Hospital price war

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http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-online/


OKLAHOMA CITY – An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed all-inclusive surgery prices online. The move is revolutionizing medical billing in Oklahoma and around the world.

Dr. Keith Smith and Dr. Steven Lantier launched Surgery Center of Oklahoma 15 years ago, founded on the simple principle of price honesty.

“What we’ve discovered is health care really doesn’t cost that much,” Dr. Smith said. “What people are being charged for is another matter altogether.”

Surgery Center of Oklahoma started posting their prices online about four years ago.

Click here to see the online prices at Surgery Center of Oklahoma.

The prices are all-inclusive quotes and they are guaranteed.

“When we first started we thought we were about half the price of the hospitals,” Dr. Lantier remembers. “Then we found out we’re less than half price. Then we find out we’re a sixth to an eighth of what their prices are. I can’t believe the average person can afford health care at these prices.”

Their goal was to start a price war and they did.

Their first out-of-town patients came from Canada; soon everyday Americans caught on.

Matthew Gang, 22, tore his patella tendon, dislocating his knee-cap playing basketball earlier this year.

Gang is from California and he is uninsured.

Surgery in his home-state was going to be about $30,000.

The posted price at Surgery Center of Oklahoma was $5,700, one-fifth the price.

Matthew and his father Tom Gang flew from California to Oklahoma for surgery.

“It was well worth it,” Tom Gang said. “I need a rotator cuff surgery right now. I’m thinking about flying out there and having my surgery because it was such a positive experience for us.”

A handful of other Oklahoma medical facilities have started joining Surgery Center of Oklahoma in price transparency:

Surgery Center of Oklahoma does accept private insurance, but the center does not accept Medicaid or Medicare.

Dr. Smith said federal Medicare regulation would not allow for their online price menu.

They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments.

Several medical facilities in Oklahoma are posting their prices online through The Kempton Group’s website, in order to circumvent that Medicare guideline.

The Kempton Group is a third-party administrator for self-funded health insurance plans in Oklahoma and Texas.

Click here for a list of Oklahoma facilities which offer online pricing through The Kempton Group.

“The key to this is really about empowering employees.” Kempton Group President and CEO J. Wayne Kempton said.

Some Hospital administrators accuse the surgery center of cherry-picking the healthiest and wealthiest patients.

Oklahoma Hospital Association President, Craig Jones, supports transparency in theory.

Jones calls the issue “complicated” and does not expect major metro hospitals to offer online price menus in the future.

“Where we can reveal information that’s meaningful to the patient, we very much support that; that’s what hospitals need to do,” Jones said. “The difficulty when you compare hospitals with surgery centers is that surgery centers, most of the work they do are elective procedures which are a bit more predictable.”

The difference in price is staggering.

News Channel 4′s Ali Meyer obtained bills from the metro’s three largest medical centers: Mercy Medical Center, Integris Baptist Medical Center and OU Medical Center.

  • Mercy Hospital charged $16, 244 for a breast biopsy; the procedure will cost $3,500 at Surgery Center of Oklahoma.
  • OU Medical Center billed $20,456 for the open repair of a fracture; the procedure will cost $4,855 at Surgery Center of Oklahoma.
  • OU Medical Center billed $21,556 for a gall bladder removal surgery; the procedure will cost $5,865 at Surgery Center of Oklahoma.
  • OU Medical Center billed $23,934 for an ankle arthroscopy; the procedure will cost $3,740 at Surgery Center of Oklahoma.
  • Integris Baptist billed $37,174 for a hysterectomy; the surgery costs $8,000 at Surgery Center of Oklahoma.
“I think there’s a tendency to over-simplify the issue of price transparency but there’s no doubt that hospitals are and need to be more accountable to the public,” Jones said. “To try to make the services and the businesses that they carry out more understandable.”

According to the hospital association, about half of Oklahoma’s hospitals are losing money.

However, the metro’s largest hospitals, which are building free-standing emergency rooms and satellite facilities, are not on that list.

“The ‘haves’ seem to be doing a little bit better and the ‘have-nots’ seem to be doing a little bit worse,” Jones said.

However prices may be dropping because of the transparency at Surgery Center of Oklahoma.

As patients are demanding price-matching, some hospitals relent.

“Hospitals are having to match our prices because patients are printing their prices and holding that in one hand and holding a ticket to Oklahoma City in the other hand and asking that hospital to step up,” Dr. Smith said. “So we’re actually causing a deflationary effect on pricing all over the United States.”

The economics are not simple.

