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Medicare Data Dump Reveals Wide Range of Hospital Billing
Even in local hospitals.

Hospitals charge a wide variety of prices for the same procedures, and the reasons for doing so are not immediately clear, according to Medicare data released Tuesday.

The New York Times cites an example about the data release: "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." The range of charges are reflected in Milwaukee-area hospitals as well.

A Times infographic color codes hospitals charging more or less than the national average for all procedures. According to said 
infographic, only Aurora St. Luke's charges more than the national average. Hospitals like Wheaton Franciscan Healthcare in St. Francis and Columbia St. Mary's bill Medicare, overall, less than the national average. 

For kidney and urinary tract infections without major complications, Columbia St. Mary's charges Medicare $15,964, Froedtert Memorial Lutheran charges $14,949 and Aurora St. Luke's charges $19,453. To have a pacemaker implanted, Waukesha Memorial Hospital charges Medicare $32, 263, Froedtert charges $52,127 and whereas Aurora St. Luke's bills $69,600. For bronchitis and asthma treatments, Froedtert Memorial Lutheran Hospital charges $9,971, Waukesha Memorial charges $10,555 and Aurora St. Luke's charges $14,600. 

Lumping all area hospitals together, as the Medicare data does, could be problematic. In a statement to
Milwaukee Magazine, Michael Brophy, chief communications officer of Aurora Health Care, says that "at Aurora St. Luke’s Medical Center, and other centers offering the sector’s most advanced care, the complexity of the illnesses treated are greater than most other hospitals. 

"Therefore," he says, "these facilities have the most advanced specialists, caregivers and equipment available, which impacts the cost of the care provided." 

It's important to note that both Medicare and private insurers don't pay the full amount charged by hospitals. Instead, Medicare has its own system of payments and private insurers negotiate what they'll pay with the hospitals. So, which hospitals actually received the most in payments? Froedtert Memorial Lutheran received the highest average payment for its treatment of infectious or parasitic diseases that require an operating room procedure. Though Froedtert bills $118,881 for the procedure, on average they receive $55,636 - the highest received for any procedure in the Milwaukee area.

Brophy says that there are many variables in hospital billing and reimbursement. "Factors such as existing insurance contracts, the level of specialized care and individual needs of the patient are just a few of the many moving parts that define the original charges." 

"The reimbursed dollars that Medicare pays are based off of their own criteria," Brophy says, "which are not impacted by those original charges, but rather by the services provided." 

Aurora officials also tout one tenet of their customer service program, which allows anyone to call and receive an estimate of the cost, deduction and co-pay for a certain expected treatment. But, of course, it would be difficult to do those kinds of price comparisons when you're in an emergency situation. 

"We feel that this program is one of the most transparent and personalized ways we can answer billing questions for patients," Brophy says.

As for those patients without insurance, they could be responsible for footing the entire bill.

Image via Shutterstock. 






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