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Same procedure can be different price at different First Coast hospitals

12:13 AM, May 10, 2013   |    comments
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JACKSONVILLE, Fla. -- A health scare and a month-long hospital visit have left Marc Bchiri with a number of scars along his right side.

"I thought the anesthesia would be the worst," he said.

While he can laugh about his health issues now, looking at his bill for $301,057, he feels like he just got kicked in the gut. Bchiri's 31-day stint at Memorial Hospital included two broken ribs, a lung collapse and surgery.

"Now I'm afraid that if I would have went down south, my bill would have been half," said Bchiri.

A new report released by the federal Centers for Medicare and Medicaid Services this week shows hospitals charge different prices for the same procedures. The data comes from bills submitted from more than 3,000 hospitals for everything from hip replacements to respiratory and heart operations.

According to the report, for a case of simple pneumonia at Baptist Medical Center Beaches, the average total payment is $7,936.

At Orange Park Medical Center, the average total is $8,629 and at the Mayo Clinic it's $10,968.

So why the difference in price?

According to the Florida Agency for Healthcare Administration, hospitals determine their own pricing.

Mike Lukaszewuski, CFO and Senior Vice President for Baptist Health, said while Medicare initially pays hospitals the same rates for the same procedures, care for the indigent and medical education will adjust a facility's cost structure.

"The hospitals that have major teaching programs incur a lot of extra costs and the government pays them an extra amount per discharge," said Lukaszewuski.

David Goldberg, Director of Marketing and Guest Services at Orange Park Medical Center, said charges are determined by a patient's insurance.

"What patients pay has more to do with the type of coverage they have than charges. Government programs like Medicare and Medicaid determine how much they reimburse hospitals. Insurance plans negotiate their payments. Everyone else is eligible for our charity care program or they receive our uninsured discounts, which are similar to the discounts a private insurance plan gets," Goldberg said in a statement.

Meanwhile, Mayo Clinic spokesperson Kevin Punsky said its charges are based on the market.

"Mayo Clinic is committed to provide transparency to our patients, including both in care quality and pricing," Punsky said in a statement. "Our formal, market-based fee process is based on the need to sustain our mission and drive affordability. Mayo Clinic's Florida campus has one hospital fee schedule for charging all patients/payers. What hospitals charge rarely reflects what they are actually paid by government or private insurers. The Centers for Medicare & Medicaid Services determines what Mayo Clinic is paid. Hospital charges vary because they reflect the individual hospital's mission and the patient population it serves."

Memorial Hospital said they will look into lowering Bchiri's bill, but after hearing about the new federal data, Bchiri is frustrated as he struggles to pay for a bill that could have been cheaper.

First Coast News

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