But for patients who are finding ways to save on medical care, that seems to be all that matters.

Integris Baptist responded to this story with the following statement:

It is difficult to compare two bills, even for the same procedure, without taking into account a person’s general health, age, weight, medical history, lifestyle, blood type, religious preferences, pre-existing conditions both known and unknown and possible complications; all of which contribute to the final charge.

Instead of offering a generic price list for medical procedures wework individually with patients to determine their financial responsibility.Through our Consumer Price Line patients can obtain charge information in advance on a variety of procedures and services offered at any INTEGRIS Health facility throughout the state of Oklahoma. This is done on a case-by-case basis taking into account insurance payments and self-pay discounts. Financial counselors are also available to help patients who may need to make payment arrangements or obtain other financial assistance to meet their obligations.

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This is how every hospital should be. I bet they don't have 10 middle managers for every employee, inventing new rules every day just to justify their existence, like the big academic hospitals.

And if Medicare/Medicaid and other populist Medicrap are not able to pay even those perfectly reasonable fees, then the solution is to not accept them, instead of overcharging all the other patients or their private insurance companies. Of course, this does not work either at the "not-for-profit" places which put a higher value on the political interests of their board members (many of whom are career politicians or "community leaders").

We should all fly to Oklahoma for our elective surgeries.
 
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I emailed Dr. Smith not to long ago with a question and some advice and he was very kind and emailed back the next day. It is a pipe dream of mine to have a surgery center, and if I ever am lucky enough to see that be a reality, the OK surgery center would be a great model.
 
This is a ridiculous and unfair comparison. 100% of surgicenter patients pay. Hospitals have to take care of many Medicaid and no pay/self pays. They need to charge more to patients with means to help defray cost of uninsured and no pays, along with the costs of 24 hr ER, trauma, stemi, code stroke, etc. Trauma surgeons, cardiac surgeons, orthopedists, anesthesiologists, cardiologists, radiologists, intensivists, CCRNs, etc don't come cheap. Surgicenters don't pay call stipends nor do they keep staff on hand just in case.

People don't understand that hospitals provide a safety net for the community that surgicenters don't. Do you want someplace to send grandpa when he gets a thoracic dissection? Or your child with a belly full of blood after a car wreck? The surgicenter can't take them. They only want to skim the easy, predictable, well paying cream. Hospitals have to take all comers and that comes at a cost. The community needs to decide that it's worth it and pony up.....or not.

It's almost like comparing anesthesiologists to CRNAs. Apples and oranges.
 
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This is a ridiculous and unfair comparison. 100% of surgicenter patients pay. Hospitals have to take care of many Medicaid and no pay/self pays. They need to charge more to patients with means to help defray cost of uninsured and no pays, along with the costs of 24 hr ER, trauma, stemi, code stroke, etc. Trauma surgeons, cardiac surgeons, orthopedists, anesthesiologists, cardiologists, radiologists, RNs, etc don't come cheap. Surgicenters don't pay call stipends nor do they keep staff on hand just in case.

People don't understand that hospitals provide a safety net for the community that surgicenters don't. Do you want someplace to send grandpa when he gets a thoracic dissection? Or your child with a belly full of blood after a car wreck? The surgicenter can't take them. They only want to skim the easy, predictable, well paying cream. Hospitals have to take all comers and that comes at a cost. The community needs to decide that it's worth it and pony up.....or not.

It's almost like comparing anesthesiologists to CRNAs. Apples and oranges.

I hear what you are saying, but I don't see why any reasonably healthy person should choose to have an elective procedure at a hospital. Like you said, hospitals have to charge much more to cover the overhead and costs involved with emergencies, non-payers, and 24/7 coverage.

Why should anyone pay huge markups to subsidize the non-payers and nonprofitable hospital services if they can pay a fair price at a surgery center? I realize it is a big problem that hospitals cant break even or profit from those extra services without overcharging other people, but overcharging everyone with simple cases is unfair and has been allowed to continue far too long.

It doesn't make financial sense to have most scheduled surgeries at hospitals... Unless you don't plan on paying. These docs seem to have found a way for folks with private insurance and self-payers to save money on healthcare. I think it's great.
 
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I hear what you are saying, but I don't see why any reasonably healthy person should choose to have an elective procedure at a hospital. .

You've seen healthy people at the hospital? Wtf? All I see is the frail elderly, the morbidly obese, and the clinically insane
 
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You've seen healthy people at the hospital? Wtf? All I see is the frail elderly, the morbidly obese, and the clinically insane

I guess it depends on the hospital. A lot of people have routine procedures for ACL, tonsils, etc. at hospitals. If it truly is only a fraction of the cost to do these procedures at surgery centers, I think the article is pretty valid.
 
