A Pacemaker In One Hospital That Costs $36,000 Might Cost $143,000 At A Different Hospital

Flickr viaA pacemaker implant that might cost a patient $36,012 in one hospital, might cost $143,124 down the road at a different hospital –– in the same zip code. 

This shocking reality of America’s hospital billing system comes from a government-sponsored study released by the federal centres for Medicare and Medicaid Services.

The same billing pattern for common medical procedures like the pacemaker turns up all over the report, which tracks the cost of more than 7 million billed procedures at virtually every major hospital in the country.

The worst part is no one seems to have a clear answer as to why. 

“It doesn’t make sense,” Jonathan Blum, director of the government’s centre for Medicare, told the AP.  He said the higher costs don’t necessarily reflect better care and regional economic differences aren’t solely to blame either.

Some discrepancies can be caused by how severe a patient’s condition is compared to another, or whether a hospital is nonprofit, for-profit, or government-backed.

But even experts are having a hard time explaining why some procedures cost 20 to 40 times as much at different facilities.

“If you’re charging 10 per cent more or 20 per cent more than what it costs to deliver the service, that’s an acceptable profit margin,” Gerard Anderson, the director of the Johns Hopkins centre for Hospital Finance and Management, told the NY Times. “Charging 400 per cent more than what it costs has no rational basis in it at all.”

At any rate, this new database could be a game changer. The uninsured have the most to lose from price discrepancies, since they don’t have the benefit of Medicare or a private insurer to bear the brunt of the cost burden. Until now, there hasn’t been a list of charges for common medical procedures anywhere near as comprehensive for consumers to sort through.

If anything, now we know that just like any consumer product, it pays to shop around for medical care  –– or, at the very least, try to negotiate. 

You can search the database for yourself or check out the embedded version below. 

<a href=”https://data.cms.gov/Medicare/Medicare-Provider-Charge-Data/s99v-duw6″ target=”_blank” title=”Medicare Provider Charge Data” data-mce-href=”https://data.cms.gov/Medicare/Medicare-Provider-Charge-Data/s99v-duw6″>Medicare Provider Charge Data</a>Powered by Socrata

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