Hospital Billing Varies Wildly, Government Data Shows
By BARRY MEIER, JO CRAVEN McGINTY and JULIE CRESWELL
A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.
In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.
In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.
Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely.
The data for 3,300 hospitals, released by the federal Center for Medicare and Medicaid Services, shows wide variations not only regionally but among hospitals in the same area or city.
Government officials said that some of the variation might reflect the fact that some patients were sicker or required longer hospitalization.
Nonetheless, the data is likely to intensify a long debate over the methods that hospitals use to determine their charges.
Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.
Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.
http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?hp&pagewanted=print
New Medicare data reveal wildly varying charges among the nation's hospitals for 100 of the most common in-patient treatments and procedures, calling into question medical billing practices just as U.S. officials try to rein in rising costs.
The escalating price of medical care may complicate the rollout of the new federal healthcare law, which is designed to make health insurance affordable for millions of uninsured Americans next year. And federal officials said they hope the data will encourage more price competition and make consumers better healthcare shoppers.
In the Los Angeles area, for instance, one hospital's average price for knee and hip replacements in 2011 was as high as $223,373. That's seven times as much as the lowest charge of $32,022 in the Southland.
The average hospital charge for treating pneumonia ranged from $17,000 to nearly $70,000 in the L.A. area.
"We want to shine a much brighter light on practices that don't seem to make sense to us," said Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services. "We do not see any business reason for why there is so much variation in the data."
http://www.latimes.com/business/la-fi-hospital-prices-20130509,0,7708192,print.story
Hospital prices diverge wildly, U.S. data show
Medicare data on hospitals' disparate prices spotlight "practices that don't seem to make sense."
By Chad Terhune and Ben Poston, Los Angeles Times
6:33 PM PDT, May 8, 2013
The escalating price of medical care may complicate the rollout of the new federal healthcare law, which is designed to make health insurance affordable for millions of uninsured Americans next year. And federal officials said they hope the data will encourage more price competition and make consumers better healthcare shoppers.
In the Los Angeles area, for instance, one hospital's average price for knee and hip replacements in 2011 was as high as $223,373. That's seven times as much as the lowest charge of $32,022 in the Southland.
The average hospital charge for treating pneumonia ranged from $17,000 to nearly $70,000 in the L.A. area.
"We want to shine a much brighter light on practices that don't seem to make sense to us," said Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid Services. "We do not see any business reason for why there is so much variation in the data."
http://www.latimes.com/business/la-fi-hospital-prices-20130509,0,7708192,print.story
How much for joints, heart attack or pneumonia? Compare how Maine hospitals charge for common services
Posted May 09, 2013, at 6:20 a.m.
Maine hospitals charge widely differing amounts for the same procedures, in some cases three times more than their counterparts, according to new data released Wednesday by the federal government.
The price variations were detailed in a slew of data released by the Centers for Medicare and Medicaid Services that for the first time made public the amounts that 3,300 U.S. hospitals charged for the 100 most common inpatient procedures. The 2011 figures disclosed the average prices that hospitals charged Medicare, the government health insurance program for seniors, as well as the much lower amounts that Medicare actually paid.
In Maine, common treatments, including care for sepsis (a severe blood infection) and respiratory infections showed wide variations. Parkview Adventist Medical Center in Brunswick charged the government an average of $56,028 to treat a patient with severe sepsis. That’s double what Parkview’s competitor just a few miles away, Mid Coast Hospital, charged Medicare and nearly triple the lowest price of $20,130 at Cary Medical Center in Caribou.
For respiratory infections involving major complications, prices ranged from $28,443 at Eastern Maine Medical Center in Bangor to $62,029 at The Aroostook Medical Center in Presque Isle.
Overall, however, Maine hospitals billed Medicare less than the average reported by other hospitals throughout the country. A look at Maine’s 10 most common diagnoses by the number of admissions — which range from pneumonia to psychoses — also showed that while some hospitals charged a hefty three times more than others within the state, Maine’s price swings fell short of wild variations seen in other states.