I guess it depends on the hospital. A lot of people have routine procedures for ACL, tonsils, etc. at hospitals. If it truly is only a fraction of the cost to do these procedures at surgery centers, I think the article is pretty valid.


The Surgicenters are very efficient and cost effective in delivering health care especially if they don't accept CMS. Hospitals must spend millions alone on just regulations, rules, Accreditation, etc.

You may think surgicenters are the solution until you get into a car accident, Kidney stone on a Friday afternoon, Acute appendicitis on Saturday, Brain Aneursym rupture, etc.

The fact is Surgicenters cause hospitals to pay stipends to Anesthesiologists because we lose the paying patients necessary to survive CMS. This in turn drives the CRNA model or "loose" supervision to keep costs down.

I don't blame anyone for wanting to earn $800K as an Anesthesiologist doing surgicenter work with NO CALL but the fact remains surgicenters hurt hospitals and all who rely on them.
 
They only thing I'll say is that the surgicenters I've worked at seem to have more regulations and more fear (self-imposed a lot of it) about being scrutinized or shutdown by the DOH or the like. At two of them it was a complete pain in the ass and way above what I had to deal with at other places from a regulatory standpoint.

But, yeah, I think every (male) anesthesiologists would probably like a gig where they get $2,000 cash money for doing boob jobs all day long on healthy, hot, insecure 26 year olds.
 
Hospitals hate physician owned surgicenters, because as been said above they try to skim out as much cream as possible. Their lobbying arm (the American Hospital Association) tries real hard to limit their growth and kill existing ones by supporting burdensome regulation and scrutiny.
 
When there are complications at these surgical centers, who handles them?

What happens when a patient requires post-op ICU care?

What happens when the patient is "fine" post-op, is discharged and then has unexpected post-op bleeding at 11pm? Or ends up in septic shock 20 hours later?

Is that included in the price? Can they return to the surgery center for care? Does the surgery center "pay" the ED and ICU?

HH
 
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I hear what you are saying, but I don't see why any reasonably healthy person should choose to have an elective procedure at a hospital. Like you said, hospitals have to charge much more to cover the overhead and costs involved with emergencies, non-payers, and 24/7 coverage.

Why should anyone pay huge markups to subsidize the non-payers and nonprofitable hospital services if they can pay a fair price at a surgery center? I realize it is a big problem that hospitals cant break even or profit from those extra services without overcharging other people, but overcharging everyone with simple cases is unfair and has been allowed to continue far too long.

It doesn't make financial sense to have most scheduled surgeries at hospitals... Unless you don't plan on paying. These docs seem to have found a way for folks with private insurance and self-payers to save money on healthcare. I think it's great.

I disagree. Democrats should all go to the hospital where most of their bill will be a transfer of wealth to the less fortunate, just like Obamacare and taxes in general.
 
All those who are glorifying the hospitals please ask yourselves if it's OK to be price-gouged for an elective procedure, just because the hospital feels like playing Robin Hood? I was billed $1500 for a diagnostic ultrasound at a major academic hospital (and on top of that the diagnosis was wrong). I have no problems with paying higher rates for my own emergent/urgent situations to compensate the hospital for its investment in infrastructure. But I have problems paying extra for *****s who use the ER as their PCP.

If Medicare wants socialism, then Medicare should pay for socialism, not the healthcare providers or the non-CMS patients.
 
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All those who are glorifying the hospitals please ask yourselves if it's OK to be price-gouged for an elective procedure, just because the hospital feels like playing Robin Hood? I was billed $1500 for a diagnostic ultrasound at a major academic hospital (and on top of that the diagnosis was wrong). I have no problems with paying higher rates for my own emergent/urgent situations to compensate the hospital for its investment in infrastructure. But I have problems paying extra for *****s who use the ER as their PCP.

If Medicare wants socialism, then Medicare should pay for socialism, not the healthcare providers or the non-CMS patients.

Agree...but I see no attempt or aspect of the billing for this OK surgery center to cover post-op complications...unless that is part of the fee that I don't see.

It's just like the NPs who claim they are primary care providers and 'independent' practioners, but if anything complicated comes up the patient goes to the ED (the MD there becomes the "supervising" doc). Similarly, if anything happens after-hours, the patients must go to the ED and there is no one for the ED doc to contact (no one on call; certainly no one on call with hospital admitting privelages).

