To the editor:
I read your article “Health Care Sticker Shock,” outlining hospital costs and seemingly encouraging people to “price shop” for their health care. As a consumer I can appreciate looking for bargains, but as a nurse in the Indianapolis area with some management experience, I would like to offer an “insider” perspective on this issue.
First of all, what you listed were the Medicare charges for specific diagnoses. There are a great many variables that factor into how these charges are determined, not the least of which is that some hospitals, usually teaching and specialty centers, receive more than other hospitals in the same area to support their programs.
At the same time, smaller local hospitals without the advanced equipment needed for more complex testing and treatment receive less. Other factors that influence these charges can include the complexity of the procedures performed and cost-of-living indicators in a given region. For example, New York City, Chicago and San Francisco receive more for the same procedure than similar hospitals in Indianapolis. That said, the amounts listed, as you pointed out, are not anywhere near the actual amounts collected.
Another issue that should factor into choosing a health center is outcomes. While this is mentioned later in the article, it does not tell you where to find such information. Before choosing a hospital for you or a loved one, people should check Health Grades or a similar website for listings that show how each hospital compares to its competition regarding different services and procedures.
If the hospital with the lowest costs also has the highest rates of complications or low success rates, it may not be the bargain you think it is. Choosing a hospital with good outcomes that also has relatively lower costs may be a better deal in the long run. Complications after a procedure or treatment often result in higher costs plus longer hospitalization, more time lost from work and family and the possibility of being transferred to one of those “more expensive hospitals” for additional care that your chosen hospital cannot provide.
And that brings me to my final point. For many of the diagnoses that you listed, one or more of the hospitals had “did not report” listed in place of a cost. In many cases that means they do not offer that service. Once you are admitted, the hospital will run whatever test they can, only to find that they need to transfer you some place else for treatment and that may once again be one of the “expensive” hospitals you were trying to avoid.
They may offer you a choice of where you want to go, but in other cases they will send you to the hospital they have a relationship with or to the nearest hospital they know that can provide the service. If you are sent to a hospital that is out of network for your insurance, you may pay a great deal more than you would have going to an in-network hospital that costs a little more in the first place. Everyone needs to remember that if it is a true emergency, they should always call 911 and go to the nearest available hospital.
I hope you and your readers will consider the whole picture and do a little more research than simply how much a hospital charges to take care of you. In some cases, delays in delivering care can cost you the use of a limb or worse. You may not realize it at the time, but the choice you are making may be more than dollars and cents — it may be life and death.