The release fell on the same day as debate by Maine lawmakers about a bill that would make an independent state agency publicly accountable for analyzing hospital financial data. Sponsored by Sen. Geoffrey Gratwick, D-Bangor, LD 1453 directs the Maine Health Data Organization to publish an annual study of hospital finances and price discrepancies.
The organization, which is partially funded by hospitals, has been publicly reporting some hospital pricing and quality information for several years.
Wednesday’s data deluge was hailed by some as a major step toward greater transparency in hospital pricing that could help to lower skyrocketing costs and equip consumers to better shop for health care. Others criticized the data as irrelevant and confusing to patients, since they included no information about hospital quality and few consumers actually pay the hospital “sticker price.”
Medicare, Medicaid and private health insurers pay only a fraction of the prices that hospitals charge.
Bill submitted by Bangor senator seeks greater transparency for hospital financial data
Posted May 09, 2013, at 10:31 a.m.
AUGUSTA, Maine — A bill that creates a special commission and an annual study of hospital financial data for tax-subsidized hospitals in Maine may be the first step toward a more transparent health care system, according to proponents of the measure.
Just finding out how much any given medical procedure actually costs is nearly impossible, said the bill’s sponsor, Sen. Geoff Gratwick, D-Bangor.
He said while there were numerous reports noting the importance of greater transparency in medical costs he liked the medieval cliche about “would you buy a pig in a poke” to describe the problem.
“Informed consumers make informed choices,” Gratwick said.
Coincidentally, Wednesday the federal government released a new report detailing great disparity in the price hospitals across the country charge for similar procedures.
Gratwick, a doctor, said creating a more transparent system on medical costs, especially costs charged by nonprofit hospitals that receive public funding, was the key reason he sought office in the first place.
A first-term senator, Gratwick co-chairs the Legislature’s Insurance and Financial Services Committee, where the bill, LD 1453, was heard Wednesday.
The bill does two primary things, according to Gratwick.
First, the bill requires the Maine Health Data Organization to conduct an annual study of hospital financial data and to contract with an independent organization to analyze the data and present it in a “format that is easily understood by the average consumer.”
The bill also requires the state’s Department of Professional and Financial Regulation within the Bureau of Insurance to consider that analysis as part of the process it uses to review health insurance rate increases.
Gratwick said the state’s Maine Health Data Organization does collect and compile information on costs by hospital but it doesn’t detail that information very well or make it easy to find or easy to compare costs from one hospital to the next.
For example he said the cost of a basic lower back X-ray in Maine can range in price from $55 to $570.
“This data is really not very useful to patients without better analysis, without being focused differently,” Gratwick said.
New Test Improves Assessment of Prostate Cancer Risk, Study Says
By ANDREW POLLACK
A new test can help distinguish aggressive prostate cancer from less threatening ones, potentially saving many men from unneeded operations for tumors that would never hurt them, researchers are reporting.
The test, developed by Genomic Health, could triple the number of men who could confidently monitor their tumors rather than undergo surgery or radiation treatments, according to the company and to researchers.
Results of a study assessing the test’s performance will be presented Wednesday at the annual meeting of the American Urological Association in San Diego.
Many of the 240,000 cases of prostate cancer diagnosed each year in the United States are considered to pose a low risk of hurting or killing the man. But sometimes those assessments are wrong. So many men, reluctant to take the chance, undergo treatments that can cause impotence and incontinence.
“It’s very hard to tell a surgeon ‘I’d like to leave a cancer in place,’ ” said Dr. Jonathan Simons, president of the Prostate Cancer Foundation, a research and advocacy organization. “Having objective information is going to help a lot of patients make that decision.”
Dr. Simons, who was not involved in the study, said the development of new genetic tests like the one from Genomic Health represented a “watershed,” akin to going from pulse rate measurements to electrocardiograms in cardiology.
Still, some experts said it was too early to assess how accurate the test really was and whether it would make a difference in men’s decisions. Insurers are going to want to know that before deciding to pay for the test, which will be available starting Wednesday at a list price of $3,820.