I suspect this models are very similar (although the motivations are different).

Who and how do you or these surgery docs propose pays for this care?

HH
 
This billing model is the same model as many other surgicenters, including the one I work at. Except that the prices are way higher here than in Oklahoma. Why? Because it's affiliated with an academic hospital and the associated bureaucracy.

Rest assured, if there any complications, they are not included in the price of the procedure here either. And if anything happens after hours, the patient still goes to the ED etc. ;)

The only difference is that it costs the patient much more, just because the place belongs to Big Box University Hospital.

When the CEO of my hospital alone is making a couple of millions a year (let's not mention a bunch of other "executives" and their perks), I am sorry but I cannot pity the poor hospital with their poor reimbursement rates, doing so much good in the world...
 
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The system is broken. But, siphoning off all the paying patients and leaving the hospitals with CMS and no pay is not the solution. That is the current situation for many hospitals.

I've seen the same doctors do the private pay patients at the surgicenter then come to the hospital after 300 pm to do their CMS cases. It's total crap.

An Anesthesiologist working at a surgicenter which only accepts private insurance and cash would earn triple what his colleague makes at the hospital.
 
All those who are glorifying the hospitals please ask yourselves if it's OK to be price-gouged for an elective procedure, just because the hospital feels like playing Robin Hood? I was billed $1500 for a diagnostic ultrasound at a major academic hospital (and on top of that the diagnosis was wrong). I have no problems with paying higher rates for my own emergent/urgent situations to compensate the hospital for its investment in infrastructure. But I have problems paying extra for *****s who use the ER as their PCP.

If Medicare wants socialism, then Medicare should pay for socialism, not the healthcare providers or the non-CMS patients.[/
QUOTE]
 
The system is broken. But, siphoning off all the paying patients and leaving the hospitals with CMS and no pay is not the solution. That is the current situation for many hospitals.

I've seen the same doctors do the private pay patients at the surgicenter then come to the hospital after 300 pm to do their CMS cases. It's total crap.

An Anesthesiologist working at a surgicenter which only accepts private insurance and cash would earn triple what his colleague makes at the hospital.

But what did you have to pay? Most insurance companies have preset allowed charges. Who cares if the charge a billion dollars if only a hundred is allowed? Unless you're uninsured of course.
 
The system is broken. But, siphoning off all the paying patients and leaving the hospitals with CMS and no pay is not the solution. That is the current situation for many hospitals.

I've seen the same doctors do the private pay patients at the surgicenter then come to the hospital after 300 pm to do their CMS cases. It's total crap.

An Anesthesiologist working at a surgicenter which only accepts private insurance and cash would earn triple what his colleague makes at the hospital.


I thought that was S.O.P. Pretty much everywhere.
 
I've had procedures performed at the hospital and surgicenter. My insurance carrier negotiated the rates at both places and my deductible was the same.
 
The Surgicenters are very efficient and cost effective in delivering health care especially if they don't accept CMS. Hospitals must spend millions alone on just regulations, rules, Accreditation, etc.

You may think surgicenters are the solution until you get into a car accident, Kidney stone on a Friday afternoon, Acute appendicitis on Saturday, Brain Aneursym rupture, etc.

The fact is Surgicenters cause hospitals to pay stipends to Anesthesiologists because we lose the paying patients necessary to survive CMS. This in turn drives the CRNA model or "loose" supervision to keep costs down.

I don't blame anyone for wanting to earn $800K as an Anesthesiologist doing surgicenter work with NO CALL but the fact remains surgicenters hurt hospitals and all who rely on them.

I understand the concern from hospitals and certain providers. The system clearly isn't set up well. We all know that. How will hospitals survive without charging healthy people enough to subsidize CMS patients and non-payers? I don't know, and I agree it is a problem. The fact remains that most customers with private insurance or self payers do not want costs inflated to subsidize someone else's care. Middle class families with good jobs and "good" insurance struggle with medical costs too. Many of them cannot afford to subsidize other patients' hospital care when they want minor procedures done.

Fixing the deeper issues with poor CMS reimbursement and figuring out how to pay for treating the uninsured are the real issues, not the groups who can provide care without requiring patients to subsidize other patients. Until that happens, likely never, many patients are better off from a financial standpoint to have elective procedures done at private surgery centers than hospitals.
 
Until they or a loved one have a medical emergency requiring the hospital. Then they expect 24/7 care with the best specialists available.

You can't have it both ways. If you don't support your local hospital with non CMS dollars then when you or a family member need care good luck with the trip to Mayo.

