In 1997, it cost me over $5,000 for an overnight observation stay.
Ambulance cost was $200
Doctor was $200
Dee Finney's blog
start date July 20, 2011
today's date May 8, 2013
TOPIC: THE OUTRAGEOUS COST OF HOSPITAL CARE
THIS IS THE REASON HEALTH INSURANCE IS SO COSTLY
Hospital Prices No Longer Secret As New Data Reveals Bewildering System,
Staggering Cost Differences
When a patient arrives at Bayonne Hospital Center in New Jersey requiring
treatment for the respiratory ailment known as COPD, or chronic obstructive
pulmonary disease, she faces an official price tag of $99,690.
Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental
Health Center charges only $7,044 for the same treatment, according to a massive
federal database of national health care costs made public on Wednesday.
Americans have long become accustomed to bewilderment and anxiety when
confronting health care bills. The new database underscores why, revealing the
perplexing assortment of prices for medical care, with the details of bills
seemingly untethered to any graspable principle.
Even within the same metropolitan area, hospitals charge prices that differ
by staggering degrees for the same procedures. People without health insurance
pay vastly higher costs for care when less expensive options are often available
nearby. Virtually everyone who seeks health care winds up paying inflated prices
in one form or another as these stark disparities in price sow inefficiencies
throughout the market.
While this basic picture has emerged as the consensus reality among health
care experts, their evidence has been primarily anecdotal. Hospitals have
protected their price lists -- documents known as charge masters -- as closely
Their prices are secret no more.
The database released on Wednesday by the federal Centers for Medicare and
Medicaid Services lays out for the first time and in voluminous detail how much
the vast majority of American hospitals charge for the 100 most common inpatient
procedures billed to Medicare. The database -- which covers claims filed within
fiscal year 2011 -- spans 163,065 individual charges recorded at 3,337 hospitals
located in 306 metropolitan areas.
The Obama administration shared the data in advance with The Huffington Post,
The New York Times and The Washington Post. What emerges through a preliminary
analysis is a snapshot of an incoherent system in which prices for critical
medical services vary seemingly at random -- from state to state, region to
region and hospital to hospital.
These price differences impose a uniquely punishing burden on the estimated
49 million Americans who have no health insurance, experts say. They are the
only ones who see on their bill the dollar amounts listed on these official
price lists. Yet these same prices effectively shape what nearly everyone pays
for health care, because they determine how much private health insurance
companies must surrender in reimbursement for services. That in turn influences
the size of the premiums that insurance companies charge their customers.
Obama administration officials declined to characterize the causes of these
gaping disparities in price, leaving unclear whether they reflect some form of
malevolence -- profiteering by some institutions or price-rigging -- or rather
more nebulous factors, such as varying estimates about the underlying costs of
[Click here to search the database.]
Administration officials said they offered up the data with hopes that its
release would administer a market corrective, forcing hospitals to take greater
heed of competitors while arming ordinary people with information they could use
to seek a better deal. The data could also spur health insurance companies to
negotiate with hospitals to seek lower prices.
"Our purpose for posting this information is to shine a much stronger light
on these practices," said Jonathan Blum, director of the Center for Medicare.
"What drives some hospitals to have significantly higher charges than their
geographic peers? I don't think anyone here has come up with a good economic
The very fact that prices are now public may bring change, he added.
"Hopefully, it will cause hospitals themselves to take a hard look at their
charge-master practices and to ask hard questions of themselves as an industry
why there is so much variation," he said.
Within the nation’s largest metropolitan area, the New York City area, a
joint replacement runs anywhere between $15,000 and $155,000. At two hospitals
in the Los Angeles area, the cost of the same treatment for pneumonia varies by
$100,000, according to the database.
Public access to this data on hospital charges pulls back the curtain on one
of the most troubling characteristics of the American health care system:
Medical providers set their prices in ways that seem arbitrary, with little
oversight and practically no market incentive to reduce them, because almost no
one actually pays the official rates.
The data lands as unexpected health care bills continue to be a leading cause
of financial ruin for American families. Uninsured and low-income people are
often subject to
aggressive debt collection by hospitals and their agents when their
illnesses result in bills they cannot pay.
Even among people of means, skepticism about American health care is common
and with reasons based in data:
Americans typically pay higher prices for health care than people in other
without gaining higher-quality care or superior health.
The new trove of billing data seems certain to amplify calls for a solution
to rising medical costs -- not only for ordinary people, but for the economy as
Health care spending continues to grow faster than the economy, though the
rate of increase has
slowed in recent years, prompting hopes that a fix may be materializing.
