patient about the charge you are going to submit to their insurance and the negotiated rate. That is information that can be useful. You are correct that it is not an exact description of exactly what they will pay out of pocket. There are also deductibles, co-insurance, out-of-pocket max, etc. That's not to do with you; that's why you're not telling them those other things. You're telling them the information that you have - the charge that you are going to submit to their insurance and the negotiated rate. You have this information. You can tell them. Just tell them.
ControlsFreak
7mo ago
You don't need to hire a consultant to inform your patient about the charge that you will be billing their insurance or the negotiated rate. Apples/oranges/whole wheat pasta is another bizarre thing that appears to have no relevance to the question at hand. You have the information we've been talking about. You can just inform your patient. You can do it before you take further action that would generate such a charge. It would be unethical to do otherwise.
ControlsFreak
7mo ago
We have already agreed that you have pieces of information that can be useful. It was very long ago at this point. Just give them the information that you have.
On the other bit, you're going to have to give me a reason why you can't inform your patient before you take other actions, because so far, a lot of your stated reasons for things have been somewhere between bizarre and bollocks, so I'm definitely not going to accept a completely unstated reason.
ControlsFreak
7mo ago
I'll take your silence to be an admission that you can inform your patient before you take other actions.
You can provide your patient the information that you have, as we have discussed over and over again.
ControlsFreak
7mo ago
You don't know in advance of the visit, but you know before you take other actions. At that point, inform your patient.
PATIENTS CANNOT MAKE DECISIONS BASED OFF OF PRICES.
This is definitely a lie.
ControlsFreak
7mo ago
Yup. You said that costs sometimes matter. Just inform your patients.
ControlsFreak
7mo ago
ControlsFreak
7mo ago
You already agreed that it can have value. Just give them the information that you have. You're out of excuses.
You are not providing any information to the insurance company. They already get the price that you charge them (that's in the bill that you send them); they already have the negotiated price (you both agreed to it). You are providing information to your patients.
EDIT: I love how it magically changed from totally meaningless information that was complete nonsense, because the insurance company decides everything anyway and they have it all anyway.... to absolutely critical and vital information, such that if the insurance company gets even a whiff of it, it'll be an insane disaster. Like wow, dude. Listen to yourself.
ControlsFreak
7mo ago
You can provide them the information that you have. That includes information like negotiated prices, so they are not only looking at sticker prices.
Why are we involved when it's the insurance who decides what things costs and how much to pay.
You are both parties to the determination of price. If you don't think you're involved at all, then I will just go tell all the health insurance CEOs that they can stop getting shot by just paying you $1 for everything. After all, you're not involved at all with anything related to prices, so that couldn't change anything, right?
...or are you involved somehow?
ControlsFreak
7mo ago
Costs matter for some things
Awesome. I'm glad we've made progress. Start giving prices. Sometimes, they won't matter. Do it anyway. Sometimes, they matter. You can do it. Just do it.
The more expensive option is very often cheaper for the patient.
Wouldn't it be nice if they had a way of getting this information? Perhaps you could help. You could, for example, share the information that you have with them. You've agreed that you do have relevant information. We all know that it's not perfect, but it can be useful. You've agreed that you do give it to patients sometimes. Just do it.
We are often legally prohibited from considering cost or making less expensive choices.
We are talking about patient choices.
Medical care in the U.S. does not function as a market.
Mostly because you do shit like lie and hide prices. Stop hurting. Start helping.
Not giving prices is more misleading and confusing. Hence the legislation efforts and assassinations. Stop acting like people are so stupid that they can't understand costs/benefits. Inform your patients, just like you do with medical costs/benefits, even though there is also a knowledge gap there, too. Stop practicing unethically.
Regulations impair things.
I'm hoping we don't go there, but you need to fix things. Ask the techies in the IoT space how just stomping their feet, refusing to do anything, and resting on, "Regulation is bad, m-kay," worked for them.
Increased price awareness does not help patients make decisions.
This is utterly false and is completely unsupportable. You couldn't imagine saying such a thing for any other industry, because it's nonsensical.
