100 Hospitals highest & lowest charges

pickledpepperRN · Jun 13, 2003

http://www.sanluisobispo.com/mld/sanluisobispo/6071235.htm

Posted on Thu, Jun. 12, 2003

Tenet cited as leader in high markups

Twin Cities, Sierra Vista price services more than seven times their cost, says disputed new study

Silas Lyons

The Tribune

TEMPLETON - Local hospitals owned by Tenet Healthcare Corp. mark up their prices more than almost every other hospital in America, according to a report that was immediately dismissed by the hospital industry as biased.

The study, released Wednesday and based on federal data, alleges that Twin Cities Community Hospital in Templeton ranked fourth highest in the nation, charging 761 percent above the cost of services. Sierra Vista Regional Medical Center came in fifth with markups of 758 percent.

Almost 4,300 hospitals were ranked in the study by the Institute for Health and Socio-Economic Policy, which is closely tied to the California Nurses Association union. The CNA is locked in bitter conflict with Tenet over attempts to organize in the company's California hospitals.

Sierra Vista nurses are represented by CNA; Twin Cities nurses are not.

"In general, what we see is the bigger you are, the more you charge," said Don DeMoro, who oversaw the study. "In general, the more you charge, the greater the likelihood by a significant degree that your bottom line is going to benefit."

Representatives for both Tenet's local hospitals and the state's hospitals as a whole questioned the validity of the report.

"You ought to look at that in terms of what is CNA's agenda," said Jan Emerson, vice president of external affairs for the California Healthcare Association, a hospital trade group. "They're fighting Tenet."

Dennis Pall, spokesman for Tenet's local hospitals, said all of the charges are set by the corporate office and he isn't allowed to comment on them.

As for the report, Pall said, "this could be very biased or prejudicial, any way you look at it."

Sixty-four of the top 100 hospitals in the study were Tenet-owned.

DeMoro brushed off suggestions that the report was tainted by CNA's conflicts.

"If there's a conflict between the Soviet Union and the Martians, the numbers would be the same," he said. "I notice they haven't said anything about the methodology. Let's hear it."

All of the data come from federal hospital cost reports. Although they're the most recent released, those figures refer to the charges set two years ago for the 2000-2001 fiscal year.

Critics also say charges are an irrelevant way to examine hospitals' billing practices. In reality, the fees set by hospitals for their many services are almost never paid in full, Emerson said.

Rather, most hospital bills are paid by huge institutions such as Medicare or private insurance companies. Medicare sets its own rates and insurance companies bargain for theirs.

Even for people who aren't covered by some sort of insurance, hospitals rarely are able to collect the amount they bill for, Emerson said.

Earlier this year, Tenet published a study that showed its actual revenue from patients in 2001 was lower than the statewide average.

In that study, however, the company's two San Luis Obispo County hospitals collected 8 percent more actual revenues, per patient day, than the county average for such earnings. The Institute for Health & Socio-Economic Policy study argues that charges -- not just actual patient revenue -- are important.

According to the study, the top 10 percent of hospitals nationwide, ranked by the difference between what they charge and what services cost, average $10 million in profit.

The next 10 percent average less than $5 million, and it drops off from there. Those that charge the least lose money.

"Charges do matter," DeMoro said. "Please, let's get over this national fiction that charges don't matter. This is nonsense."

According to DeMoro's report, Twin Cities earned $13.4 million in net profit in 2001-02, while Sierra Vista netted $9.3 million

pickledpepperRN · Jun 13, 2003

http://www.calnurse.org/top200/toptenbystate.pdf

caroladybelle, BSN, RN · Jun 14, 2003

Several of the South Florida hospitals on the most expensive list.

With the pittance of wages that they pay Florida nurses and the lousy staffing, they should be ashamed.

And they can't even blame unions (at least, I don't think that they can).

pickledpepperRN · Jun 14, 2003

Don't think unions are prevalent in Texas either.

To my knowledge Texas has MANY top hospitals that are NOT the most expensive.

http://www.dailysentinel.com/news/newsfd/auto/feed/news/2003/06/13/1055477236.04889.3111.0272.html

6/13/03 Study names Medical Center one of most

expensive in nation

By JOHNNY JOHNSON, Sentinel Staff

Nacogdoches Medical Center was recently named as one of the most expensive

hospitals in the country, according to a study by the Institute for Health and

Socio-Economic Policy.

In a list of the nation's 100 most expensive hospitals, Nacogdoches Medical

Center came in at No. 91.

Medical Center was one of only nine Texas hospitals to make the list, eight of

which are owned by Tenet Healthcare Inc.

The IHSP study, which was conducted for the California Nurses Association, was

based on federal cost reports that contained patient discharges during fiscal year

2000/2001. The rankings were determined based on a ratio comparing hospital

costs and hospital charges.

Local hospital administration deferred comments to Tenet Corporate officials.

Tenet spokesman Steven Campanini said that the study means nothing to the

people of Nacogdoches, and that all of the data in the study should be taken with

a grain of salt.

"The Nacogdoches community needs to recognize that this report needs to be

viewed in light of its authors," he said.

Campanini said that people who look at this study should look at it knowing that

both the California Nursing Association and the Institute for Health and

Socio-Economic Policy work together to specifically target and attack Tenet every

chance they get.

According to Campanini, top officials at the IHSP and the CNA are husband and

wife and they have "private agendas" to target Tenet facilities because CNA is a

nurses union which is currently trying to recruit nurses from certain Tenet

hospitals in California.