In 1999, average charges billed to Medicare were equal to 104 percent of the
cost to provide medical care, according to a report issued last June by the
Medicare Payment Advisory Commission, an expert panel that counsels Congress. By
the ratio had more than doubled to 218 percent.
The Centers for Medicare and Medicaid Services long has had access to
hospital charges via the cost reports facilities must submit to the agency, said
Blum, the Obama administration official. Before now, few had given a thought to
making the data public. His agency's actions were inspired in part by
a sweeping Time magazine article on hospital charges by author Steven Brill
published in March, Blum said.
The newly released data covers facilities that were collectively responsible
for 90 percent of inpatient claims to Medicare while excluding certain
institutions, such as children's hospitals and cancer centers.
The Huffington Post reviewed the two dozen types of services billed to
Medicare at least 100,000 times in fiscal 2011 in 13 metropolitan areas spanning
the U.S. The locations varied in population from less than 1 million to the
largest three metro areas: New York; Los Angeles; Chicago; Portland, Ore.;
Austin, Texas; Jacksonville, Fla.; Richmond, Va.; Birmingham, Ala.;
Tucson, Ariz.; Honolulu; Madison, Wis.; Provo, Utah; and Chattanooga, Tenn.
How is it possible that two hospitals in close proximity would set prices as
differently as Bayonne Hospital Center in New Jersey and the Lincoln Medical and
Mental Health Center in New York? It's partly a relic of how hospitals used to
operate and partly reflects their strategies to maximize revenues in ways that
don't have a direct connection to the cost of the care they provide any
"The charge masters are totally irrational," Robert Laszewski, a former
health insurance company executive who consults for health care companies as
president of Alexandria, Va.-based Health Policy and Strategy Associates, wrote
in an email to The Huffington Post.
Hospitals used to base prices on health care costs and on the need for profit
that would, among other things, enable them to make investments in their
facilities, Laszewski explained. "They became the baseline from which the
hospitals started," he wrote. But over time, hospitals raised charges in
anticipation of negotiating discounts with private health insurance companies
while maintaining their revenue streams, he said.
Prices have continued growing over decades to the point where there is no
plausible justification for them, according to Laszewski: "Over the years, the
charge masters have become more and more disconnected from reality."
The charges are the prices hospitals establish themselves for the services
they provide. Although Medicare and Medicaid don't base their payment rates on
these figures, private health insurance companies typically do, which means they
usually pay more for the same health care than the government does. That
translates into higher premiums for people with insurance. And uninsured people
are expected to pay the full list price or a discount from that number, which
tends to mean they pay more than anyone else.
When a hospital doesn't get paid as much as it wants from one source, it
tries to make up the difference in other ways, such as billing so-called
self-pay patients -- almost always the uninsured -- for the full list price of a
service, said Robert Huckman, a health care expert at Harvard Business School.
Even when hospitals agree to huge discounts for patients who can't pay the bill,
those discounts are taken from inflated prices much higher than those the
government or private insurance companies pay, he said.
"The charge master is complete nonsense that really doesn't matter -- unless
you are an uninsured person and you're getting these huge bills driving you
toward bankruptcy," Laszewski wrote. "The biggest irony of the U.S. health care
system is that only the uninsured -- often people who don't have a lot of money
-- are the only ones the hospital expects to pay these incredibly inflated list
Hospitals also inflate charges to raise money for things that aren't related
to treatments, said former Sen. David Durenberger (R-Minn.), who is senior
health policy fellow at the University of St. Thomas in Minneapolis.
"The biggest factor by far, in my experience, is what are you trying to
cross-subsidize," he said. Hospitals will increase charges to finance things
like technology upgrades and education and research and to compensate for their
operational efficiencies, Durenberger said.
Myriad reasons legitimately explain how a health care service may be priced
much differently from area to area, including labor costs and other local
economic circumstances. But such factors fail to explain price discrepancies
among hospitals in close proximity, Huckman said. "There's no doubt that the
variation in charges is significantly larger than the variation in the
underlying costs for these hospitals," he said.
The new Medicare database is replete with examples of inexplicably high
prices and wide variations between hospitals in the same geographic area. The
peculiar disorganization of the American health care system is evident by
looking at just a few instances.
In the New York metro area, Bayonne Hospital Center -- part of a chain called
CarePoint Healthcare -- charges the highest prices for several types of
procedures, including COPD treatment, among the regional hospitals reviewed by
HuffPost. Its price for that treatment runs four times the average in the New
York area, according to the database. Medicare -- the government health care
program for older people and people with disabilities -- paid an average of
$6,826 for these same treatments within the New York area -- or less than 7
percent of Bayonne Hospital Center's charge.
