Hospital charges: Some bill more 'because they can'

Teflon Don said:
There is a lot of overhead in a hospital. And of
Course lets not forget the uncompensated care the gobblement forces on them.

The real problem in healthcare is a complete lack of understanding of economics among our citizenry.
Click to expand...

I don't deny the lack of understanding economics, heck, I'm one of them. We have lots of hospitals here and the cost issues are the same as the one in the OP. You can pay a much different price for the same service in hospitals that may be 10 miles apart.
 
Here is a little known fun fact. But did you know that Johns Hopkins never was held to the same Medicare reimbursements other health systems had to deal with? Yup. It's true

I know it sounds astonishing that the government focused on "fairness" for all would carve out exemptions for a special case, but it's true
 
christiefan915 said:
This article was in today's paper and below are some excerpts. I think it makes a nice counterpoint to Damo's thread about MS drugs. Maybe someone can explain why the free market hospital system here (read: monopoly) gets to gouge patients "because they can." How is Obamacare worse than this?


"When Steven Gray was diagnosed with terminal Stage IV pancreatic cancer in 2012, he received treatment at both Johns Hopkins Hospital in Baltimore and UPMC Passavant near his Butler home. The family was fortunate, said his wife, Patty Cudoc-Gray, because their insurance covered all but the $20 co-payments for each visit.

But when she later examined the Explanation of Benefits records sent by Pittsburgh insurer Highmark, she could hardly believe what she saw:

For Mr. Gray's last round of outpatient chemo at Johns Hopkins on Jan. 10, 2013 -- including medications, IV therapy, supplies and pharmacy service -- the hospital charged $2,544.65 and was paid $2,493.06 by Highmark.

Two weeks later, for the same procedure and ancillaries, UPMC Passavant charged $13,789.75 and Highmark paid $7,704.40.

Looking at the line item charges for standard chemotherapy drugs, she later learned that Highmark paid Johns Hopkins $761.40 for 1 milligram of Docetaxel. For the same dose of the same drug, UPMC got $2,542.50.

Another example: For a 200 mg Gemcitabine injection, Hopkins collected $143.10. UPMC got $1,051. "I said, 'How can they charge five times the amount [as Johns Hopkins] and collect three times the amount?' " asked Ms. Cudoc-Gray.

Gerard Anderson, director for the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, thinks he knows why UPMC charges more.

"Basically the answer is simple: Because they can," he said. "There is nobody telling them how much they can charge and so they charge as much as they can get."

Mr. Anderson said the Grays' experience illustrates the ills of the current health care payment system, which outside of Medicare sets no limits on what a hospital can charge -- even as it keeps those charges hidden from the consumers who end up paying higher insurance premiums.

Ms. Cudoc-Gray "had no idea about the relative costs prior to going to both places," said Mr. Anderson. "And she couldn't have because the prices are unknown. They're a secret."

Read more: http://www.post-gazette.com/busines...ary-widely/stories/201402160092#ixzz2MwbjhD2p
Click to expand...
In addition hospitals often do this to use these profitable items to pay for other services that they provide. You've probably heard the horror stories of charges like this or $500 for an aspirin. To use an example, hospitals often to this to help defray the cost of very expensive technology that often doesn't get used. Say the hospital has a $10 million CRT devise but only needs to use it 10 times a week. They really can't justify the cost of having one, so they increase the charges for other services to pay for the machine.

This is why in the industrialized nations that have reformed health care price controls play a critical part to play in reducing costs. That's a big part of what the reporting requirements in the ACA are about. The data generated can help determine doe a specific modality work and if so, what is its actual cost. All modern industrialized nations, except the US, does this and used the data to publish a pricing catalogue that the health care industry much use in charging consumers so that these sort of abuses are curtailed.

Keep in mind that since a lot of these charges occur with the seriously ill and either end up bankrupting that person or they simply do not have the means to make the payments and the tax payers are left footing the bill.
 
christiefan915 said:
I don't deny the lack of understanding economics, heck, I'm one of them. We have lots of hospitals here and the cost issues are the same as the one in the OP. You can pay a much different price for the same service in hospitals that may be 10 miles apart.
Click to expand...

But you are still missing the point, charges are largely irrelevant.

Explanation Of Benefits or EOBs are a joke and just get people fired up about things they know little about
 
Teflon Don said:
Anyone thinking there is a free market in healthcare either doesn't understand free markets or doesn't understand how healthcare is paid for.

I know that many will not accept this, but hospital charges are largely irrelevant. Hospitals and insurance companies negotiate prices for the care of patients.

Of course hospitals don't negotiate with the gobblement because it is a coercive monopolistic entity. Since the advent of DRGs hospital charges are meaningless. For a long time private insurance subsidized the meager reimbursements by the gobblement. But, no more.

