Readit News logoReadit News

Deleted Comment

riceart commented on Open source hospital price database   dolthub.com/repositories/... · Posted by u/alecst
maxerickson · 2 years ago
If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
riceart · 2 years ago
Insurance exists to cover losses from unexpected events. Medical complications are unexpected events.

Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence. Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site).

If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself.

> more or less exists for each procedure

This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.

Deleted Comment

Deleted Comment

riceart commented on Open source hospital price database   dolthub.com/repositories/... · Posted by u/alecst
maxerickson · 2 years ago
If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpredictable risk onto the patient who has less control than they do?

Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.

riceart · 2 years ago
> Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.

That’s what you think is the common root cause of complications?

You clearly are not interested in a productive discussion.

As for a fee for unpredictable occurrences - that’s what insurance is.

Deleted Comment

riceart commented on Open source hospital price database   dolthub.com/repositories/... · Posted by u/alecst
WaitWaitWha · 2 years ago
> Does such a thing exist? [...] I think millions of US citizens would subscribe.

Yes, such thing exists.

My friend just had an endoscopy & colonoscopy together. She was able to get a price estimate through her hospital's portal both with and without her insurance, prior to her procedures, requiring no special interaction besides picking the service she was interested in and if she wanted to see the price with or without insurance.

The system seem to show her anything and everything she needed, from a routine office visit, these procedures, to delivering a baby. It not only includes the price at that facility but also a range from low to high, and where the facility fits. It also gives breakdown of the fees, although not deep enough.

The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.

riceart · 2 years ago
> The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.

Lol, that mom and pop shop.

That’s the largest EMR vendor in North America and second in the world.

They’re the provider of the patient portal frontend amongst other things but there’s a lot more behind the scenes that must be done (with varying levels of quality) that is institution specific. Just using Epic does not make this work.

riceart commented on Every Signature Is Broken: Insecurity of Microsoft Office’s Ooxml Signatures   usenix.org/conference/use... · Posted by u/pseudotrash
D13Fd · 2 years ago
Signing a PDF via "/s/ Name E. Name" and sending it via e-mail solves the "lost pages" issue, and doesn't require the parties to use cryptographic techniques.
riceart · 2 years ago
Without cryptographic techniques that is all easily forged.
riceart commented on ICDStories: Unraveling Medical Mysteries Through the Lens of ICD-10 Codes   icdstories.substack.com/... · Posted by u/imfinn
thunderbird120 · 2 years ago
Let me speak as someone who has published quite a bit of research using information derived from EHR data, most of which was ICD codes.

EHR data is fucking terrible. The quality is laughably bad. Despite there being standards for when specific codes should and should not be used, there is no way to actually enforce correct usage. This means coding practices may vary dramatically depending on exactly who is inputting the code. ICD codes get used incorrectly a fairly alarming proportion of the time. The most common deficiency is just missing codes. For whatever reason a lot of conditions just don't get recorded as ICD codes. You can look at the actual written doctors notes and see that they clearly noted that a patient had a specific condition but the ICD code associated with that often just never gets entered.

What's worse, its also common to have codes which are just flat out wrong. This can take many different forms but is usually the result of lazy medical history questionnaires.

"Do you have diabetes?" asks the questionnaire. Patient checks yes. Patient gets ICD-10 code E11. But E11 is the code for Type 2 diabetes. The patient has Type 1 diabetes, which is much less common. If I run a query to select all patients with Type 1 diabetes from my large EHR database I will miraculously find that more than 90% also show up in queries which select all Type 2 diabetes patients. Very interesting considering that the medically reported frequency of double diabetes in T1D patients is around 4%.

This is just one of many many many issues you see when working with EHR data. Findings derived from large scale EHR data can never be considered more than preliminary. Never.

I have personally had discussions with people who, even when getting their data from a single institution, have had to physically go around to different hospital departments and tell them to stop collecting certain types of data because they were so bad at it that they are making the rest of the data unusable.

Unless you have a carefully curated data collection process you will always be dealing with this issue. EHR has a lot of theoretical potential but the data quality issues negate almost all of it. It's really unfortunate.

riceart · 2 years ago
Have you ever had to enter codes as a provider in Epic for instance? The UX is fucking terrible. Incentives are completely misaligned for accurate coding in academic institutions. Finally the ontology of ICD codes are trash on their face.
riceart commented on ICDStories: Unraveling Medical Mysteries Through the Lens of ICD-10 Codes   icdstories.substack.com/... · Posted by u/imfinn
ivalm · 2 years ago
I think it's more about being entertaining, rather than truly educational to someone who is already a dr.
riceart · 2 years ago
Right from the about page:

> Our clinical vignettes serve multiple purposes. They provide a distinctive, engaging learning tool for medical students and healthcare professionals looking to familiarize themselves with the ICD-10-CM system.

u/riceart

KarmaCake day336January 7, 2023View Original