100 Hospitals highest & lowest charges

Home Health Columnist / Guide · Jun 12, 2003

Highest Charges Compared to Costs--Philadelphia, Pa Area ---all in my backyard.

16. Graduate Hospital, Philadelphia

17. Delaware County Memorial Hospital

25: Crozer Keystone Medical Center

32. Frankford Hospital, Philadelphia

34 Abington Memorial Hospital

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Graduate Hospital, an inner Center City Philadelphia hospital run by Tenet having charges greater than those of Temple University (with a larger indigent base that also performs heart and other transplants) is unbelievable.

#17 in Nation is Delaware County????? They are a part of Crozer Keystone Health system. This is a 236 bed local community hospital in Drexel Hill, Delaware County just on the outskirts of West Philadlphia. They are located in a middle class community that mostly has insurance. No open heart, no transplant programs, a small CCU without really high tech patients found at Philly teaching hospitals like Jeff, Penn, Temple or even Lankenau!

#25 Crozer Chester Medical is the Flagship hospital of Crozer System and located next door to the poorest city in the nation, Chester, PA. They have 426 beds, are a tertiary-care teaching hospital with a trauma designation, high tech ICU/CCU, open heart unit, great Burn Center, Peds, NICU. If your sick in my county and don't want to go to a name facility in Philly, this is the hospital everyone chooses. (10 minutes from my home, their ER staff saved my son when he went into anaphylaxis two years ago.) This facility I can understand as having higher rates for it cares for a high indigent population. I'm very surprised that their smaller sister institution Delaware County is ranked higher. The hospital health system I work for has an even higher indigent population as these facilities as mostly serves West/Southwest Philadelphia, but didn't even make the top 200. As a result of Crozer being listed so high, they have undergone restructuring "belt tightening": closed the skilled nursing units at Crozer, Delaware County and Taylor hospitals, elminated paramedic transfer service at Taylor and Delaware County and eliminated some positions.

#32 Frankford in Philadlephia also has a high indigent population but is a small local community hospital too. Surprised they too are listed so high.

#34 Abington Memorial is located in an upper middle class community. They do perform complex Cardiac care (new). Don't understand how they can justify their costs higher that Philly teaching hospitals who handle the more complex cases, therfore sicker patients often indigent too.

Most of the top 100 facilites are undergoing extensive review of their Medicare charges, will be interesting to see how it turns out.

Katnip, RN · Jun 12, 2003

Wow. The only ones in my area were all on the lowest list. I'm impressed and surprised about at least one.

EmeraldNYL, BSN, RN · Jun 12, 2003

Funny how so many Philly hospitals made the list. And they were all Tenet hospitals, suprise!!

pickledpepperRN · Jun 12, 2003

June 11, 2003

Contact: the IHSP at 510-267-0634.

America's 100 Most and Least Expensive Hospitals

New Study Links High Hospital Charges to Higher Profits

The full report and more information is available on the CNA website at http://cna.igc.org/top200

The nation's most expensive hospitals are also the hospitals which are racking up the highest average profits, according to a comprehensive new research report by the Institute for Health and Socio-Economic Policy (IHSP) commissioned by the California Nurses Association.

Included in the report is a listing of the 100 most expensive and 100 least expensive hospitals, based on just released federal cost reports with aggregated data for millions of patient discharges in fiscal years 2000-2001 filed for nearly 4,300 U.S. hospitals.

Surveying all hospital charges for all in-patient and out-patient services and other financial categories, the nation's 100 most expensive hospitals mark up their gross charges an average of 525% over their costs, a significant contributor to skyrocketing health care costs that are pricing increasing numbers of families out of health care coverage, according to CNA and the IHSP.

For the first time ever, the report also documents a direct correlation between high hospital markups over costs and higher hospital profits or net income. The 100 hospitals with the highest average gross charges also had the greatest average profits, while the bottom 100 on average reported financial losses.

Additionally, the report found links between high charges and the growing corporatization in the health care industry. Only five hospitals in the Top 100 were not part of hospital chains, while 69 of the nation's least expensive 100 hospitals were not system affiliated.

Size also matters. The larger a hospital as measured by average number of beds, the higher the markup on gross charges over cost, the report found.

