Hospital charges for same procedure vary widely

Hospital charges for same procedure vary widely

URBANA — Charges for the same surgery or treatment can vary widely at three local hospitals, newly released government data shows.

And the differences in some cases aren't small.

The average covered charges for one category of hospital admission alone — major small and large bowel procedures with major complications and comorbidities — totaled $115,987 at Carle Foundation Hospital, $147,606 at Presence United Samaritans Medical Center and $201,750 at Presence Covenant Medical Center.

What hospitals charge is typically a mystery to consumers. The data released by the Centers for Medicare and Medicaid Services, intended to lift the veil, includes prices from 2011 at thousands of hospitals across the country on the top 100 inpatient stays most frequently billed to Medicare.

Also included is the average Medicare payment made to each hospital for those inpatient stays.

Charges can vary widely even in the same community and hospital system, but the numbers don't explain why.

Illinois Hospital Association spokesman Danny Chun says hospital charges are based on many factors — their labor costs, their geographic area and the services they provide, to name a few.

Some hospitals, for example, those that are academic teaching hospitals and/or maintaining more costly services such as Level 1 trauma centers, neonatal intensive care centers, burn units and transplant centers, have higher costs to cover.

Some hospitals also serve greater numbers of uninsured patients and those on Medicare and Medicaid, meaning they have more uncompensated costs to cover, Chun said.

"You've got to come up with the revenues to cover your costs," he said.

Some examples of the wide cost swings: Charges for going to the hospital for a respiratory infection with complications and comorbidities ran $53,546 at United Samaritans and $38,902 at Covenant — both in the same hospital system.

The national average inpatient charge for certain joint replacements was $50,116, but there was a wide swing in prices for same coded procedure locally: $92,656 at United Samaritans, $65,635 at Covenant and $46,391 at Carle.

If you were hospitalized for COPD, or chronic obstructive pulmonary disease — the third leading cause of death in the U.S. — and you had comorbidities and complications, there was a $10,000 price difference between the two Urbana hospitals.

It cost $30,716 at Covenant, $20,670 at Carle and $26,732 at United Samaritans.

What Medicare paid on charges was much less. For COPD, for example, the average Medicare payment was $6,097 at United Samaritans and $6,319 at Covenant.

Officials at Covenant, United Samaritans and Carle weren't available for comment on the data release.

Chun called it "a starting point" but nothing close to a useful tool for consumers.

"I would never recommend that anyone use this data to do comparison shopping," he said.

That's because the charges don't reflect what any hospital patient in Illinois pays, Chun said.

Medicare and Medicaid pay hospitals substantially less than they charge. And for patients with private insurance, the charges and out-of-pocket costs are negotiated by contracts between their insurers and health care providers, he said.

And if you're uninsured: The amount uninsured hospital patients must pay is capped and subject to mandatory discounts under the Illinois Uninsured Patient Discount Act, Chun points out.

The state Uninsured Patient Discount Act requires hospitals to provide free or discounted care to income-eligible uninsured patients and caps the maximum hospitals can collect from uninsured patients in one 12-month period at 25 percent of the annual family income.

"I'm making this point because (Centers for Medicare and Medicaid Services) did this data dump, and it's, in a way, confusing to consumers if you just look at charges and say, oh my God, is that what I have to pay for that," Chun said.

Examples at local hospitals

 

Average covered charges for some common Medicare inpatient stays at Presence United Samaritans Medical Center in Danville, Presence Covenant Medical Center in Urbana and Carle Foundation Hospital in Urbana.

CC = complications and/or comorbidities; MCC = major complications and/or comorbidities.

Respiratory infections with CC

United Samaritans: $53,546

Covenant: $38,902

Carle: $34,569

Simple pneumonia & pleurisy without CC/MCC

United Samaritans: $24,055

Covenant: $23,881

Carle: $22,322

Heart attack, discharged alive with CC

United Samaritans: $27,415

Covenant: $22,019

Carle: $32,468

Major small & large bowel procedures with MCC

United Samaritans: $147,606

Covenant: $201,750

Carle: $115,987

Major joint replacement or reattachment of lower extremity without MCC

United Samaritans: $92,656

Covenant: $65,635

Carle: $46,391

Hip & femur procedures (except major joint) with CC

United Samaritans: $49,992

Covenant: $60,724

Carle: $51,553

Diabetes with CC

United Samaritans: $25,008

Covenant: $28,651

Carle: $17,446

Major cardiovascular surgery without MCC

United Samaritans: Not done at this hospital

Covenant: $106,556

Carle: $118,242

Medical back problems without MCC

United Samaritans: $29,153

Covenant: $21,842

Carle: $26,887

Source: Centers for Medicare and Medicaid Services

http://go.cms.gov/16WaMfH

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ERE wrote on May 10, 2013 at 10:05 am
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For all the criticism levied at Carle, the leader in Central Illinois/Eastern Indiana healthcare, it's great to see this article which shows their outstanding care is consistently the least costly. Congratulations, Carle! 

Danno wrote on May 10, 2013 at 3:05 pm

Hmm. Drive past other stations to save $1? Myself/perhaps others, if it comes down to saving 1-2 cents per gallon (say 15 gal...15-20 cents?)...ummm...I go to the less busy one across the intersection. I really would prefer to be...'discharged alive'...