BOISE -- We all know that medical care is not cheap. But how much does each procedure cost in each hospital across the nation? That's information that's been tough to get thanks to hospitals closely guarding their fees. But for the maybe the first time ever, we have an answer.
Wednesday, the U.S. government released the average charges for Medicare for each hospital in the nation for the 100 most common in-patient procedures. There are huge discrepancies.
Hospitals cannot charge different amounts for Medicare and non-Medicare patients, so these prices are across the board. Take a look at some numbers for the most common procedure in Medicare, joint replacement. What's not common is the price that hospital charge.
Average Medicare charges for major joint replacement:
Saint Luke’s Magic Valley – $26,068
Saint Alphonsus Nampa - $28,993
Saint Luke’s Boise – $29,935
Saint Alphonsus Boise - $35,999
Saint Alphonsus Ontario – $36,395
West Valley Medical Center- $52,003
You can see that there's a wide range of charges for the six hospitals in our area, some in the same hospital systems, with $26,000 separating the most and least expensive. Why?
Ken Dey with Saint Luke's says that can be tied to a difference between non-profit and for-profit hospitals, along with dozens of other factors. "The prices are set by the hospital, obviously, and there can be things like the patient mix, the severity of patients, the type of procedures offered, the equipment. There's a multitude of factors."
However, Dey and other hospital spokespeople say they rarely are reimbursed their full price. And in this case, Medicare reimburses them the lowest amount. Take a look at those numbers and you can see there's also much less variation.
Average total Medicare payments for major joint replacement:
Saint Luke’s Magic Valley – $13,175
Saint Alphonsus Nampa - $12,853
Saint Luke’s Boise – $13,531
Saint Alphonsus Boise - $13,538
Saint Alphonsus Ontario – $13,856
West Valley Medical Center - $16,057
The West Valley Medical Center released a statement which says, "What patients actually pay has more to do with the type of insurance coverage they have rather than charges. Government programs like Medicare and Medicaid determine how much they reimburse hospitals. Insurance plans negotiate their payments. Everyone else is eligible for our charity care program or our uninsured discounts, which are similar to the discounts a private insurance plan gets."
Dey agrees, saying St. Luke's even negotiates with the uninsured, and gives other discounts. "That listed price that you see is not the price you pay. In fact, it would be rare that anyone would pay that price."
Saint Alphonsus responded to the release of this information by reminding people that every patient, and their care, is different. "This CMS data are based on average charges for different kinds of cases. The data does not reflect what any particular patient can expect to pay because first very few patients care is payed as charges, but are paid based on rates negotiated with health care plans and employers," said Elizabeth Duncan with Saint Alphonsus. "Secondly the data reflect a small number of cases and the amount of care, and therefore the amount of payment, will vary from patient to patient."
The government hopes that releasing this information will motivate hospitals to even out their charges. Dey says St. Luke's was already working toward that.
Also, these numbers confirm what we had heard for years, that Idaho already has relatively low medical costs.