Major joint replacement surgery at the hospital comes in at $155,769, which
is almost three times the local average and more than nine times the price at
Lincoln Medical and Mental Health Center in the Bronx. Medicare paid an average
$18,944 in that area.
Garfield Medical Center in Monterey Park, Calif., outside Los Angeles,
charges $241,654 to take care of a patient undergoing renal failure with major
complications, which is almost 10 times the price at Beverly Hospital about 5
miles away in Montebello and more than three times the regional average.
And Birmingham's Brookwood Medical Center has the highest charges in 14 of
the 24 Medicare billing categories in area facilities HuffPost reviewed,
including a $156,958 price for simple pneumonia and inflammation of the lung.
That's almost 12 times what the same treatment costs at Russell Hospital about
an hour away in Alexander City, Ala., and about four times the local average.
Loyola Gottlieb Memorial Hospital in Melrose Park, Ill., outside Chicago,
charged the highest prices for 16 of the 24 procedures reviewed by HuffPost. For
kidney failure, Loyola Gottlieb charged $97,926, more than twice average cost of
59 hospitals in the Chicago area. The price is more than five times what John H.
Stroger Jr. Hospital, 12 miles to the east, charges.
Those numbers reflect data from fiscal year 2011, and an official from Loyola
University Health System, which runs the Gottlieb Memorial Hospital, said the
hospital has reduced charges by an average 25 percent since then. "Loyola
University Health System closely monitors charges and conducts reviews regularly
to ensure that the health system is competitive in the Chicago market," said
Chief Financial Officer Jay Sial, in a written statement.
The other hospitals named in this article did not respond to or declined
requests for comment.
The public availability of hospital charges is unlikely to bring swift and
radical change to pricing or spare uninsured patients from exorbitant bills,
said Huckman, the Harvard health care expert. Still, he added, it’s a good
"It would be hard for a hospital -- unless there's a justified reason -- to
be able to preserve a large margin over what its otherwise equal competitors
charge," Huckman said. "If someone knows the amount that even the most
advantaged payer reimburses a hospital for a particular service and they can
take that in with their own bill, I think that gives a pretty powerful
opportunity for that customer to interact with the organization and say, 'Why is
my number so different?'"
Jay Boice, Aaron Bycoffe and Andrei Scheinkman contributed to this
PREVIOUS PAGES ABOUT HOSPITALS
WE HAVE OVER 1,000 PAGES ABOUT HOSPITALS
THESE ARE THE ONES WITH THE WORD 'COST' ON THEM
in Kansas City, whose three-million-dollar
cost would be paid for by Kansas City ..... One
occasion involved the Queen Elizabeth Research Hospital
in Adelaide, ...
Cost-effective implementation of
operations is achieved by NSA computer ..... Gunn is a
former Veterans Affairs clinical psychologist at the VA
Hospital in Ann ...
Dr. Karl Jandrey / U.C. Davis Veterinary
Hospital: "We're looking for nice pink mucous ...
You can return the animal for a refund and the cost of
veterinary care, ...
At Thomason Hospital in El Paso,
officials said their first attempt to estimate the cost
found $1 million over just three months. Thomason Hospital
responded by ...
Costs a couple of bucks a bucket.
... Or get real fur, but probably will cost more.
.... first aid kit (see the STOMP portable hospital
at www.cheaperthandirt.com as ...
night, the ambulance rushed the
infant to the neonatal intensive care unit at St. Mary's
Hospital, Knoxville, Tennessee. ... There is no
cost, but lots of rewards.
Ivan damaged Grenada's main hospital
and several of its hurricane shelters, ...... and
expectations of a disruption in gulf production pushed up oil
prices more ...
This close-knit group determines whether prices rise or fall (by their control of the
released from a maximum security prison or mental hospital,
but people who ...
They have already discovered that some
hospitals will have Swat Teams at the ..... For my
part, whatever anguish of spirit it may cost, I am
willing to know the ...
So many people are sick that
hospital emergency rooms are swamped and
..... at a direct cost of more than
US$60 million and an indirect cost to the
industry of ...
Should Diana have been taken to
hospital from the crash scene sooner than she
.. because I had my body
mass index tested at the V.A. hospital two
days after ... The cost of liberty
is eternal vigilance; this is the lesson that
America forgot in ...
Mar 21, 2012 –
... look at a house that only cost
$259 a month rent and when he got there, ...
us to a room where we could change clothes into
She spent three months in
hospital and had to learn how to talk and walk
again. ...... (The cost of which
will fall on the employer NOT the State of New
Sep 16, 2009 –
Serious medical cases can be referred to
hospital, where they are treated at the
patients' own cost. Educational services
consist of one primary ...
