Consumers in May got to see what hospitals across the country charged for some of the most commonly performed inpatient medical procedures.
“Up until now there hasn’t been a one-stop shop to compare hospitals in the state, across multiple procedures,” said Victoria Veltri, Connecticut’s healthcare advocate. “It was a big move nationally, never mind for the state of Connecticut.”
The discrepancies, reflected in the 2011 data released by the Centers for Medicare & Medicaid Services, were eye-opening. Even in a state as small as Connecticut, there could be a difference of $100,000 or more for the same procedure — though there was much less of a difference between what hospitals were actually reimbursed for the procedure by Medicaid, Medicare or private insurance.
Those without insurance can be charged the full freight, said Veltri, if they earn an income above 250 percent of the federal poverty level.
The discrepancies in charges are difficult to make sense of, and not only for consumers.
“The data isn’t data that you could simply sit down at a desk and say, ‘Two plus two equals four,’ and it’s all very logical,” Veltri said. “One of the most valuable things that have come out of the release is to show how unclear it is and how little transparency there really is in pricing health care.”
Take the example of a knee replacement.
Stamford Hospital in 2011 charged $65,897 for a major joint replacement. Meanwhile, Danbury Hospital, just 30 miles away, charged $34,849 for the same procedure – a difference of more than $31,000.
Medicare, though, reimbursed Stamford and Danbury hospitals $16,932 and $16,458 respectively – a $474 difference.
The price differential carried over into emergency services.
If a patient was treated for a heart attack at Stamford Hospital, he could have been charged $57,410. The same year Danbury charged $33,152 – a difference of $24,258. When reimbursed, they received $14,275 and $13,798 respectively in actual payments – a $477 difference.
But this information may not be that helpful for consumers, said Kevin Gage, chief financial officer at Stamford Hospital.
“What the consumer really should be concerned about is what kind of discount was negotiated for their insurance, or in the case of Medicare, what Medicare paid,” Gage said. “Ultimately, what consumers should care about is what they pay out-of-pocket.”
Michele Sharp, director of Communications and Public Affairs for the Connecticut Hospital Association, said charges differ because hospitals and the needs of their communities vary.
“Each hospital reflects its individual mission, the prevalent medical issues of the patient population it serves, [and] specialized services or programs it provides,” Sharp said.
Other factors include whether it is a teaching hospital, conducts medical research or if it cares for a high number of uninsured patients.
The current system is complicated for the public to understand, Gage said.
“I’d rather have one price, here’s what we charge, here’s what we get paid, but that’s just not the way the system works,” Gage said.
The interactive infographic below compares hospital charges for 15 commonly performed medical services in Connecticut. Click the radio buttons to move from procedure to procedure and hover over the tiles to see the charge.
Note: Patients undergoing one of the 15 procedures above may have also had other medical issues, referred to as comorbidities and complications. Charges for procedures complicated by other medical issues were different in price.
** Major comorbidities or complications
* Complications or comorbidities