The "Average Covered Charges" for "#329 Major Small & Large Bowel Procedures" range from $31,804 in Maryland to $557,902 in California, according to the National Provider Charge Database linked below. This is an astounding variance in pricing. What are the justifications?
As luck would have it, each procedure is given the same ID# nationally so, by sorting the database, we can see the variables for a specific procedure.
For "Major Small & Large Bowel Procedures" the ID# is 329, I sorted the Excel spreadsheet by Procedure # by State by Provider to find the costs listed for each state and Utah specifically. Below are charts showing which hospitals are charging the most and the least for this procedure.
I feel like a big item on my personal wish list was provided today:
A National Provider Charge Database, an Excel Spreadsheet which you can access here. This is a large file, but well worth the time to download because you can use features like "Sort" and "Find" to pinpoint information you are interested in.WHY I CHOSE BOWEL SURGERY: I have a friend that is facing bowel surgery so I thought it might be interesting to see how prices in Utah compare. I made this chart by extracting information from the above-referenced database/ The $Figures in the last column represent tens-of-thousands, btw:
Variable Cost of 329 Bowel Surgery in Utah:
The difference between the highest and lowest Average Covered Charges for the 329 Bowel procedure in Utah is $65,977:
University of Utah Hospital $132,585 minus Dixie Regional $66,608 equal $65,977 LESS at Dixie which is in Southern Utah's St George area. In short, U of U charges 2x as much as Dixie Regional.I might recommend that my friend check out Dixie Hospital in St George that actually does more of the 329 Bowel Procedures than the University of Utah Hospital FOR HALF THE COST.*
Next, I thought it might also be interesting to check out the national prices for this procedure. I provide charts below, as a picture is worth a 1,000 words and, in the case of 329 Bowel Surgery, hundreds of thousands of dollars.
After sorting the entire spreadsheet to pinpoint Procedure 329, I copied and pasted all the listed items into a new spreadsheet.
There are 1,476 hospitals listed ie 1,476 varying charges for the 329 Bowel Procedure. With this new Procedure 329 specific worksheet, I then sorted by Average Covered Charge.
Here are the details regarding "Methods Used" to produce the data:
What is perhaps even more interesting is the similarity of the Average Total Payments paid by Medicare which, after perusing the list, seems to range from the low $20,000s at CANONSBURG GENERAL HOSPITAL. PA up to $101,796 for WESTCHESTER MEDICAL CENTER, NY.
75% of the Medicare payments are under $41,000 and 50% of the Medicare payments are under $35,000.
It would be wonderful to have a detailed explanation to address these questions:
1. What is the justification for this huge disparity in Average Covered Charges?So many questions.
2. What is the basis for the Small Range of Average Total Payments and for the increased payouts for the outliers?
3. What happens to the huge Balances? Are these tax write-offs? If so, these for-profit hospitals charging huge fees also get huge write-offs.
4. Are these unpaid balances use to classify a hospital as a non-profit hospital?
5. What is the justification for charging the uninsured the total Averge Covered Charges when even the hospitals listing over $400,000 for this procedure receive, on average, under $60,000?
6. In short, why isn't the Average Total Payments amount used as the actual Average Covered Charges? What's the numbers game being played?
7. Do the Average Covered Charges, as listed, affect what patients are required to pay out-of-pocket?
I hope those who enjoy having research staffs will dig a little deeper.
Fiscal Year 2013 DRG Weights and Rates for DRG Numbers Between 300 and 399* Surprisingly, the highest costs for the 329-Major Small & Large Bowel Procedures in Utah are charged by Utah's State-owned and operated premiere teaching hospital, the University Health Care/Univ Hospitals & Clinics, where you can pretty much be guaranteed to be a hands-on opportunity for up and coming medical students to practice on. The higher pay out from Medicare to the U of U might, in fact, be based on an Education Stipend for this teaching hospital (See the "Column Heading Descriptions" Chart at end of article).
* = low volume DRG with fewer than 10 cases. The Medicare weights and LOS are used for these DRGs.
# = PM-DRGs with fewer than 10 cases. An average weight over the past 5 years were used for these DRGs.
w cc = with Complications and Comorbidities.
w/o cc = without Complications or Comorbidities
This is an interesting read: Why hospital culture influences medical costs
Even when a consultation is not really necessary – a “bogus consult,” in hospital jargon – the attending still may embrace the request cheerily. Both trainee and supervisor know the consult is not really necessary. But for the supervisor, the added work may be worth the added pay.
Those incentives will be familiar to any physician at a teaching hospital, immersed in the quirks of academic medicine.