Even the senior investigator of the study, Dr. Peter R. Carroll, said he was not sure.
“Certainly for a group of men it will have an impact,” Dr. Carroll, who is chairman of urology at the University of California, San Francisco, said in an interview. “The question is how many men and how many physicians.”
One hospital charges $8,000 — another, $38,000
By Sarah Kliff and Dan Keating,
Consumers on Wednesday will finally get some answers about one of modern life’s most persistent mysteries: how much medical care actually costs.
For the first time, the federal government will release the prices that hospitals charge for the 100 most common inpatient procedures. Until now, these charges have been closely held by facilities that see a competitive advantage in shielding their fees from competitors. What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services.
In the District, George Washington University’s average bill for a patient on a ventilator was $115,000, while Providence Hospital’s average charge for the same service was just under $53,000. For a lower joint replacement, George Washington University charged almost $69,000 compared with Sibley Memorial Hospital’s average of just under $30,000.
Virginia’s highest average rate for a lower limb replacement was at CJW Medical Center in Richmond, more than $117,000, compared with Winchester Medical Center charging $25,600 per procedure. CJW charged more than $38,000 for esophagitis and gastrointestinal conditions, while Carilion Tazewell Community Hospital averaged $8,100 in those cases.
Maryland has a unique system for hospital rate charges, so differences were smaller, and its average rate was lower than that of any other state in the most common procedures reviewed by The Washington Post. The highest average charge for a lower joint replacement was $36,000 by University of Maryland Medical Center in Baltimore, much lower than the highest rates in other states.
Elsewhere, Las Colinas Medical Center just outside Dallas billed Medicare, on average, $160,832 for lower joint replacements.
Five miles away and on the same street, Baylor Medical Center in Irving, Tex., billed the government an average fee of $42,632.
In downtown New York City, two hospitals 63 blocks apart varied by 321 percent in the prices they charged to treat complicated cases of asthma or bronchitis. One charged an average of $34,310; the other billed, on average, $8,159.
Experts attribute the disparities to a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts. Although the government has collected this information for years, it was housed in a bulky database that researchers had to pay to access.
The hospital charges being released Wednesday — all from 2011 — show the hospitals’ average list prices. Adding another layer of opacity, Medicare and private insurance companies typically negotiate lower charges with hospitals. But the data shed light on fees that the uninsured could pay.
Eastern Maine Healthcare Systems bid for Portland hospital draws support
Posted May 07, 2013, at 4:04 p.m.
PORTLAND, Maine — A bid by Eastern Maine Healthcare Systems to add a Portland hospital to its network drew unanimous support Tuesday at a public hearing about the deal.
Announced in late December, the system’s proposed merger with Mercy Health System of Maine would mark Brewer-based EMHS’ first foray outside its traditional footprint of northern, eastern and central Maine. The deal, if approved by regulators, is expected to buoy the financially struggling Mercy while giving EMHS its first foothold in southern Maine.
All 13 people who testified at the public hearing — largely employees, board members and others with professional relationships to the two organizations — urged the Maine Department of Health and Human Services to approve the merger. The department’s certificate of need division is reviewing the deal, which won federal approval in late February.
About 60 people attended the hearing held at the Holiday Inn by the Bay. Many of the speakers supported the merger as a way to preserve Mercy as a choice for patients in southern Maine. Portland’s other acute care hospital, Maine Medical Center, is a member of the MaineHealth system.
Did recession or health-care overhaul slow rise of medical costs?
Posted May 07, 2013, at 1:09 p.m.
WASHINGTON — People with health insurance saw increases in their medical costs slow from 2009 to 2011, signaling potential structural changes in the industry that could cut health-care inflation and save the U.S. government hundreds of billions of dollars, according to two studies.
The changes include greater use of generic drugs, higher out-of-pocket costs and more efficient care, a trend encouraged by the 2010 health-care overhaul, said David Cutler, a Harvard University health economist. If they permanently slow growth, the government may reap $770 billion in unexpected savings from projected expenditures by 2021, wiping out a fifth of the budget deficit, one of the studies found.