The current system is a mess and the surgicenter model where the doctors keep the facility fee is destroying the fragile system.

I am all for a free market system or even a socialized medical system but under Obamacare we have neither.
 
The system is broken. But, siphoning off all the paying patients and leaving the hospitals with CMS and no pay is not the solution. That is the current situation for many hospitals.

Maybe we should go back to a cash system where everybody pays as they go. Flatten everything out. It is amazing how much of what a patient is billed goes to pay for other things. Sunshine is the best antiseptic. That's why surgicenters are attractive in the first place. The ER is a cost black hole. It's also a loss leader, as you'd put it Blade.
 
Until they or a loved one have a medical emergency requiring the hospital. Then they expect 24/7 care with the best specialists available.

You can't have it both ways. If you don't support your local hospital with non CMS dollars then when you or a family member need care good luck with the trip to Mayo.

The current system is a mess and the surgicenter model where the doctors keep the facility fee is destroying the fragile system.

I am all for a free market system or even a socialized medical system but under Obamacare we have neither.

Surgicenter is a free market concept. IMO, the onus is on the hospital to do better. There is a reason the surgicenter is attractive.
 
Surgicenter is a free market concept. IMO, the onus is on the hospital to do better. There is a reason the surgicenter is attractive.

They can't control who walks in the ER. We have this thing called EMTALA. Another horrible piece of legislation in my opinion. It encourages the "three hots and a cot" mentality that fills ERs especially on cold nights. Along with thousands of dollars of unnecessary tests that aren't gonna get reimbursed.

That just doesn't happen at surgicenters. Everyone pays there and it also robs the big hospital of a revenue stream.

Pay cash or go home. The ER ain't a free hotel.
 
They can't control who walks in the ER. We have this thing called EMTALA. Another horrible piece of legislation in my opinion. It encourages the "three hots and a cot" mentality that fills ERs especially on cold nights. Along with thousands of dollars of unnecessary tests that aren't gonna get reimbursed.

That just doesn't happen at surgicenters. Everyone pays there and it also robs the big hospital of a revenue stream.

Pay cash or go home. The ER ain't a free hotel.

They also have triage and govt subsidies. I'm not going to fault a fair price surgicenter for the shortcomings of the already
established crappy laws.
 
They also have triage and govt subsidies. I'm not going to fault a fair price surgicenter for the shortcomings of the already
established crappy laws.

No. No one can. Just trying to make sure everyone understands why hospitals bitch about surgicenters.

The solution? Everyone pays cash. The costs of healthcare would drop like a stone.
 
The solution? Everyone pays cash. The costs of healthcare would drop like a stone.

<--- skeptical.

The cost of any service will never "drop like a stone". It may fall, yes, but there will be drug companies, device manufacturers, etc who will see an opportunity and increase their own prices as soon as they can.
 
<--- skeptical.

The cost of any service will never "drop like a stone". It may fall, yes, but there will be drug companies, device manufacturers, etc who will see an opportunity and increase their own prices as soon as they can.
I think the key is less regulation, less middle man interference. What's the happy medium? Well, not what we have now.
 
Did you look at the prices posted by that cash ASC? I would say those prices "dropped like a stone." You can't price gouge a customer paying cash. Unlike insurance companies, cash payers will simply not buy the expensive device or service and shop for a better price.
 
Speaking of cash pay. If everyone had to pay cash for medical school, most of them would be cheaper with no frills or they'd be out of business. Less BS student centers and Taj Mahal libraries. Cash payers simply wouldn't put up with 50k/year tuition. The $50k tuitions are a direct result of funny money provided by the federal government.
 
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Yes. It's the "other people's money" phenomenon. If you pay a fraction amount of money for a service that, if you use it, will give you 20-30x the value of what you're paying for it there's no incentive not to gouge people.

Access to money causes people to access money.
 
"Cheap money" has inflated the price of everything including higher education, housing, and stocks. The question everyone asks is when will the spickett be turned off. That's why markets react so strongly to the verbage the fed uses in their reports.
 
The spigot won't be turned off until it financially bankrupts this country. Obama has never cared about where the money comes from. This goes back to his days as a community organizer. You just write a grant or proposal and the money shows up. The rest is details. We're done unless and until we get someone in the White House who actually has a true business background.
 
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Yes. It's the "other people's money" phenomenon. If you pay a fraction amount of money for a service that, if you use it, will give you 20-30x the value of what you're paying for it there's no incentive not to gouge people.

Access to money causes people to access money.

aka. Tragedy of the Commons.
 
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