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 Of the 50 hospitals with the highest markups, 49 are for-profit,
including 25 owned by Community Health Systems.
Community Health and other for-profits did not respond to requests
for explain their markups, but in the past hospitals have said list
prices, shown on a "chargemaster," are irrelevant because "no one"
pays those.
In fact, out-of-network patients and the uninsured are often charged
list prices, said Dr. Renee Hsia of the University of California,
San Francisco, who has studied hospital charges but was not involved
in this research. "People do get bills based on the chargemaster,
and for out-of-network care insured patients pay a percentage" of
chargemaster prices, she said.
Auto insurers, covering care after accidents, and workers'
compensation also pay full freight. "That results in higher premiums
for auto insurance and for employers who pay into workers' comp,"
said study co-author Ge Bai of Washington & Lee University. "That
means we are all victims of these markups."
She and Gerard Anderson of Johns Hopkins Bloomberg School of Public
Health blamed lack of regulation and transparency for 1,000 percent
markups. Non-transparency means patients cannot learn what a
procedure will cost before they get a bill, preventing comparison
shopping.
Those bills can be eye-opening. Hsia, for instance, found that
charges for a lipid panel blood test varied from $10 in one
California hospital to $10,169 in another; opening blocked arteries
cost $22,047 in one, $165,386 in another.
For their study, Anderson and Bai analyzed 2012 data, the latest
available, from the Centers for Medicare and Medicaid Services to
identify the 50 hospitals with the highest markup over Medicare's
allowed charges, which Medicare considers a hospital's cost.
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The 50 had an average markup of 1,010 percent (see Factbox), vs. 340
percent for the other 4,433.
Data for 2013, released last week, support the findings. The
hospital with the highest markup in 2012, North Okaloosa Medical
Center in Florida, charged $113,000 to treat respiratory infections
in 2013, vs. Medicare's $10,000. In second place, Carepoint
Health-Bayonne in New Jersey charged $193,000 for pneumonia vs.
Medicare's $9,600.
To treat hemorrhage, common in auto accidents, Okaloosa charged
$79,350 vs. Medicare's reimbursement of $5,177.
(Editing by Jonathan Oatis)
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