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ACA Transparency: Dramatically Different Medicare Bills Set Hospitals Thinking

Posted by on May. 11, 2013 at 7:24 PM
  • 51 Replies

Dramatically Different Medicare Bills Set Hospitals Thinking

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A map of Alaska.
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For the first time, the federal government has publicly what hospitals bill Medicare for the 100 most common diagnoses and treatments.

The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things.

Hospital veteran , the CEO of Central Peninsula General Hospital in Soldotna, was eager to review the on hospital charges as soon as it was out.

"It's going to create ripples across the nation, really, on pricing," he says. "It does show some pretty big disparities between hospitals."

For example, , in Anchorage, charges Medicare $46,252 for a patient with heart failure and a major complication. Alaska Native Medical Center, also in Anchorage, charges $20,839.

In both cases, Medicare doesn't pay anywhere close to the full charge. The government reimburses Regional $13,950 and Alaska Native, $12,935. Private insurance usually pays more than Medicare, but negotiates the amount.

The system doesn't make much sense, but Davis says more transparency will help:

"For there to be pressure on pricing on the consumer side, the consumer has to understand what it's going to cost them. And so, I think this is a good report. I think it's going to force hospitals to address their pricing."

Davis says the data show the prices at his own hospital, Central Peninsula, are fair. And he doesn't expect to make any adjustments.

But Bruce Lamoureux, CEO of the health system in Anchorage, says his hospital will consider changing some prices, down or even up, based on the report:

"There are some instances where our charges for a particular procedure are, in one case, half of a different provider's, and in a different case, twice a different provider."

Lamoureux thinks the information actually gives consumers some negotiating power when it comes to health care costs, something they've never had before. He says the system of hospital pricing and reimbursement is badly broken and this step toward more transparency is long overdue.

But a hospital bill is only one part of the overall health care cost picture.

"That's kind of like a rack rate in the hotel room," says Karen Perdue, president of the . "Most people aren't paying that one rate in the hotel. Different payers are demanding different deals at the hospital, so I think what consumers need is not only a more accurate way to determine what their costs are going to be, but also what the full cost will be, not just the hospital cost."

Like the charges from doctors and anesthesiologists, which aren't included on a hospital bill. Perdue says her board is looking at ways to make hospital cost data easily available to consumers. But health care is a complicated industry and it's not an easy task.

"Transparency, for us, feels like the future and where we should be going, and where we should be putting our effort," she says. "How we should do that in a way that is meaningful to the consumer is the challenge ahead of us."

This story is part of a collaboration with NPR, Alaska Public Radio Network and .

Nerdy White Person

by on May. 11, 2013 at 7:24 PM
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Replies (1-10):
jessilin0113
by Platinum Member on May. 11, 2013 at 7:40 PM

In all honesty, flat charges are a bit misleading.  Assuming both hospitals fall under the same Medicare classification, a patient will end up paying about the same amount at either, because if they are contracted with Medicare, they have to accept the Medicare allowable rate, which goes off of the coding, not the pricing.  The hospital that charges more will write off more, that's all.  Now, if you are talking about a self-pay patient, completely different story, but insurance reimbursment, overall, is not affected by pricing. 

DSamuels
by Gold Member on May. 11, 2013 at 7:46 PM

I heard something about this on the radio the other day. They were saying in Alabama, I think, that a hip or knee replacement is anywhere from $23,000 to $140,000 depending on the hospital in the same city. That is a HUGE difference in price. 

This is from an article in the New York Daily News:

There are vast disparities nationally. The average charges for joint replacement range from about $5,300 at an Ada, Okla., hospital to $223,000 in Monterey Park, Calif.

It's not just national or even regional geography. Hospitals within the same city also vary wildly. In Jackson, Miss., average inpatient charges for services that may be provided to treat heart failure range from $9,000 to $51,000, the Department of Health and Human Services said.



Read more: http://www.nydailynews.com/news/national/hospital-charges-vary-greatly-care-report-article-1.1338476#ixzz2T1yMQcCD
NWP
by guerrilla girl on May. 11, 2013 at 7:51 PM
4 moms liked this

These costs should be transparent. It isn't right that people are paying for a service that they have no idea how much it will wind up costing and if they can get the same service for half the price on the other side of town. Our system is so screwed up. I think more transparency will help.

Billiejeens
by Gold Member on May. 11, 2013 at 8:48 PM
1 mom liked this
Quoting NWP:

These costs should be transparent. It isn't right that people are paying for a service that they have no idea how much it will wind up costing and if they can get the same service for half the price on the other side of town. Our system is so screwed up. I think more transparency will help.




Less Government will help.
Being able to shop around will help.
I can comparison shop for big screen TV's but not health care.
Someone else paying the bill is the problem, so obvious it is comical that supposed intelligent people can't see it.

yourspecialkid
by Platinum Member on May. 11, 2013 at 9:47 PM
4 moms liked this

 This is one of the things I wish the hc law would have addressed...putting the charges out there in the open.  People don't buy a car, a home or even a cell phone without knowing what they are getting and how much it will cost.

Most of the insured end up okay because of the policy limits...but insurance is part of the problem.  I would rather have seen a move away from insurance and a move to plans where you could sort of prepurchase services....5 office visits and a routine physical per year for X amount of dollars...then a catastophic policy to cover cancer and such.

I just don't think we will see a cost reduction in hc as long as insurance to cover hangnails to car wrecks is in the mix.

 

NWP
by guerrilla girl on May. 11, 2013 at 10:54 PM
2 moms liked this

Insurance is a large part of the problem.

Quoting Billiejeens:

Quoting NWP:

These costs should be transparent. It isn't right that people are paying for a service that they have no idea how much it will wind up costing and if they can get the same service for half the price on the other side of town. Our system is so screwed up. I think more transparency will help.




Less Government will help.
Being able to shop around will help.
I can comparison shop for big screen TV's but not health care.
Someone else paying the bill is the problem, so obvious it is comical that supposed intelligent people can't see it.


Neon Washable Paint

NWP
by guerrilla girl on May. 11, 2013 at 10:55 PM
3 moms liked this

You and I agree that insurance is a serious part of the problem...and my biggest problem with the ACA.

Quoting yourspecialkid:

 This is one of the things I wish the hc law would have addressed...putting the charges out there in the open.  People don't buy a car, a home or even a cell phone without knowing what they are getting and how much it will cost.

Most of the insured end up okay because of the policy limits...but insurance is part of the problem.  I would rather have seen a move away from insurance and a move to plans where you could sort of prepurchase services....5 office visits and a routine physical per year for X amount of dollars...then a catastophic policy to cover cancer and such.

I just don't think we will see a cost reduction in hc as long as insurance to cover hangnails to car wrecks is in the mix.

 


Neon Washable Paint

PestPatti
by on May. 11, 2013 at 11:40 PM


  I have always billed physcians charges, never facility charges. Cost prior to service isn't always that easy to answer.   There are some radiological exams that have different components, how many views will they need.  So many different things come into play.

 I do notice that we have one particular insurance company who wants information regarding all ER visits.  I have  to send notes and kick it to the patient to call them.  

  

Goodwoman614
by Satan on May. 11, 2013 at 11:45 PM
1 mom liked this

Universal healthcare.

NWP
by guerrilla girl on May. 12, 2013 at 7:45 AM
Bump
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