The answer lies in the $20 copay quoted in this article. This patient like many are not making rational economic decisions because they are shielded from the true costs of their care.

It reminds me if when Mott came on here indignant about his hospital charges because his itty bitty heart skipped a beat. Of course it was easy for Mott to feign indignation after the fact, but I am sure that he derived all sorts of piece of mind from the blood work, EKG and cardiac stress they did for him.

Unfortunately people are getting exactly what they deserve and have asked for. They just don't know it and they will always blame somebody else.
Click to expand...
No actually I didn't. It was my family doctor who was concerned and suggested the stress test and I just followed his advice and ended up paying $2 grand to walk on a tread mill for 5 minutes to find out what I already knew.
 
One other thing that I find quite humorous is that Apple has a profit margin of about 65% and nobody thinks they are being gouged for their iPhone.

But Mott had a little blip in his tiny ticker and all of a sudden he is pinching pennies. Here is a thought. Bring your own ASA
 
Does Christiekins think the government should set prices for goods and services if they "don't have time" to comparison shop?
 
christiefan915 said:
This article was in today's paper and below are some excerpts. I think it makes a nice counterpoint to Damo's thread about MS drugs. Maybe someone can explain why the free market hospital system here (read: monopoly) gets to gouge patients "because they can." How is Obamacare worse than this?


"When Steven Gray was diagnosed with terminal Stage IV pancreatic cancer in 2012, he received treatment at both Johns Hopkins Hospital in Baltimore and UPMC Passavant near his Butler home. The family was fortunate, said his wife, Patty Cudoc-Gray, because their insurance covered all but the $20 co-payments for each visit.

But when she later examined the Explanation of Benefits records sent by Pittsburgh insurer Highmark, she could hardly believe what she saw:

For Mr. Gray's last round of outpatient chemo at Johns Hopkins on Jan. 10, 2013 -- including medications, IV therapy, supplies and pharmacy service -- the hospital charged $2,544.65 and was paid $2,493.06 by Highmark.

Two weeks later, for the same procedure and ancillaries, UPMC Passavant charged $13,789.75 and Highmark paid $7,704.40.

Looking at the line item charges for standard chemotherapy drugs, she later learned that Highmark paid Johns Hopkins $761.40 for 1 milligram of Docetaxel. For the same dose of the same drug, UPMC got $2,542.50.

Another example: For a 200 mg Gemcitabine injection, Hopkins collected $143.10. UPMC got $1,051. "I said, 'How can they charge five times the amount [as Johns Hopkins] and collect three times the amount?' " asked Ms. Cudoc-Gray.

Gerard Anderson, director for the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, thinks he knows why UPMC charges more.

"Basically the answer is simple: Because they can," he said. "There is nobody telling them how much they can charge and so they charge as much as they can get."

Mr. Anderson said the Grays' experience illustrates the ills of the current health care payment system, which outside of Medicare sets no limits on what a hospital can charge -- even as it keeps those charges hidden from the consumers who end up paying higher insurance premiums.

Ms. Cudoc-Gray "had no idea about the relative costs prior to going to both places," said Mr. Anderson. "And she couldn't have because the prices are unknown. They're a secret."

Read more: http://www.post-gazette.com/busines...ary-widely/stories/201402160092#ixzz2MwbjhD2p
Click to expand...

e
Its clearly not a secret as its published in this article. But had you read the article the answer is plainly stated. The joint near Pittsburgh is a must have facility and as such can demand superior terms of payment because they will, overall, provide a wide variety of care to a population with no other nearby choices. There is more to the medical biz than meets the eye. This is why you cannot entrust it to burocrats who are generally less capable that th population here.
 
Teflon Don said:
One other thing that I find quite humorous is that Apple has a profit margin of about 65% and nobody thinks they are being gouged for their iPhone.

But Mott had a little blip in his tiny ticker and all of a sudden he is pinching pennies. Here is a thought. Bring your own ASA
Click to expand...
I do. I think they're grossly over priced....which is why I don't own one. Go Android. Ahh I think you kind of miss the point of insurance.
 
Celticguy said:
e
Its clearly not a secret as its published in this article. But had you read the article the answer is plainly stated. The joint near Pittsburgh is a must have facility and as such can demand superior terms of payment because they will, overall, provide a wide variety of care to a population with no other nearby choices. There is more to the medical biz than meets the eye. This is why you cannot entrust it to burocrats who are generally less capable that th population here.
Click to expand...

She had "had no idea about the relative costs prior to going to both places"... she learned prices when she got the paperwork after services were performed.

And, we have plenty of choices here. UPMC is #1 in Pittsburgh, #1 in PA, and in the top ten hospitals in the nation. Also, I said in a previous post the costs can be very different in two hospitals that are only five miles apart.

This is a list of hospitals in Pittsburgh, Pennsylvania.

 
You must log in or register to reply here.
Back
Top