On Monday I said that this week’s focus would be to look at specific hospitals that are charging over $20,000 through Medicare for an intracranial hemorrhage and note any charging policies or factors that are going into the absurd pricing. However, after looking at just 2 of the highest priced hospitals it was clear that something very wrong was going on. My notes from the hospitals are as follows:
- Of the 50 hospitals with the highest price markups, 49 are for-profit hospitals and 46 are owned by for-profit health systems.
- Johns Hopkins Health Center – Advantage MD (Highest Cost at $48,632.28)
- John Hopkins created a “Medicare Advantage plan that is offered by private companies that contract with the Centers for Medicare and Medicaid Services to provide both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance)”
- 11% of the eligible population is enrolled in a Medicare Advantage plan (national is 34%). Approximately 900,000 Marylanders are eligible for Medicare
- ******”The hospital pursued the suits even though they collected millions of dollars from other patients, in the form of higher rates for hospital services, to cover costs for low-income patients who lacked insurance or enough insurance to cover out-of-pocket expenses”
- San Francisco General Hospital (Second Highest Cost at $34,455.00)
- Out-of-network with all private insurance
- “Emergency room fees are also higher, on average, than ERs nationally, in the state of California, and in the city of San Francisco. In the city, they’ve charged up to five times as much. The fees are set by the San Francisco Boards of Supervisors, which has voted for steady increases, doubling the charge since 2010”
- “Facility fees” – “Nina Dang, a 24 year-old woman treated at the hospital after a bike crash, was billed $11,176 for her emergency room visit. The largest item on her bill was a $24,074.50 emergency room facility fee”
- Billed $9.20 for a single ibuprofen tablet in 2013
The biggest takeaway I found was the idea of facility fees and how they can vary not only by hospital or service, but for the same service from person to person, depending on how much money they need to make up for those individuals who can’t pay for their visit. Even further, hospitals like John Hopkins not only gouge services, but then go after those who weren’t able to pay for these “hidden” fees on their bills.
With all of this information in mind, I believe that I can start writing my overall paper, with adding additional statistical analysis or geo-maping along the way.