The studies, published Monday in the journal Health Affairs, suggest that while the recession accounted for almost 40 percent of the decline, hitting those who can’t afford medical care, other factors also were at work. The analysis will be part of the debate between President Barack Obama and Republicans over how to control spending growth for Medicare and Medicare.
“Folks have gotten the message: The money flows are going to be different, and they’re very much responding to that,” said Cutler, who co-authored one of the reports.
The two studies aim to shed light on why the annual growth of medical spending slowed from a high of about 8.8 percent in 2003 to an average of about 3 percent per capita from 2009 to 2011, according to data reported in January by the Centers for Medicare and Medicaid Services. Total health spending in the U.S. amounted to 17.9 percent of gross domestic product in 2011 or about $2.7 trillion, the agency said.
While neither study calculated a direct effect from the 2010 Affordable Care Act, Cutler, a former Obama adviser, said in a telephone interview that its influence is “gathering steam over time. It’s not a coincidence these things are happening at the very same time that policies are starting to penalize re- admissions, infections and things like that.”
Opponents of the 2010 law have said the slowdown is almost entirely attributable to the recession, and they expect when the law kicks in full force next year, spending growth will begin to surge again.
In one study, researchers analyzed health spending from 2007 to 2011 by employees with insurance supplied through 150 large companies. The growth of their medical spending dropped from more than 5 percent annually in 2009, adjusted for increases in out-of-pocket spending, to less than 3 percent in 2010 and 2011, the research found.
“I don’t want to downplay the importance of the recession,” said Michael Chernew, a professor of health-care policy at Harvard Medical School in Boston who also was an author of the study. “But even if you get rid of at least the direct effect of the recession, there was really something else going on.”
The indirect effect is harder to gauge, he said. While large firms maintained health insurance for their employees, the recession may have pressured them to work harder at holding down spending growth, he said.
“An alternative theory is that the slowdown in health-care spending growth reflected structural changes in the factors underlying the health-care system and that spending growth will remain low for some period of time, even after the economy fully recovers from the recession,” Cutler said in his paper.
The Next Contagion: Closer Than You Think
By MICHAEL T. OSTERHOLM
MINNEAPOLIS
THERE has been a flurry of recent attention over two novel infectious agents: the first, a strain of avian influenza virus (H7N9) in China that is causing severe respiratory disease and other serious health complications in people; the second, a coronavirus, first reported last year in the Middle East, that has brought a crop of new infections. While the number of human cases from these two pathogens has so far been limited, the death rates for each are notably high.
Alarmingly, we face a third, and far more widespread, ailment that has gotten little attention: call it “contagion exhaustion.” News reports on a seemingly unending string of frightening microbes — bird flu, flesh-eating strep, SARS, AIDS, Ebola, drug-resistant bugs in hospitals, the list goes on — have led some people to ho-hum the latest reports.
Some seem to think that public health officials pull a microbe “crisis du jour” out of their proverbial test tube when financing for infectious disease research and control programs appears to be drying up. They dismiss warnings about the latest bugs as “crying wolf.” This misimpression could be deadly.
It’s important to understand our relationship with the microbial world. Most microscopic organisms benefit humans, other organisms or the environment in some way — for example, they help us digest our food and keep bad bugs in check.
At the same time, we are never far away from one of the 1,400 kinds of disease-causing microbes that are capable of infecting people; many infect animals, too. Of these microbes, known as pathogens, about 500 can be transmitted from humans to other humans. And around 150 of them can cause epidemics — rapidly spreading outbreaks of serious, sometimes life-threatening, disease.
Cancer Vaccines Get a Price Cut in Poor Nations
By DONALD G. McNEIL Jr.
The two companies that make vaccines against cervical cancer announced Thursday that they would cut their prices to the world’s poorest countries below $5 per dose, eventually making it possible for millions of girls to be protected against a major deadly cancer.
