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50 hospitals charge uninsured 10 times than insured patientsFollow

#1 Jun 09 2015 at 1:00 AM Rating: Decent
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Fifty hospitals in the United States are charging uninsured consumers more than 10 times the actual cost of patient care, according to research published Monday.

All but one of the these facilities is owned by for-profit entities, and by far the largest number of hospitals — 20 — are in Florida. For the most part, researchers said, the hospitals with the highest markups are not in pricey neighborhoods or big cities, where the market might explain the higher prices.

Topping the list of the most expensive hospitals is North Okaloosa Medical Center, a 110-bed facility in the Florida Panhandle about an hour outside of Pensacola. Uninsured patients are charged 12.6 times the actual cost of patient care.

Community Health Systems operates 25 of the hospitals on the list; Hospital Corp. of America operates another 14.

“They are price-gouging because they can,” said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health, co-author of the study in Health Affairs. “They are marking up the prices because no one is telling them they can’t.”

He added: “These are the hospitals that have the highest markup of all 5,000 hospitals in the United States. This means, when it costs the hospital $100, they are going to charge you, on average, $1,000.”

The researchers said other consumers who could face those high charges are patients whose hospitals are not in their insurance company’s preferred network of providers, patients using workers’ compensation and those covered by automobile insurance policies.

Carepoint Health-Bayonne Medical Center in Bayonne, N.J., for example, also charges rates 12.6 times the actual cost of patient care. But state law limits the maximum that hospitals can charge uninsured patients to 115 percent, a spokesman said.

By comparison, the researchers said, a typical U.S. hospital charges 3.4 times the cost of patient care.

Officials representing the 50 hospitals disputed the findings, saying they provide significant discounts to uninsured and underinsured patients to help cover their out-of-pocket costs.

Understanding hospital pricing and charges is one of the most frustrating experiences for ordinary consumers and health-care professionals alike. It’s virtually impossible to find out ahead of time from the hospital how much a procedure or stay in the facility is going to cost. Once the bill arrives, many Americans have difficulty understanding them.

Most hospital patients covered by private or government insurance don’t pay full price because insurers and programs like Medicare negotiate lower rates for their patients.

But the millions of Americans who don’t have insurance don’t have anyone to negotiate on their behalf. They are most likely to be charged the full hospital price. As a result, uninsured patients, who are often the most vulnerable, face skyrocketing medical bills that can lead to personal bankruptcy, damaged credit scores or avoidance of needed medical care.

Researchers said the main factors leading to overcharging are the lack of market competition and the fact that the federal government does not regulate the prices that health-care providers can charge. Only two states, Maryland and West Virginia, set hospital rates.

In the United States, hospitals have something called the chargemaster, a lengthy list of the hospital’s prices for every procedure performed in the facility and for every supply item used during those procedures, such as the cost of one Tylenol tablet, or a box of gauze.

Most patients don’t pay the chargemaster rates because the federal government and private insurers negotiate lower rates for their patients. The government almost always pays fixed amounts based mostly on patients’ conditions.

In determining the size of markups, researchers used as their benchmark what Medicare allows for the costs of care. That includes direct patient costs, such as emergency room and operating room care, and indirect costs, such as administration and pharmacy. It does not include private doctors’ costs.

The study looked at government reports for all Medicare-certified hospitals between May 2012 and April 30, 2013. To calculate those with the highest markup, they tallied up the total charges, then divided by the patient care cost, which they defined as total costs Medicare agrees to pay for those with its government-subsidized health insurance.

“For-profit players appear to be better players in this price-gouging game,” said Ge Bai, an assistant accounting professor at Washington and Lee University and a co-author.

Carepoint Health, which owns the Bayonne Hospital and two other hospitals in Hudson County, N.J., said charge-pricing affects less than 7 percent of total patient interactions system-wide. Without it or adequate reimbursements, “our safety-net hospitals risk closure,” Carepoint said in a statement. Urban hospitals are reimbursed by insurers at lower rates than suburban ones, a spokesman said.

Officials at Community Health Systems of Franklin, Tenn., which operates 25 of the hospitals, and Hospital Corp. of America, based in Nashville, which operates 14, said hospital charges rarely reflect what consumers actually pay. They said their hospitals offer significant discounts to uninsured patients and charity care for those who qualify. Community Health Systems said in a statement that it provided $3.3 billion in charity care, discounts and other uncompensated care for consumers last year. It also noted that several of its hospitals were not owned by CHS at the time the data were reported.

Anderson said researchers chose to show the current ownership status because the company bought the hospitals knowing about the inflated prices.

HCA said in a statement that its uninsured patients are eligible for free care through its charity care program or they receive discounts that are similar to the discounts a private insurance plan receives.

The Federation of American Hospitals, which represents for-profit hospitals, said the listed hospitals provided nearly $450 million in uncompensated care in 2012 alone. Including the discounts “would have had a significant effect on the charge-to-cost-ratio reported, and therefore the implications of the study’s results,” it said in a statement.

