Same procedure, different bills at Pa. hospitals

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PITTSBURGH – Pennsylvania hospitals sometimes charge vastly different rates for the same medical condition, according to Medicare health care billing information released by the government Wednesday.


In Philadelphia, the Hospital of the University of Pennsylvania bills $26,674 for chest pain.


The same medical condition at Uniontown Hospital in Uniontown is billed at $5,687, while the Reading Hospital Medical Center in Reading bills an average of $16,696.


Medicare pays hospitals on its own fee schedule that isn’t based on the listed charges. And, insurance companies routinely negotiate discount rates with the hospitals, so in many cases actual payments are lower than the initial billing.


But patients who are uninsured can be billed the full amount. And some with private insurance may find their share of the bill is inflated as a result of a hospital’s higher charges, federal officials said.


There are big differences even within the same company. The University of Pittsburgh Medical Center-Hamot in Erie bills $27,425 for bronchitis and asthma, while UPMC-Mercy in Pittsburgh bills $19,900, and UPMC-Passavant in Pittsburgh bills $26,768.


Among Pennsylvania hospitals, the basic diagnosis of bronchitis and asthma is billed at widely different rates.


In Philadelphia, the Hospital of the University of Pennsylvania bills $35,342, while Uniontown Hospital bills $7,001.


The variations exist across the nation.


At Beth Israel Medical Center in New York, the average charge to treat a blood clot in a lung is $51,580. Down the street at NYU Hospitals Center, the charge for the same care would be $29,869.


At the Mayo Clinic in Minnesota, the list price is $16,861.


Experts said the wide variations don’t make sense.


Jonathan Blum, the Medicare deputy administrator, said the higher charges don’t reflect better care. And the amounts are too huge to be explained by obvious differences among hospitals, such as a more expensive regional economy, older or sicker patients, or the extra costs of running a teaching hospital, he said.


Dr. David Goodman, co-author of the Dartmouth Atlas of Health Care, said “It does show how crazy the system really is, and it needs some reform.”


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