Thanks to Pap tests, fatal cervical cancers are almost unknown today in rich countries. But the disease kills an estimated 275,000 women a year in poor countries where Pap tests are impractical and the vaccine is far too expensive for the average woman to afford, so the price cut could lead to a significant advance in women’s health.
The offer exemplifies a trend that started a decade ago with AIDS drugs: pharmaceutical companies, under pressure not to ignore the world’s poor, provide low prices on their newest products as long as donors guarantee large orders and pay for them.
The World Health Organization, which has been pressing for faster progress in maternal health, greeted the news as “a great step forward for women and girls.”
When the new price was described, Dr. Paul D. Blumenthal, a professor of gynecology at the Stanford University School of Medicine who has pioneered cervical cancer prevention techniques in poor countries, said, “Mazel tov!” As long as there is enough affordable vaccine for the ever-growing populations of poor countries, he said, “this is good news for girls, women and their families.”
The lower prices — $4.50 for Merck’s Gardasil vaccine and $4.60 for GlaxoSmithKline’s Cervarix — were negotiated through the GAVI Alliance, which was created in 1999 with a grant from the Bill and Melinda Gates Foundation to deliver more vaccines to the world’s poor.
The low price will initially apply to a few million doses for demonstration projects in Kenya, Ghana, Laos, Madagascar and elsewhere, but Dr. Seth Berkley, the alliance’s chief executive, said he hoped that by 2020, 30 million girls in 40 countries would get the vaccine at that price or less.
The vaccines must be kept refrigerated, and three doses are normally given over six months — requirements that add to the difficulty of deploying them in poor countries.
The vaccines cost about $130 a dose in the United States. The lowest price that any other agency or government has negotiated, Dr. Berkley said, is the $13 paid by the Pan American Health Organization, which has a bulk rate for Latin American countries.
The successes of Obamacare
By Nancy-Ann DeParle,
Nancy-Ann DeParle was assistant to the president and deputy White House chief of staff for policy from February 2011 to January 2013. From March 2009 to February 2011, she was counselor to the president and director of the White House Office of Health Reform.
For more than 100 years, leaders from both parties struggled to bring affordable health care to all Americans. When President Obama took up the fight, many people predicted defeat. Three years, 34 repeal votes, one Supreme Court decision and a presidential election later, some are questioning whether government is capable of implementing the historic law. Concern is understandable: The Affordable Care Act (ACA) transforms a health-care system that accounts for one-sixth of the U.S. economy and is central to our lives. But recent history shows that big changes in health-care policy can be implemented.
The worries being voiced are familiar to those who follow health-care policy. They’re certainly familiar to me. I became the administrator of Medicare and Medicaid in 1997, just as Congress passed the most sweeping changes in Medicare’s history. The Balanced Budget Act of 1997 cut nearly $400 billion from providers such as doctors, hospitals and nursing homes; cracked down on waste and fraud; created a new Medicare HMO program; and launched the Children’s Health Insurance Program (CHIP) with a goal of covering millions of uninsured children.
Even members of Congress who voted for the law soon questioned whether it could work. Critics said that it was too big and complicated, that payment reductions would drive doctors and hospitals out of business and strand senior citizens without care, and that states would not cooperate in enrolling children in CHIP. Some predicted a Y2K crisis that would cripple government computers.
In fact, the law saved billions more than originally projected and extended the life of the Medicare “trust fund” by almost a quarter-century. We modernized payment systems and cut Medicare waste and fraud nearly in half. Millions of children in every state were insured thanks to CHIP.
A few years later, similar doubts surrounded the launch of two Republican initiatives: President George W. Bush’s Medicare prescription drug plan and Mitt Romney’s health-care reform in Massachusetts. Today, the Medicare prescription drug benefit helps millions of seniors, and the Massachusetts plan is a model for the nation.
Soon the Affordable Care Act will add a new chapter to this history of real-world success.
Critics say the law is complex. They are right. When Obama first took office, 51 million Americans were uninsured, premiums had more than doubled in the preceding decade, and insurers could deny coverage to those who needed it most. If easy solutions existed, someone would have found them long ago.