Anderson said it made little economic sense to “mark something up 10 times what it actually costs and then give a discount.” He added: “Clearly they expect someone to pay these inflated prices.”

He noted that the cost of workers’ compensation and auto insurance polices are higher in the states where hospital charges are unregulated because companies have to pay the higher rates.

The idea for the paper came when co-author Bai received a hospital bill six years ago after her son was born. “I realized that I could not understand the bill,” said Bai, a certified public accountant. She thought to herself that if she couldn’t figure it out, how could the average American? Bills for other items that consumers buy are relatively easy to understand, she noted.

“But we do not understand the bills for this, our most valuable asset,” she said. “This is ridiculous and sad.”


This is a pretty good example of the problem with a for-profit health care system. Realizing that people have to have care, and have to pay for it, these hospitals have decided to try to boost profits to an asinine amount. I'm not saying that universal health care is the solution, because bringing that in suddenly would be somewhat disastrous, but there needs to be some kind of system to prevent this, and perhaps basic care(ER visits, GP checkups, etc) should be covered by the government.

Thoughts?
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#2 Jun 09 2015 at 1:06 AM Rating: Excellent
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Driftwood wrote:
This is a pretty good example of the problem with a for-profit health care system. Realizing that people have to have care, and have to pay for it, these hospitals have decided to try to boost profits to an asinine amount. I'm not saying that universal health care is the solution, because bringing that in suddenly would be somewhat disastrous, but there needs to be some kind of system to prevent this, and perhaps basic care(ER visits, GP checkups, etc) should be covered by the government.

Thoughts?
gbaji wrote:
They can just go to the silver mine hospital down the road.

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#3 Jun 09 2015 at 1:12 AM Rating: Decent
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Is that from the massive thread that's almost entirely you gbaji and alma going on in gigantic posts that I haven't managed to get through reading?

It feels like much more of a Varus thing to say than a Gbaji thing.
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Eske wrote:
I've always read Driftwood as the straight man in varus' double act. It helps if you read all of his posts in the voice of Droopy Dog.
#4 Jun 09 2015 at 1:57 AM Rating: Good
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Driftwood wrote:
Is that from the massive thread that's almost entirely you gbaji and alma going on in gigantic posts that I haven't managed to get through reading?

It feels like much more of a Varus thing to say than a Gbaji thing.
For your reading pleasure.
gbaji wrote:
Jophiel wrote:
gbaji wrote:
Why don't they employ nothing but children?

Because children aren't equipped to do every job.


Right. So those other jobs are ones which require some degree of skill/experience/maturity/size/strength/whatever. Just checking.

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If I need 100 miners and I pay them all ten bucks a day, then that's what I have. If I can replace 50 of them with kids for $5 a day, I do that and pocket the other $250 in labor costs. I don't give the adults a $2 raise. The fact that I still have 50 adult miners doesn't magically invalidate the fact that I just laid off the other 50 to save $250 on labor costs that I'm keeping.


Sure. But the mine down the road does the same thing and does decide to pay its adult workers, who are all doing jobs that are more difficult in some way, a $2/hour raise. So those who have the most of whatever the adults have and the children do not, will go work for that mine instead of this one. And (assuming there's a dollar reason for needing adults to do those jobs instead of children) that mine will therefore produce more of whatever they're mining over time, thus making greater profits than the mine that does not do this. It will also attract the best adult workers versus that other mine, thus having fewer accidents, work stoppages, etc.

The mine owner will pay the workers whatever wages maximize its own profits. That does *not* always mean low wages.

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What fantasy world do you live in?


Which one do you live in? For your argument to work no one must ever earn more than minimum wage. Since that's clearly not true, we must accept that there are profit reasons for employers to pay their workers more rather than less. Ergo, in industries in which narrow profit margins are the rule (which may not be mines, but may be say retail outlets like Walmart), wages are constrained more by those narrow margins than by other factors and thus the degree to which an employer can increase the wages of their more experienced/mature workers is constrained by the minimum wage they must pay the least experienced/mature workers.

And in that condition (which is where a **** of a lot of working class single parents are), raising the minimum wage hurts those people rather than helps them.


That's my argument. What's yours? You keep assuming that employers will always just take any opportunity to pocket money rather than pay it to their workers despite absolute proof that this is not true. Absent that false assumption, what do you have?
tl;dr

gbaji thinks that all economic problems can be solved by the workers.

Oh..and that business owners wont sacrifice workers for the sake of profits.






TEEHEE
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#5 Jun 09 2015 at 6:41 AM Rating: Good
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It's kind of funny how everyone knows what gbaji thinks about all this when he hasn't posted anything in this topic yet.
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#6 Jun 09 2015 at 7:23 AM Rating: Excellent
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That's the beauty of pattern recognition. Next he'll wonder why no one has ever addressed his so-called points.
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#7 Jun 09 2015 at 9:13 AM Rating: Decent
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#8 Jun 09 2015 at 9:21 AM Rating: Good
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Driftwood wrote:
Link

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You could have broken that quote into three posts and been two closer to 10,000 and a title without an admin to give it to you.