The Price of Silence -
Introduction by Laurence Fishburne (Watch in high
quality and ... After working for 10 days at
the Shifa Hospital in the war-torn
Stop trying to prove things at all
costs and start trying to see what actually
the reality is. .... Hospital
officials in neighboring Danbury said they were
treating three ...
Dec 19, 2012 – Stop
trying to prove things at all costs and start trying to
see what actually ..... in front of them, leaving one of
them needing hospital treatment.
Apr 3, 2009 – Linda
Miller, a spokeswoman at Our Lady of Lourdes Hospital
in ...... to do risk and cost-benefit analysis,
and the role of the pharmaceutical ...
Mar 26, 2012 – The
reason why there is cost shifting is because the
government has mandated that. It has required hospitals
to provide emergency treatment, ...
The family was taken to Windom Area
Hospital, where all six were pronounced ....
Abramson said yesterday that he expects the cost of
cleaning up debris and ...
Nov 28, 2006 – Among the
cost cutting initiatives was a push to privatize of the
.... appendectomy on February 16, 2006 at Hudson Valley
Oct 19, 1997 – Trudot
was in the hospital at the time. ...
consequences of a crystal methamphetamine -- or "crank" -- habit
that costs $4,800 to $6,000 a week.
Jul 20, 2012 – One of
the injured was just 3 months old, according to hospital
workers. ..... as all the extras that you need to
effectively run these guns cost a lot ...
Feb 14, 2013 – ...
1971, Assistant Director of the Cost of Living Council
from 1971–73, ...... On October 15, 2008, Cheney returned
to the hospital briefly to treat ...
Dec 30, 2006 – Adam Air
is a privately owned, low-cost airline that began
... who goes by only one name, as he waited at the local
hospital for news of his son.
That presumably would cost
quite a bit of money in lost revenue. ......
board member and a library board member, I
served on a hospital
Mar 9, 2004 –
that she could know the price
increase that much in the .....
treatment is complete, he is
afraid to go home.
Jan 12, 2012 –
me a price
of $2.75 an hour and then
quickly changed it to a ......
hosted 850 pregnant ...
Mar 1, 2001 –
I looked at
several of the gifts, one of which was a fancy
box of pencils that cost
3-15-01 - DREAM - I was in a
have suffered a mental breakdown and
was admitted to Bethesda Naval Hospital
No matter what the cost
either in dollars or lives, the U.S. had to win
Mar 1, 2003 –
inside, I found a label that said it had
was a big building - a school room and doctors
like a hospital
units, ambulances, all kinds
of sheriff's vehicles, tents which looked
2002, Pg 858 – The government will
establish a Public Health Fund at a cost
Feb 8, 2012 –
father was misdiagnosed at the public
for over a ...
nuclear reactor's cost
while receiving no benefit!
Feb 13, 2012 –
which was a good price
, but I asked the
clerk if she had any ......
room visits, more hospital
and premature ...
Mar 1, 2010 –
me of a hospital
colored lab coat I've
seen on nurses, but it ......
of potatoes weighs 55 pounds) (That would
gains a $20 per acre cost-saving
(compared to older techniques
that .... and called as well as
media , hospitals,
clinics and medical
Dec 20, 2011 –
Dozens of armed federal
agents storm Hospital
Santa Monica (California) ....
their actions by claiming the
products contain the wrong
As support for
the war collapses, the cost
will become clear: For most
citizens, ..... attacking
antiwar demonstrators and
sending many to the hospital,
... illegal ...
Mar 16, 2002 –
... a city that had
become a hospital
center for german, american and
british ... This enraged Hitler,
who issued a command that may
have cost ...
Jun 23, 2009 –
The Iraqis took Lynch to
the local hospital,
where she was kept for ......
which cost the lives of
several million of the
Indonesian Communist Party.
control uranium supplies and
prices globally, and one
serves ...... Kamal Hadeethi, a
physician at a regional
hospital, said, "The
corpses of the ...
Mar 7, 2008 –
I went to the
hospital and the doctor was
going to take me upstairs and he
wasn't quite finished with
another patient, ..... at only
Sep 11, 2001 –
representatives said they had
hoped to see more ..... In such
fashion, American citizens will
pay the price for evils
nurtured by a ...
Dec 6, 2011 –
The new bathrooms
reportedly cost three
million yuan. ..... From 1941 to
1945 was in the building complex
to a hospital, and
again from 1945 to ...