Why Obamacare is oversold
By Robert J. Samuelson,
It’s the great moral imperative behind the Affordable Care Act (“Obamacare”): People should not be denied health care because they can’t afford insurance. Health status and insurance are assumed to be connected, and opponents have often been cast as moral midgets, willing to condemn the uninsured to unnecessary illness or death. The trouble is that health status and insurance are only loosely connected. This suggests that Obamacare may result in more spending and health services but few gains in the public’s health.We now have a study based on Medicaid in Oregon implying just that. Judging the effect of insurance on health has always been difficult, because the uninsured are different from the insured: They’re poorer, younger and often sicker. How much of their worse health reflects a lack of insurance? To answer, researchers need to compare similar people with and without insurance.
Oregon’s expansion of Medicaid — the federal-state insurance for the poor — unwittingly solved this problem. In 2008, the state decided to increase enrollment by 10,000. But there were 90,000 people on the waiting list, so the state adopted a lottery to decide who would receive coverage. The result was two similar groups of poor people — one with insurance (Medicaid) and one without — that could be compared. The New England Journal of Medicine recently published the study.
The most overlooked finding is that the uninsured already receive considerable health care. On average, the uninsured annually had 5.5 office visits, used 1.8 prescription drugs and visited an emergency room once. Almost half (46 percent) said that they “had a usual place of care,” and 61 percent said that they had “received all needed care” in the past year. About three-quarters (78 percent) who received care judged it “of high quality.” Health spending for them averaged $3,257.
True, when people were covered by Medicaid, many of these figures rose. The annual number of office visits went to 8.2; the number of drugs, to 2.5; the share of patients with a usual place of care, to 70 percent; the proportion receiving all needed care, to 72 percent. Preventive care also increased. The share of patients receiving screening for cholesterol moved from 27 percent for the uninsured to 42 percent; the share of women older than 50 having mammograms jumped from 29 percent to 59 percent; the share of men older than 50 getting PSA tests for prostate cancer doubled, from 21 percent to 41 percent. Spending rose to $4,429.
Unfortunately, the added care and cost didn’t much improve physical health. The study screened for high blood pressure, high cholesterol, diabetes and the risk of heart attack or stroke. No major differences were detected between the uninsured and Medicaid recipients. There was more treatment for diabetes, although no difference was found between the two groups on a key indicator of the disease.
http://www.washingtonpost.com/opinions/overselling-obamacare/2013/05/09/f9446786-b8be-11e2-92f3-f291801936b8_print.html
Maine groups call for universal health coverage
Posted May 09, 2013, at 3:12 p.m.
PORTLAND, Maine — Several Maine advocacy groups joined forces Thursday to launch a new grass-roots campaign for universal health insurance coverage.
At press conferences in Portland and Bangor, the coalition urged Mainers to work toward a new health care system that recognizes treatment for illness and disease as a human right. Represented organizations included the Maine People’s Alliance, Maine AFL-CIO and the Maine State Nurses Association.
About 45,000 Americans die every year due to a lack of health care, while 44 percent of Maine employers don’t offer health coverage, said Jennie Pirkl of the Maine People’s Alliance.
“For all the improvements of the Affordable Care Act, we still have a broken system where too many people are being left behind,” she said. “We can’t continue like this, and we can’t continue to let the for-profit insurance industry control so much of our government. We must recognize health care as a human right and organize to make things better.”
The coalition did not present a plan for achieving universal insurance coverage, but said their goal was to ensure that all Maine people have access to high-quality care and a greater voice in how the health care system is run.
Marie Pineo of Falmouth said she worries about her financial stability after her MaineCare coverage ceases in May following eligibility changes approved during the most recent legislative session.
“I have a heart condition that does not allow me to work full-time hours, which means I cannot hope to get lucky by finding one of the few jobs that offers health insurance,” she said. “We are scared and stressed, which only leads to more health problems. Health care is a human right; it is a matter of life and death, and we can’t afford to deny care anymore.”
No comments:
Post a Comment