Politics

May 9, 2013

High hospital bills go public, but will it help?

The Obama administration hopes that releasing the information will lead to answers to the riddle of hospital pricing — and pressure some hospitals to lower their charges.

The Associated Press

WASHINGTON — For the first time, the government is publicly revealing how much hospitals charge, and the differences are astounding: Some bill tens of thousands of dollars more than others for the same treatment, even within the same city.

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Health and Human Services Secretary Kathleen Sebelius testifies on Capitol Hill in April at a House Ways and Means Committee hearing on President Obama's budget proposal for fiscal year 2014. Hospitals within the same city sometimes charge tens of thousands of dollars more for the same procedure, figures the government released for the first time Wednesday show.

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Why does a joint replacement cost 40 times as much at one hospital as at another across the country? It's a mystery, federal health officials say.

"It doesn't make sense," Jonathan Blum, Medicare deputy administrator, said Wednesday. The higher charges don't reflect better care, he said.

And the amounts are too huge to be explained by obvious differences among hospitals, such as a more expensive regional economy, older or sicker patients, or the extra costs of running a teaching hospital, he said.

The average charges for joint replacement range from about $5,300 at an Ada, Okla., hospital to $223,000 in Monterey Park, Calif., the Department of Health and Human Services said. That doesn't include doctors' fees.

In Maine, the lowest and highest amounts billed to Medicare for a joint replacement are at two hospitals approximately 15 miles apart in Aroostook County: Cary Medical Center in Caribou charged $22,870, while The Aroostook Medical Center in Presque Isle charged $55,425, an amount that is just above the national average. Maine Medical Center in Portland charged $28,216 for a similar procedure, while MaineGeneral Medical Center in Augusta charged $33,212.

Hospitals within the same city also vary greatly. At Beth Israel Medical Center in New York, the average charge to treat a blood clot in a lung is $51,580. Down the street at NYU Hospitals Center, the charge for the same care would be $29,869.

At the Mayo Clinic in Minnesota, the list price is $16,861.

That isn't necessarily what you pay.

Medicare pays hospitals on its own fee schedule that isn't based on the listed charges, Blum said. And insurance companies routinely negotiate discount rates with the hospitals.

But patients who are uninsured can be billed the full amount. And some with private insurance may find their share of the bill is inflated as a result of a hospital's higher charges, officials said.

Blum said the Obama administration hopes that releasing the information, at the website www.cms.gov, will help lead to answers to the riddle of hospital pricing — and pressure some hospitals to lower their charges.

The database also will help consumers shop around, he said.

The variations shouldn't be a surprise, since hospitals might violate antitrust regulations if they shared "proposed or negotiated rates" with each other, said Rich Umbdenstock, president of the American Hospital Association. Forty states do require or encourage hospitals to make some payment information publicly available, he said.

"The complex and bewildering interplay among 'charges,' 'rates,' 'bills' and 'payments' across dozens of payers, public and private, does not serve any stakeholder well, including hospitals," Umbdenstock said.

Consumer advocates said making the charges public is significant, even if most patients don't pay those rates.

"I think the point is to shame hospitals," said Chapin White of the nonprofit Center for Studying Health System Change.

Dr. David Goodman, co-author of the Dartmouth Atlas of Health Care, said, "It does show how crazy the system really is, and it needs some reform."

Goodman argues that hospitals should be required to go further and post the charges that patients actually pay out-of-pocket, depending on what medical coverage they have. The Dartmouth Institute for Health Policy has long found wide geographic variation in Medicare payments for the similarly ill, yet people who receive more expensive care don't necessarily receive better care. Sometimes hospitals just add tests or treatments they don't really need.

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