Saturday, March 24, 2012

Eleven Thousand Dollar Colonoscopies And Other Hospital Follies

Some people refer to California as a socialist state. We have an ultraliberal all-Democratic state government that many people feel is anti-business and anti-growth. Yet occasionally they do some things that actually are quite helpful. A few years ago the the state legislature passed a law requiring California hospitals to publicly disclose all fees charged at their facilities. It also demanded the cost of the twenty-five most common procedures at each location be made public. The state then gathered all the data and put it into a public database called the Chargemaster. It is fascinating reading. The costs that are submitted reflect the amount that an uninsured patient will likely face if he presented to that hospital. It doesn't take into account substantial discounts that are usually made when hospitals negotiate their fees with the insurance companies.

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Let's take a perusal of one hospital in California, Stanford University Medical Center. Printed here is a copy of the twenty-five most common procedures up to June, 2011. I was astonished to find that they charge $11,222 for a colonoscopy with biopsy. An upper endoscopy with biopsy, which may take all of five minutes or less, will present the patient with a $10,962 bill. A transforaminal epidural steroid injection will set a patient back $10,918 for a case that may take no more than five to ten minutes.

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Just so that the good people at Stanford don't think that we're picking on them, let's choose a Southern California hospital next, Ronald Reagan UCLA Medical Center. UCLA's  list shows that in general they charge a bit less than Stanford. Maybe it is because they are affiliated with a state run public university. But if you don't have insurance, the prices can still be ruinous. A colonoscopy with biopsy will cost a patient $3,817 while an EGD with biopsy will lighten $4,684 from one's checkbook. Even more fascinating is the comprehensive charge list made by UCLA. Here you can find that a dessert and beverage will cost the patient $10 and if the patient needs a ventricular assist device, he will get socked with a $291,460 bill.

Finally, let's browse through a massive Excel database submitted by another large California hospital, Cedars-Sinai Medical Center. Again, anything that is done inside the hospital building will be charged. If you need blood, the Y-type tubing used to hang blood will cost the patient $110.82. The anesthesia charges for the first hour of surgery including an arterial line results in a $5,814.36. That is separate from the doctor's fee and the cost of the arterial line itself which is $668.19. Breast implants at this Beverly Hills hospital will cost anywhere from $123 to $6,280.07. Just so the guys don't get left out, inflatable penile implants range in prices from $1,175 up to 26,518.81. Hmm. Wonder why the men get "shafted" for more dough? Oh, and don't accidentally choke on your food while you're in Cedars. Hard to believe, but performing a Heimlich maneuver on you will cost $102.17. But if you're chocking to death, I'm sure you won't mind paying that charge instead of shopping around for the best prices.

If searching by every hospital is too laborious, there is even a database for comparing the price of a procedure between different hospitals. Here you can find some common procedures such as child delivery or joint replacement and how much it costs across different hospitals. For instance, a diagnosis of chest pain in Los Angeles County will cost a patient $37,799 at Olympia Medical Center but only $4,704 at Motion Picture and Television Hospital.

Sure it is easy for people to tell patients to shop around for the best prices before going to the hospital. As you can see the prices vary enormous from one location to another. But when you're sick, who has the time or the energy to search through all these huge databases and compare prices? The information is here, at least in California. But this won't lower the cost of healthcare. I think perversely people may decide that they want to go to the most expensive facility for their treatment, since the priciest means the best, right? So back to the drawing board for the government in their attempt to lower healthcare costs.

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