Troubled Tenet Healthcare dominates the expensive list, owning the top 14 slots, and 64 of the top 100. Doctors Medical Center in Modesto, Ca., placed first with a sticker price of 1,092% above its costs on hospital services. That means Tenet Doctors would bill $10,092 for a patient's case where the costs were $1,000. Nearby Doctors Hospital of Manteca was the next highest with average markups of 920%.

HCA - The Healthcare Company ranked second among the top 100 with eight hospitals, followed by Saint Barnabas Health Care System, a New Jersey-based chain with four hospitals in the top 100. Overall Tenet's hospitals averaged gross markups of 477% over costs. Of some 280 U.S. hospital chains, only Crozer-Keystone, a small system in the Philadelphia area, had a higher average markup than Tenet for its hospitals, with a charge to cost ratio of 585%.

"These numbers, and the wide chasm in billing practices, suggest that some hospitals, particularly those that command large market share, may be inflating gross charges to make windfall profits or net income, while many other smaller facilities are struggling simply to keep the doors open," said IHSP director Don DeMoro.

Following previous reports by the IHSP/CNA and others, some hospital executives have said that high gross charges were unrelated to net income, DeMoro noted. "This data, reported by the hospitals themselves, identifies a direct association between what the hospitals charge and their bottom line."

Some hospitals have also contended that their charges are fixed by Medicare or other payers, but a report by the California Public Employees Retirement System earlier this year found that Blue Cross, which administers claims for CalPERS, paid Tenet almost three times more for bypass surgery than it paid to non-Tenet hospitals in California.

CNA President Kay McVay, RN, said the huge markups in hospital bills "drive up overall health care costs for everyone. Patients and consumers are being priced out of our health care system. When we see growing numbers of uninsured and underinsured families, and double digit health care premium increases that encourage employers to drop or reduce health benefits, these outrageous markups are a major contributor to our national health care crisis."

"While Tenet is not the only offender, these numbers clearly demonstrate that Tenet's pricing practices encourage other hospitals in the same markets to jack up their prices as well," said McVay. For example, the highest ranking non-Tenet hospital on the list, Sutter Health's Memorial Hospital in Modesto, Ca., with an average 597% markup, competes with two nearby Tenet hospitals, Doctors Modesto and Doctors Manteca - the top two among the top 100.

Three states, California, Florida and Pennsylvania accounted for about 64% of the top 100. All three states are dominated by corporate hospital chains. By contrast, New York State, with 194 hospitals in the data set, 188 of which were non-profits, had a statewide average charge-to-cost ratio of 181%, significantly below the national average of 206%.

Tenet's dominance on the current list is notable for other reasons. Previous reports on Tenet's billing practices have been on earlier years of public data. Tenet has said in investor conferences that its most aggressive pricing strategy did not go into effect until after 2000. "This is the first year of federal data that reflects the effect of the increase with Tenet facilities so far above other hospitals in gross charges," DeMoro said.

The full report and more information is available on the CNA website at http://cna.igc.org/top200

passing thru · Jun 12, 2003

IMHO, doctors are as big a crooks as lawyers.

passing thru · Jun 12, 2003

IMHO, doctors are as big a crooks as lawyers.

pickledpepperRN · Jun 12, 2003

Originally posted by passing thru
IMHO, doctors are as big a crooks as lawyers.

I changed from an HMO that made me wait 6 weeks for all the approvals for an MRI to a plan that costs me MUCH more. The same doctor now wants me to have so many tests never thought of before. I have had so many tests like ultrasound, and MANY negative biopsies, colonoscopy (work nights). I feel better than when it was almost impossible to get an appiontment. Could it be the $$$?

Gldngrl · Jun 12, 2003

Spacenurse-

Oh, most definitely yes! I did a paper about MDs and a conflict of interest when they are to be patient advocates, yet they're doing backroom deals w/ HMO's and being offered "disincentives" to provide care. They, unfortunately, as well as the HMO's have been able to avoid liability under the law for their actions (or shall we say inaction). I pay outright for my neurologist and then submit the bill to the insurance and get some reimbursement...but I know my MD's in my corner.

pickledpepperRN · Jun 12, 2003

Originally posted by mmb-rnjd
Spacenurse-
Oh, most definitely yes! I did a paper about MDs and a conflict of interest when they are to be patient advocates, yet they're doing backroom deals w/ HMO's and being offered "disincentives" to provide care. They, unfortunately, as well as the HMO's have been able to avoid liability under the law for their actions (or shall we say inaction). I pay outright for my neurologist and then submit the bill to the insurance and get some reimbursement...but I know my MD's in my corner.

