Hospital Medicare Charges: You Don’t Always Get What You Want

June 8th, 2015 by Tom Lynch

In early June of this year, the Centers for Medicare and Medicaid Services (CMS) let loose a treasure trove of data. One data set lists inpatient charges of 3,000 hospitals for the 100 most frequently billed diagnoses of 2013. The differences between what the hospitals billed and what Medicare paid are eye-popping, as are the differences between what hospitals within just a few miles of each other charged.

The inpatient data shows Medicare paid about $62 billion to cover more than 7 million discharges. Our good friends at Modern Healthcare have analyzed the data. This, from Modern Healthcare’s Bob Herman:

Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

The CMS data is shining a light on the process. The agency has now released data from 2011, 2012 and 2013. Charges for various inpatient and outpatient procedures differed significantly again in 2013 as they did in prior years. In many instances, charges fluctuated greatly among hospitals in the same region.

A Modern Healthcare analysis of the inpatient payment data shows Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.

Did you catch the part about the listed charges being irrelevant, because they’re only starting points for negotiations? Reminds me of the last time I bought a car.

You might be tempted to say, “That’s crazy! Why do hospitals do that?” Let me answer with a little story.

A few years ago, I was a Trustee at a major teaching hospital in Massachusetts, a tertiary care facility, one of the biggies. At one Board meeting early on in my trusteeship I asked the CEO how the hospital was compensated for uninsured people who were indigent. His answer? “We charge them the moon.” Note to reader: he’s talking about the indigent patient, here. “Then, when the state’s uncompensated care pool gets around to paying us, we’ll get a lot more than if we just charged them what the procedure cost, in which case we’d get a lot less than what the procedure cost.” I never forgot that lesson in hospital economics.

So, you see, when hospitals say their charges are “starting points,” they’re telling the truth. And that is one spooky scary example of what a first-class horrendoma the American healthcare system (if you can call it that) has become.

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