I’m taking poetic license with the headline as I’m still trying to wrap my head around the unbelievable disparity in hospital charges and Medicare reimbursements. And the even larger disparity among the charges but Medicare knocks them back. My own bills for medical visits, tests, x-rays, etc. of course show that the insurance company negotiates lower rates, but hospital charges bring us into the world of the fantasy fiction, except that these numbers are all too real and all too painful.
Before I reached the reimbursement column, I had a revelation, having always thought teaching hospitals cost more and charged more because of the burden of training all those docs-in-training with the faculty members, extra equipment, library, and so forth. Not so, as smaller hospitals often have much higher fees than, say, Yale-New Haven.
One reason for the outrageous charges may be the number of people it takes to translate the numbers and procedures into English. Here’s just one example, courtesy of the Hartford Courant’s database.
Do we have a laparoscopic cholecystectomy W/O CDE W CC or laparoscopic cholecystectomy W/O CDE W/O CC/MCC? At Middlesex Hospital the “w/o cde” would be charged at more than $53,000, but the average payment would be about $12,000, based on thirteen discharges. The second procedure is charged at just under $35,000 and paid at $8,000 for the same number of discharges. The much larger Hartford Hospital up the road with twenty-three discharges, charges $43,000 and receives $15,000 for “w/ cc” and $24,500 for “w/o cc/mcc,” receiving $10,500 with twenty-nine discharges. Yale had an average charge of $52,000 and payments of nearly $17,000 for twenty-six discharges “w/cc.” The ‘w/occ/mcc” based on eighteen discharges, came in at $33.000 vs. $12,000.
What’s depressing about the example given in the main story is that a “simple case of pneumonia,” which can cost between $5,000 and $25,000 nationwide, can be prevented with a vaccine. Many of these charges are probably added on because patients are already in the hospital and contract pneumonia because they can’t get up and move around.
I could spend all night sifting through this info, but it would drive me nuts! I can see shopping around for non-emergency joint replacements or gastric bypass, but how often do we get to choose if there’s a burst appendix or (God forbid) an “intracranial hemorrhage or cerebral infarction,” with our without cc? Presumably the heroic EMTs and paramedics will get the patient as fast as possible to the first place capable of stopping the bleeding and restoring function.
The lesson here is don’t get sick!