I'm glad that you had no problem with the entire rest of my list of benefits. Given that the only benefit you gave on your side rests on the assumption that everyone else is too stupid (a bad assumption) that you need to be appointed to keep them in the dark and make all their choices for them (which isn't likely to help, anyway; how are you currently preventing them from going to the hospital where they happen to end up with the bill for $300k?), I think it's pretty clear that your approach is not helping. It's hurting. It unethical. It's bad business practice. It's bad economics. There is nothing good about what you are doing.
NYT had a doctor apologist op-ed this morning. Hilariously skewed, of course, but they also disagreed with you.
As a young doctor, I struggled with this. Studies show this drug is the most effective treatment, I would say. Of course, the insurer will cover it. My more seasoned colleague gently chided me that if I practiced this way, then my patients wouldn’t fill their prescriptions at all. And he was right.
Costs matter. Inform your patients. Stop lying and saying that they don't. I've given you a long list of reasons; compared to your one, extremely terrible reason for doing what you're doing, the choice is clear.
they are shooting people who work for insurance. The people who are the problem.
First, hilariously naive that you think you'll be spared if the anger boils over into something like regulation. Second, if you're going to claim that they're the problem, tell me how you're going to fix it. I don't want to hear you just complaining and finger pointing; I want solutions. How are you going to start cleaning up this mess?
Informed consent has nothing to do with price
Price is part of the costs/benefits. You are practicing medicine unethically if you are not properly informing your patients of the costs/benefits.
I also can't promise you a price or cost or charge before hand.
Not a strict promise. We've been through this. You know this. You know that you can do better.
You have yet to explain how providing more detail on cost, price, or charges adds any value to the system.
It is unethical to perform a procedure on a patient before acquiring informed consent. It's basic decency in business practice. It's good to stop lying to people and telling them that you can't do something that you know you can. I'd think in recent years, you'd be a bit in tune with the idea that if your profession is being seen as lying to the public, it can cause a significant reduction in your status and credibility. Conversely, if you start doing the basic thing, patients will have more faith in the medical system, believing that the market is operating more fairly and that they are not being overcharged for services. This fosters greater societal trust in the medical system and encourages broader participation in preventive and other health measures. Price transparency is an important component of many properties of markets. It can affect people's decision-making and allocate resources more efficiently. It reduces information asymmetry. It reduces surprises and the anger they generate. When patients know the cost of their treatment options, they can plan financially, leading to higher adherence to prescribed treatments. For example, patients who know they can afford the cost of necessary medications or follow-up procedures are more likely to stick with the treatment regimen, leading to better health outcomes. It speeds up price discovery, increases consumer welfare, and it can also be linked to encouraging innovation. The Nobel prize that Stigler got for this sort of stuff was looooooong ago.
You have yet to explain how doing everything you can to hide prices, lying to people, telling them it's impossible adds any value to the system.
Nah, man. They didn't ask for anything like you suggested. And two thirds complied fully within a pretty short time frame, because what they asked for obviously could be done. I'm sure in a couple more years, that number will be higher.
Just do it. Just do what you know you can already do. What you already admitted that you can do; it was a lie before when you said you couldn't. You already admitted that you do do from time to time. We've been through every objection, in detail. I've responded, in detail. You're all out of excuses at this point and are just resting on speculative claims that it could possibly take a modicum of effort. Boo hoo. Grow up. They're literally shooting your people on the streets of New York City. Others are cheering. Stop lying to yourself and to others. Actually inform your patients and actually get informed consent. You probably will like the haphazard results that will follow if you don't clean up your act less.
ControlsFreak
7mo ago
Hold your horses. I'm hoping for incremental change. I ain't nearly that hopeful, either. More likely, we'll get some bomb of other confused regulation, which might have some incidental pro-consumer stuff.
I get the numbers. I consider the factors relevant to them. I consider the options in context of a variety of concerns relevant to my situation. Perhaps, I proceed with discussion and/or deliberation. I consider priorities and tradeoffs that likely apply. Then, I make decisions (perhaps a sequence of decisions). Are we going to have to go through Decision Theory 101? Are you next going to ask, "What is the nature of a decision?"
EDIT: Read the NYT snippet again if you are having difficulty.
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