... is a well
oiled machine that is there to
be used, even at the cost
of the planet. ..... fact whilst
in Gilford they washed the
hospital laundry to test
low flying UFO and
then taken to an Air
no one would explain
.... its planes is
going to cost;
maybe, despite the
skepticism of the
scientists and ...
compared to that of
assigning a paid law
sending many to the
says the loss of
income is compounded
by food prices
that are "still
recently rushed to
1, 2003 –
Remains that a
as charred torso,
thigh bone and skull
on ...... In
as dubious as the
27, 2012 – In
1961 Aho was
committed to a
an event he later
attributed to ...
The ritual beings
with a prayer,
usually led by
and tunnelled into
the rock to create
arms dumps. .....
Next week he may be
silence with a Thai
14, 2012 –
... being held at
saying Obama had
cost the nation
Generators kept the
operating and no
patients were in
danger, ..... not
going to cost
anybody their home
and it's not going
anybody their life,"
11, 2001 –
But that flexibility
comes with a
under the act .....
said Mary Johnson of
the Greater New York
28, 2012 –
State Estimates of
Associated with ...
of Visits to
Sep 11, 2001 –
Pentagon Repairs to
Cost Well Over $1 Billion
.... A portable morgue and field
hospital were set up on
a highway next to the building.
Dec 1, 2000 –
I also wanted to see a
price list which
enumerated the different types
of ...... As it turned out, it
was a hospital of some
kind and I was working ...
Mar 26, 2000 –
Dozens more people have
been admitted to hospital
with heat-related illnesses,
authorities said. The heat wave
..... Cost of Extreme
cost has been diplomatic,
as downstream neighbors suspect
..... “I had to go to
hospital and was put on
medication to get rid of the
infections from the ...
May 10, 2012 –
So if microwaves are not
safe for babies and in
hospital settings, can they
really be .... Become a member
and get all products at
wholesale cost ...
May 12, 2012 –
Mr. Sendak, who died at
Danbury Hospital, lived
nearby in Ridgefield, Conn. ....
“How much does it cost
to get to where the wild things
Dec 13, 2011 –
... information that
could affect the stock price
can be a criminal offense,
...... to Cooper University
Hospital in Camden, a Level
I trauma center.
About the High Price of
Cheap Food 10. ...... After a
month in the hospital,
he was transferred to a
rehabilitation center and soon
will be home to ...
costly in history of
California. So far ... Fighting
the disaster is reported to have
so far cost more than
$300m (£150m) and ... He later
died at a hospital.
At first I was
concerned about how far it was
away from a hospital,
then I .... to give us an
estimate of what it would
cost to set up a radio
station in the building.
Jan 2, 2004 –
It cost $2-10 -
to get into the theatre. ......
to go back into the hospital
and she didn't want to
because she was afraid to hear
the voices again.
Feb 1, 1993 –
It cost $1.00.
He said he was sick and would
have to be in the hospital
awhile. He asked me to take care
receive a £17million lump sum
payment but the price
would be the loss of her royal
status. The princess was not
someone to stand on ceremony but
Mar 5, 2012 –
There may be quite a
price on the reproductive
elements of some ..... as a
clinical psychologist at the Ann
Arbor Veterans Affairs
Hospital. There ...
military draft long past, the
thinking seems to go, what
cost can a U.S. ... He
wanted to be able to walk into a
hospital and not be
asked for insurance ...
... to problem
solve building of lunch room
tables with benches vs cost
vs work, ..... They all looked
like patients in a hospital
anyway and this place didn't
Feb 8, 2002 –
UAN has pledged to
sponsor the annual cost
of Phyllis' retirement .....
Soap operas like ''Passions''
and ''General Hospital''
are big hits, the ...
Chattanooga Mayor Bob Corker and
..... percent for the same
cost of helping two
candidates with 45 percent
chances get ...
Feb 27, 2007 –
are going through the roof and
will now rise again over ......
Later the man was taken to
George Washington University
Feb 3, 2013 –
... civilian and one
firefighter who was treated at a
hospital and released.
..... of more than $5,650,000
(including the cost of
fire suppression), or ...
close to two
weeks in the hospital
recovering from pneumonia. On
July 27, 2003, ...... of the
document, determine the cost
of forgery, means, motive,
Feb 10, 2012 –
These souvenir philatelic
covers are readily available at
low cost. .... He was
put in Bethesda Naval
Hospital psychiatric ward
where he was ...
Oct 1, 2001 –
The clerk said, "The ugly
two types of donuts would
cost 15 cents each, then
...... I went to the
hospital, and had all the
heart tests and they found ...
Oct 1, 2005 –
... tell another woman
that she lived in an apartment
that cost her $10,000
...... Lilly and I were at the
for about ten of fifteen