Medicare releases hospital prices for outpatient procedures

 
 

Louisiana, Florida and Texas ranked the highest in the nation in terms of total cost per Medicare beneficiary, with the program spending an average total of $10,713 per capita in Florida in 2011, compared to a national average of $9,003 for the same year.
Louisiana, Florida and Texas ranked the highest in the nation in terms of total cost per Medicare beneficiary, with the program spending an average total of $10,713 per capita in Florida in 2011, compared to a national average of $9,003 for the same year.
CHRISTOPHER A. RECORD

dchang@MiamiHerald.com

That could add up when prices are so varied. For example, an MRI at the University of Miami Hospital charged Medicare an average of $4,984.50 while Jackson Health System, located across the street, charged the federal healthcare program $2,919.08, according to the numbers released Monday.

In Broward, the average charge submitted to Medicare for an MRI differed by about $1,700 between Memorial Regional Hospital in Hollywood ($4,860.22) and Broward General in Fort Lauderdale ($3,146.27).

The national average for an MRI, according to the data: $2,587.59.

Despite the price variances, though, Medicare paid all four hospitals about $350 for an MRI.

Another reason prices will become more important for privately-insured consumers is a shift toward high deductible plans, or “consumer driven healthcare,’’ in which patients are responsible for paying a pre-agreed amount of their total medical costs before the insurance kicks in. That’s also likely to push consumers to shop around more since the first chunk comes out of their pockets.

For years, though, hospitals have been reluctant to publish prices for fear of relinquishing a competitive advantage.

But the Obama administration’s release of hospital charges and Medicare reimbursement rates has spurred at least one local hospital executive to pledge even greater transparency in pricing — namely, the rates charged to and reimbursements paid by private insurers, which remains highly confidential.

Steve Sonenreich, chief executive of Mount Sinai Medical Center in Miami Beach, made a public pledge in May to divulge the contractual rates the hospital charges private insurers for diagnoses and treatments.

Like officials in the Obama administration, Sonenreich argues that price transparency among hospitals of similar quality will lead to lower healthcare costs. But he also accused some South Florida hospitals of driving up costs by leveraging their market position to extract higher fees from private health insurers.

But by charging higher rates, Sonenreich said, these hospitals force private insurers to negotiate lower rates of payment with other hospitals for the same procedure.

That leads to higher costs for employers and higher premiums for employees, he said.

Among the data released Monday were Medicare spending averages per beneficiary broken down by state.

Louisiana, Florida and Texas ranked the highest in the nation in terms of total cost per Medicare beneficiary, with the program spending an average total of $10,713 per capita in Florida in 2011, compared to a national average of $9,003 for the same year.

In Louisiana, home to the nation’s highest Medicare spending per beneficiary, Medicare spent $11,088 per capita in 2011. The federal healthcare program for seniors spent the lowest amount per beneficiary in Hawaii, at an average of $5,564 per capita in 2011.

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