Medicare Data Reveals U.S. Hospitals Vary Widely on Pricing for Same Procedures

Medical malpractice lawyers at Pintas & Mullins Law Firm highlight the most recent data released by the federal Centers for Medicare and Medicaid Services. The data from 2011 taken from facilities in 13 metropolitan areas reveals that hospitals throughout the United States are charging wildly different amounts for 100 of the most common inpatient procedures.

Among the 100 most common procedures included joint replacement, heart failure, and chronic obstructive pulmonary disease (COPD). For example, if a patient is admitted to New Jersey’s Bayonne Hospital Center for COPD treatment, that person should expect to pay nearly $100,000. Less than 30 miles away, in the Bronx, New York, the same COPD procedure at Lincoln Medical and Mental Health Center would charge the same patient only $7,000.

Even within the city of Chicago prices vary wildly. At Loyola Gottlieb Memorial Hospital, for example, treatment for kidney failure costs patients about $98,000. This is more than five times the amount charged at Chicago’s John H. Stroger Jr. Hospital, located 12 miles away, for the same treatment – a little over $17,000. Loyola actually charged the highest prices in the entire state of Illinois for several types of procedures, such as small and large bowel surgeries.

Medicare and Medicaid are sharing this information with the public for the first time ever in hopes that it would force hospitals to pay better attention to their pricing and competitive business models. Ideally, the information would also help the American public make better decisions about where they receive their medical care.

Of course, all 3,000 hospitals included in the data have differing factors that may influence their expenses, such as patient base. A spokesperson for the Illinois Hospital Association noted that whether a hospital has a Level 1 Trauma Center – compared to a Level 2 or 3 – can affect pricing.

However, there really cannot be a rational justification for a $90,000 gap for the exact same procedure. Some assert that, perhaps, there is a major difference in the quality of care, or patients at one hospital may be significantly sicker than at another. Previous research from smaller sets of data reveal, however, that there is no significant connection between what you pay for the medical care you receive and how “good” it is.

Even the director of the Center for Medicare, John Blum, does not have a good economic argument as to why some hospitals have such considerably higher prices than others in surrounding areas. Blum states that he hopes the newly public information will bring about change in the industry and force hospitals to take a harder look at their charge-master practices.

Realistically, in a final stab of irony, only those without health insurance are actually billed these official prices for the procedures. Medicare and private health insurance companies typically negotiate with hospitals for lower charges, so these estimates aren’t what those with health insurance pay. It may not be right, but it is where our healthcare system is currently at.

One important factor this data does not show is what the actual appropriate price for these procedures is supposed to be. Previously, hospitals would base price estimates on the need for profit that would enable them to make further investments. Over time, however, estimates were raised in anticipation of negotiations from insurance companies, and have only continued growing.

Medical malpractice lawyers at Pintas & Mullins Law Firm urge the public to take a look at this database, which can be found here. Our attorneys have decades of experience handling all types of malpractice cases, including failure to diagnose, improper treatment, and medical mistakes. If you feel you have been injured as the result of medical negligence, you may be entitled to significant compensation through a malpractice lawsuit.

Free Consultation
  • Please enter your first name.
  • Please enter your last name.
  • Please enter your email.
    This isn't a valid email address.
  • Please enter your phone number.
    This isn't a valid phone number.
  • Please make a selection.
  • Please make a selection.
  • Please enter your message.