I analyzed hospital price lists so you didn't have to
Wrote Hacking Healthcare for O&#x27;Reilly, created ClearHealth&#x2F;HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah.<p>It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However &quot;Hanlons Razor&quot; -- never attribute to malice that which is adequately explained by stupidity -- definitely applies.<p>Many health systems are a lot more like &quot;medical malls&quot; than they are single monolithic enterprises. Lots of health systems use really, really old technology and also a lot of it from a company called &quot;Epic&quot;. Epic does what it wants, when it wants and there is basically nothing anyone can do about it. There is rarely one central consistent mechanism and source of truth for pricing data because it gets generated from a complex web of different entities, systems, and processes. Herding all those cats is why it can take a health system a long time to comply. And also why a fine of even a million dollars can be small potatos vs the cost of actually complying in a timely manner.<p>Just one facet, MUMPS is a widely used technology which you probably haven&#x27;t heard of and which very few technologists understand. Lots of people are struggling to create new code to meet the new regulations using 1970s era technology including MUMPS.<p>Another, a lot of health systems have been around a really long time. The insurers they work with also, (since the 1960s at least). They have Electronic Data Interchange EDI relationships built on the standard called 837. Business logic that surrounds pricing and billing is often buried in 50 years of tech debt. Everyone is deathly afraid of making too many changes too fast because when those systems break the money stops flowing and a health system will literally go insolvent. People still have hard physical lines connected to Medicare mainframes.<p>This is a similar situation to other regulated industries like banking, airlines, etc. Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of cards with chewing gum, paper clips and hope.<p>Disclaimer: I have been involved with the development of some of the fee schedules and health systems mentioned&#x2F;criticized.