Database: Vast Differences Between Valley Hospital Charges – Article published by The Fresno Bee.

Data reveal vast billing differences.

The data provided Wednesday by the Obama administration details the sometimes vast spreads between what different hospitals charge at least on paper for similar services. It also reveals the chasm between the amounts claimed by hospitals and what they receive in reimbursements from the federal government.

“Users will be able to make comparisons between the amount charged by individual hospitals within local markets and nationwide,” according to the Centers for Medicare and Medicaid Services website.

But C. Duane Dauner, president of the California Hospital Association, complained Wednesday that the Medicare data “is less relevant and may confuse patients as well as the public” because it neither reflects what Medicare, Medi-Cal, private insurers or uninsured patients pay for hospital services.

For a relatively uncomplicated case of pneumonia, for example, the Medicare data shows average hospital charges ranging from $18,647 at Madera Community Hospital to $37,435 at Merced’s Mercy Medical Center. But the average Medicare reimbursement for the two hospitals was almost the same about $6,400 per case.

The more complex the procedure, however, the more pronounced are the differences. At the Fresno Surgical Hospital, the average charge for a major joint replacement, without any serious complications, was about $45,000, with an average Medicare payment of about $13,000. That compares to an average charge of more than $122,000 at Porterville’s Sierra View District Hospital, where the average Medicare reimbursement was about $17,400.

┬áIf it sounds confusing, that’s because it is, said Jan Emerson-Shea, the hospital association’s vice president of external affairs.

“Every hospital has its own formula for determining those charges,” she said. Hospitals with more intensive services such as trauma centers or burn units likely have higher costs for technology and staff than smaller hospitals that are reflected on their charge lists, she said.

However, Emerson-Shea added, “it’s really an academic exercise that CMS went through today. … Nobody pays any of those charges.”

 


The federal Centers for Medicare and Medicaid Services released Medicare billing data Wednesday for 100 of the most frequently billed services and procedures.

Medicare and Medi-Cal pay far less than what services cost, and insurance companies negotiate discounts for services for their customers as well. And in California, CHA’s Dauner said, state law requires hospitals to provide free or discounted care for uninsured patients who earn up to 31/2 times the federal poverty level.

The full national database of Medicare information released Wednesday is online.