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.