Did the same with the dermatologist. MUCH better than the 'gatekeeper'.

My family practice MD did all she could with the HMO when I was hurt. If I had known it would take 2 weeks for permission to see an orthopod, another week for an appointment, 2 weeks for authorization for the MRI, a week waiting for the appointment, 2 weeks to authorize a visit to the Ortho guy, and two more weeks to start PT I would have gone to ER.

Next time I told my MD I would pay and she sent me to a great ortopedic doctor. Neither missed work nor developed a 'frozen shoulder' as had been the case the first time.

pickledpepperRN · Jun 13, 2003

http://www.sun-sentinel.com/business/local/sfl-ztenet12jun12,0,564731.story?coll=sfla-business-front

Study says Tenet hospitals in S. Florida are among nation's priciest

By Glenn Singer

Business Writer

June 12, 2003

Nine of the 100 most expensive hospitals in the United States are in South Florida, and all but one are owned by Tenet Healthcare Inc., according to a study released on Wednesday by the California Nurses Association.

The study, conducted for the union by the Institute for Health and Socio-Economic Policy of Orinda, Calif., used Medicare cost reports for fiscal 2000-2001 submitted by 4,292 hospitals. It found that Tenet owns 64 of the highest-cost hospitals, including those ranked 1-14 on the list.

A Tenet spokesman, Steve Campanini, said his company "questions the methodology and will not dignify the report with a response" because the nurses' union "is engaged in a contentious corporate campaign to recruit Tenet's California nurses, and they are entrenched in a protracted strike at a couple of our hospitals in northern California."

He also said the director of the policy institute, Don DeMoro, is the husband of the nurses' union executive director, Rose Ann DeMoro, and has his salary paid by a grant from the union. Union spokesman Charles Idelson confirmed the DeMoroes are married and that Don DeMoro wrote the report.

According to that 48-page report, Doctors Medical Center in Modesto, Calif., tops the high-cost list with a "sticker price" of 1,092 percent above costs on all hospital services combined. That means the hospital billed $10,092 for each $1,000 in costs. It made $125.4 million is fiscal 2000-2001.

Ranking 28th, Tenet's Florida Medical Center was the most-expensive Florida hospital on the list with total charges exceeding total costs by 572 percent, the study showed. Also in the top 100 were Tenet's Palmetto General Hospital, Delray Medical Center, Coral Gables Hospital, Hialeah Hospital, North Ridge Medical Center, Hollywood Medical Center and West Boca Medical Center. HCA's Palms West Hospital in Loxahatchee also was among the highest 100.

Researchers used the phrase "sticker price" because, except for private-pay patients, no one pays full price at a hospital. But the report notes that those gross charges "are a key variable in determining actual reimbursements" from Medicare, Medicaid, HMOs and workers compensation programs.

The report indicated that chain hospitals generally charge far more than independent hospitals and those run by nonprofit groups including municipalities and religious orders. For example, one of the four lowest-cost hospitals on the list, independent Atlantic General Hospital in Berlin, Md., reported total charges equal to total costs. It made $240,000 in fiscal 2000-2001.

No Florida hospital was among the 100 lowest-cost medical centers on the list.

Glenn Singer can be reached at [email protected] or 561-243-6612.

passing thru · Jun 13, 2003

That is sooooooooooo disgusting. Docs are the same everywhere.

You or your family member walk in with good insurance,

and you will have every test in the book ordered.....if you have private pay insurance....

Every doc I see wants to heart cath me;;;;;;;;;;;; Fat chance !!

(coronary by-pass on the way, ""Oh, we found a blockage"

and the others want to MRI me to death !!!!

Pleez !

every shift I work -- I see what they order & do to these 80 & 90 somethings who aren't mentally capable of comprehending

and refusing.

Docs are glorified salesmen.....