"Reports like this are misleading and inappropriate," Campanini said. "We believe

we are in line with the rest of the hospital industry in what we provide to the

community. Gross charges do not accurately reflect what hospital's receive in

reimbursements."

In an interview with The Dallas Morning News, Joanne Jung, a spokeswoman with

the California Nurses Association, said that CNA stands behind it survey, which is

based on factual federal data.

Tenet, which is currently under federal investigation for Medicare issues and billing

practices at certain hospitals, had 64 hospitals in the top 100.

The entire IHSP study can be found at http://www.calnurse.org.

pickledpepperRN · Jul 11, 2003

What Price Health Care?

Hospital charges fueling health-care crisis

Kay McVay

Friday, July 11, 2003

URL: http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/07/11/ED83885.DTL

As policy-makers struggle to come to grips with a persistent crisis in cost, quality and access to health-care services, any reform that fails to rein in excessive hospital billing practices will surely fail.

The California Public Employees Retirement System recently announced plans to boost its average premium rates by up to 18 percent, a decision that will doubtless set off a new spiral of premium increases.

As premiums climb, more businesses try to recoup their expenses by reducing health benefits for employees, increasing co-paymentss or deductibles, or dropping coverage altogether.

The results: The number of uninsured rises; those with reduced benefits wait longer for needed medical care, often delaying care until it's most expensive -- in the emergency room. Medical debt accounts for half of all personal bankruptcies, and far too many people are one unexpected medical bill away from homelessness. More than a third of American families are "very worried" about their health-care costs, reported a recent Kaiser Family Foundation poll.

While the role of pharmaceutical corporations and HMOs in driving up costs is well known, the pricing practices of big hospital chains is often hidden. A report by the Institute for Health and Socio-Economic Policy, commissioned by the California Nurses Association, should help lift that veil. Among its findings and implications:

-- High hospital charges are a key factor in driving up health-care premiums and health-care costs generally. Hospitals that charge patients the most make the most money.

-- Some hospitals with the highest charges are making windfall profits, encouraging other hospitals to raise their charges. Corporate-owned hospitals have among the lowest average costs and the highest markups on their bills.

-- The "economies of scale" savings promised in the merger mania of the 1990s created a boom for health-care executives and speculators, but resulted in higher costs for consumers. States and markets that are dominated by corporate chains tend to have higher charges and higher profits.

-- More hospitals are targeting the most lucrative services to maximize revenues or profits, especially operating rooms, and downgrading services that produce lower reimbursements. One result is the growth of designer medical care and specialty hospitals.

The report surveyed federal cost reports for 4,300 hospitals across the United States. But California, which is dominated by large hospital systems, is the most affected. Among the 100 U.S. hospitals with the highest markups in their gross charges over costs, 38 are in California. No. 1 on the list: Doctor's Medical Center of Modesto, which marks up its gross charges by 1,092 percent over its costs and recorded more than $125 million in profits in fiscal year 2000-2001, the most recent year of data available. In other words, Doctor's Medical Center would bill a patient $10,920 where the costs were $1, 000.

Many individual patients are well aware of the consequences. An Orange County woman broke her leg in 2001 and needed follow-up surgery to repair radial nerve damage. She went to one of the hospitals in the top 100. Her total bill following a 36-hour hospital stay -- $95,000. On a smaller scale, consider the Oakland science teacher who splashed scalding water on herself. She was billed $1,145 for two 4-by-4-inch bandages and burn cream.

Out-of-control hospital billing practices should have our attention -- and demand greater oversight and public protection. Some legislative hearings on abuses in hospital pricing practices have been held. It is only a small beginning.

Market-based medical care has worked spectacularly well for a handful of health-care executives and investors. But it's been a disaster for patients and consumers. A fundamental overhaul of the system is needed, with global budgets to control price-gouging and a single standard of universal quality care for all.

Kay McVay is president of the 50,000-member California Nurses Association. The full report can be viewed at http://www.calnurse.org.

Dplear · Jul 14, 2003

This is so skewered it is rediculous. The hospitals that are listed as charging the most are for profit hospitals..hence the reason to charge more. The ones listed as charging the least are either not for profit or non profit. They cannot make a profit by law. We have to stop demonizing the making of profit. It is NOT AN EVIL thing.

Dave

geekgolightly, BSN, RN · Jul 15, 2003

Originally posted by Dplear
This is so skewered it is rediculous. The hospitals that are listed as charging the most are for profit hospitals..hence the reason to charge more. The ones listed as charging the least are either not for profit or non profit. They cannot make a profit by law. We have to stop demonizing the making of profit. It is NOT AN EVIL thing.

Dave

I agree that it is not an evil thing to want to make money. But what I would like to see is what correlation there is between high profit margins and working conditions for nurse's/ Do the hospitals that cna afford it compensate the nurses well? I'm curious.

It also stands to reason that a thousand percent markup is a little unreasonable and might be part of the reason that health insurance prices are being driven up. I think a thousand percent markup is certainly excessive, even for a for-profit hospital.

EmeraldNYL, BSN, RN · Jul 16, 2003

Originally posted by geekgolightly
I agree that it is not an evil thing to want to make money. But what I would like to see is what correlation there is between high profit margins and working conditions for nurse's/ Do the hospitals that cna afford it compensate the nurses well? I'm curious.

The Tenet hospitals in Philly pay on par with the other large hospitals in the area-- around $23-24 an hour for new grads. Benefits are decent-- tuition assistance for furthering ed, partial loan repayment for new grads, etc. I loved Hahnemann when I did clinicals there but decided to accept a position with another (non-Tenet) hospital instead.