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#9 Jun 09 2015 at 9:31 AM Rating: Excellent
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Speaking of medicine, we recently needed to schedule a potentially costly test on the advice of a well respected specialist (Flea knew him from her hospital days). We're currently getting the "Eeehhhh.... maybe your specialist says this but our wallets would prefer not" from the insurance company.

Boy, am I glad government doesn't get between me and my health care!
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Wow. Regular ol' Joph fan club in here.
#10 Jun 09 2015 at 10:54 AM Rating: Excellent
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Your HMO: perfectly willing to gamble on your health for a buck.
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#11 Jun 09 2015 at 11:37 AM Rating: Excellent
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Well, we have a PPO but they also seem willing to chase a dollar before chasing wellness.
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Wow. Regular ol' Joph fan club in here.
#12 Jun 15 2015 at 4:32 PM Rating: Default
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Kuwoobie wrote:
It's kind of funny how everyone knows what gbaji thinks about all this when he hasn't posted anything in this topic yet.


No one in this thread has correctly written what I think about all this. Some quick points that leap out at me:

1. The article doesn't actually say that uninsured people pay 10 times more than insured people. It says that they are charged 10 times more than the "cost" for the health care (which is the actual cost to the hospital, not the amount they charge some other group). In fact, the article says this:

Quote:
The researchers said other consumers who could face those high charges are patients whose hospitals are not in their insurance company’s preferred network of providers, patients using workers’ compensation and those covered by automobile insurance policies.


So not "uninsured", but "don't have a special deal with that particular hospital". Still a valid topic of discussion, but not quite the narrative implied by the thread title.

2. It's not clear that "for profit" is the problem here. Again, it seems like an attempt to fit the facts to an existing narrative, rather than following the facts to a conclusion. What sort of care is given in these facilities? Are we really comparing apples to oranges here? I'd imagine a private hospital providing specialized elder care might have a higher markup than one setting broken bones, for example. The high percentage in Florida might also give us a hint in this regard. Point being that this may not mean at all what is implied. There just isn't enough data in the article to know what we're really talking about.


3. As mentioned in the article, the method of charging for health care services is byzantine, to say the least. The statistics quoted here could simply be an artifact of what point in that process the dollar "costs" are being compared. Several quotes mentioned that the cost being used for comparison isn't the amount the patient actually pays, it's just that one process charges "full price" and then adjust that after the fact, while the other reduces that price prior to being billed. A more fair comparison would look at total of out of pocket plus insurance payout costs for equivalent care. But that sort of comparison is nowhere to be seen in the article.


It looks like a fluff piece, full of true but misleading facts. I could speculate about the purpose of the article, but it mostly seems to be designed to get people to come to the exact false assumptions that several of you arrived at. So... mission accomplished, I guess. Not saying that all is perfect in health care land, but this isn't really an accurate (or fair) assessment of the problems. In the case of costs to patients, that is largely driven by the very price controls that this article would most likely cause people to demand. It's a far more complex issue than just blaming greedy hospitals.
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#13 Jun 15 2015 at 4:47 PM Rating: Good
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BO-ring.
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#14 Jun 16 2015 at 7:58 AM Rating: Good
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Kavekkk wrote:
BO-ring.
You'd think after spending a week trying to prove just how unpredictable he was he'd come up with something actually new instead of "they're facts, but I don't believe them so they don't count."

Yes, I read it. Yes, it's been rebutted before. No, I'm not engaging in repetition.
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#15 Jun 16 2015 at 8:05 AM Rating: Excellent
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I could speculate about the purpose of the article, but it mostly seems to be designed to get people to come to the exact false assumptions that several of you arrived at.

"I could speculate about the purpose of this article but let me speculate about the purpose of this article"?
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Wow. Regular ol' Joph fan club in here.
#16 Jun 16 2015 at 5:14 PM Rating: Decent
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Jophiel wrote:
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I could speculate about the purpose of the article, but it mostly seems to be designed to get people to come to the exact false assumptions that several of you arrived at.

"I could speculate about the purpose of this article but let me speculate about the purpose of this article"?


Sorry. I was trying to be brief. I meant that I could write a long drawn out analysis of what the article's purpose was, quoting various parts, and detailing them, but I'll just stick with a one sentence overview instead. Better?
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#17 Jun 16 2015 at 5:15 PM Rating: Decent
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lolgaxe wrote:
Kavekkk wrote:
BO-ring.
You'd think after spending a week trying to prove just how unpredictable he was he'd come up with something actually new instead of "they're facts, but I don't believe them so they don't count."


Which is still not the same as "people can just go to the hospital down the road and get a better deal", right?
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King Nobby wrote:
More words please
#18 Jun 17 2015 at 7:28 AM Rating: Good
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If that's the victory condition you want to go with, then sure.
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