Tag Archives: charges

Wide variations in health care providers’ charges raise questions about the right rate

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Source: Analysis of Spending on Shoppable Services in Massachusetts, the Pioneer Institute, Boston, August 2020.

Early last month, a report from the Pioneer Institute in Boston showed that Massachusetts consumers could have saved $22 million in 2015 if they got health care from lower-cost providers instead of from the highest-priced health care providers.

In “Analysis of Spending on Shoppable Services in Massachusetts,” researchers wrote that consumers could have saved $116.6 million if the savings were adjusted for inflation over four years.

The researchers analyzed what providers charged in 2015 for 16 shoppable services, such as elective or non-emergent surgery. Continue reading

Scrutiny of hospital charges likely to intensify in wake of pandemic

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

hospital-roomAs the nation’s hospitals strain to keep up with the demand to care for COVID-19 patients, it seems almost unfair to ask how much all of this treatment will cost. Still, we know that the costs will be high, both for the care itself and for what health insurers, employers and consumers will end up paying.

In a recent report, the health insurance marketplace Covered California projected that the one-year costs of testing and treatment related to COVID-19 could range from $34 billion to $251 billion. These new costs could cause health insurance premiums for individuals and employers to rise by 40% or more next year in the absence of federal action, the report said, adding that insurance premiums would increase because insurers would want to recoup any losses from the pandemic this year and plan for any future losses they might incur next year. Continue reading

CMS unveils dataset on top hospital discharge payments

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

The public can now compare hospital-specific charges for the top 100 most frequently billed discharges at the 3000+ hospitals across the US that receive Medicare payments.  The Center for Medicare and Medicaid Services unveiled its free Medicare provider charge dataset which can be analyzed down to ZIP code level.

Jonathan Blum, acting principal deputy administrator of CMS, said in a webinar with AHCJ members that this effort has been years in the making, as part of the agency’s effort to be more transparent.

Data for FY 2011 is on the AHCJ website, downloadable as an Excel file (a CSV file is available from CMS). From there, it can be sorted by diagnosis related group (DRG) codes, city, state, ZIP and charges. This tool allows journalists, advocates and consumers to compare costs nationally, between or among states, cities, or counties. Data is only available for Medicare Inpatient Prospective Payment System (IPPS) — the fee-for-service component — based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG). These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. It does not include data for U.S. territories or Puerto Rico, or for any Medicare Advantage payments.

Chris Powers, acting director of the Information Products Group, Office of Information Products and Data Analytics demonstrated the dataset by comparing the varying cost of a total joint replacement. Selecting the specific DRG code netted charges ranging from $321,000 to just over $20,000.

The goal is to empower consumers, particularly those who are uninsured and may have to bear the entire cost, who may be underinsured, or who have a high deductible, to ask about appropriate charges  for a given procedure and question discrepancies that cannot be explained by geography, patient population, or affiliation differences. Medicare IPPS pays a fixed cost to hospitals, however, this data can be used as a guideline for non-Medicare fee-for-service charges.

In the Q&A section of the webinar, I asked if there would be a similar data set compiled for Medicare Advantage payments so consumers insured under those plans can also compare charges. Powers said CMS is looking at what the next steps are in terms of data release. “That is a very good question and certainly those concerns are in our minds as we make those considerations.”