How much does blood cost?

[urge]

PRBC?
FFP?
PLT?

Does the hospital mark up the price and make money out of it?

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[Pilot Doc]

Seems like the Red Cross charges my institution something like $250 for a unit of PRBC. The hospital definitely marks it up. Do they make money? Who knows.

 

[Noyac]

Don't quote me but I seem to remember $800 for a 6pk of plts.

 

[dfk]

from what i can remember, 0.9% saline costs over 100$ at my facility, so.. i can't imagine the outrageous prices across the board.

 

[MacBook]

Got to love what I've costed the government

 

[leviathan]

from what i can remember, 0.9% saline costs over 100$ at my facility, so.. i can't imagine the outrageous prices across the board.

For a 1000cc bag?

 

[Pilot Doc]

For a 1000cc bag?

Yep. Although it would be better to say the hospital CHARGES $100 for 1L of saline. It probably cost them less than $1 to purchase that bag.

Regardless, very few patients (or their insurance companies) are going to pay anything for a bag of saline, at least in the OR. Most payors have negotiated a flat rate facility fee for procedures.

 

[coprolalia]

Cost and charge are two completely different concepts.

-copro

 

[dfk]

Yep. Although it would be better to say the hospital CHARGES $100 for 1L of saline. It probably cost them less than $1 to purchase that bag.

Regardless, very few patients (or their insurance companies) are going to pay anything for a bag of saline, at least in the OR. Most payors have negotiated a flat rate facility fee for procedures.

yes, i was referring to it 'costing' the patient.

 

[TheSandMan]

yes, i was referring to it 'costing' the patient.

I think it was in Marino's ICU book that he mentioned that a liter NS bag was about $10, which I thought was expensive considering how much we go through. Can't remember why he mentioned it; it may have been when he was comparing the benefits of NS vs albumin.

 

[zippy2u]

I picked up some extraordinary "gypsy blood" from Anthony Bourdain for a pretty penny. Urge, you a quart low? Regards, ---Zippy

 

[coprolalia]

Can't remember why he mentioned it; it may have been when he was comparing the benefits of NS vs albumin.

Interesting and provocative review article in the October issue of Anesthesiology on this very subject. Mil, did you check that out? Goes with a lot of what you've been saying on the subject.

-copro

 

[Tenesma]

0.9% saline costs $.94 and charge is $26

crazy...

 

[geogil]

as an undergrad I worked as a phlebotomist. We would draw from PICCs (well, the nurse would draw, we'd deal with the blood) pretty often, and the nurses would use 10cc saline flushes all the time. One nurse told me that a 10cc flush was $10. Any truth to that? if so, it seems outrageous that 1cc of saline = $1. just curious.
-g

 

[leviathan]

as an undergrad I worked as a phlebotomist. We would draw from PICCs (well, the nurse would draw, we'd deal with the blood) pretty often, and the nurses would use 10cc saline flushes all the time. One nurse told me that a 10cc flush was $10. Any truth to that? if so, it seems outrageous that 1cc of saline = $1. just curious.
-g

That would mean a 1 litre bag of saline is $1000. I don't even think anyone here was saying it costs that much. As a paramedic it looks like our supplier gives us normal saline at a cost of $1.43 per 1000 cc bag.

 

[pjl]

Our saline is $0.68, LR $0.71. All those extra ions sure are cheap. Unfortunately I can't find a listing for blood.

 

[coprolalia]

One nurse told me that a 10cc flush was $10. Any truth to that?

This is representative of the "urban myth" that gets perpetuated in the hospital time and time again. One person, completely pulling a number out of their ass, quotes some totally made up dollar amount... and it somehow spreads like wildfire until everyone believes it.

We don't even track the usage of our pre-filled saline syringes in the hospital. That, right there, tells you that it ain't $10 a pop.

I had a relatively recent example of the hospital "urban myth" that I went on an active campaign to stop. They were the "purple towels" that people use to wipe down surfaces and equipment in the OR between cases. Somehow, the rumor got out that these were carcinogenic. How did I almost get sucker-punched by this myth? Well, I'll tell you...

During a case, I whipped one of these out and started wiping down my stethoscope, because we were doing a MRSA case. The circulator, about 50-years-old, fat, and crotchety (you know, the "I've been here for 30 years and I know more than you ever will, you stupid resident" type), looks over at me and watches me grab the plastic dispenser. She doesn't say anyting until I pop the lid and pull one out. As I'm wiping down my stethoscope, she barks at me, "Put gloves on!"

"Huh?", I say back to her.

"PUT GLOVES ON!" she demands.

I respond, "Why?"

"Well, fine," she then says dismissively, "get cancer if you want."

Now, I'd overheard this, other OR and ancillary staff repeating this mantra, off and on since I'd started residency. But, it had never been so pointedly directed at me, though. Over the years, I'd simply laughed at it when I heard it, and hadn't thought much else about it. But, now this know-it-all nurse had finally thrown down the gauntlet.

"These things don't cause cancer," I say.

"Ummm... yes. They. Do.", she responds matter of factly with her eyes in that wide-open disdainful and reproachful look you'd see in your visiting aunt's face when you were 7-years-old as you tried to sneak a piece of candy before Thanskgiving dinner.

"Ummm. No. They. Don't." I say back to her, returning the challenge and continuing to wipe my stethoscope with the towellete in my bare hand.

Now, I've done this, I dunno, probably hundreds of times before. My hands have never gotten irritated, I've never had any skin reaction, and I haven't noticed any fungating squamous lesions developing on my hands.

"Well, go ahead then," she continues on, "suit yourself."

"Sandy," I won't drop it at this point. We are in a Mexican standoff. "Where did you hear that these things cause cancer?"

"Like I said," she replies again, "suit yourself." Implying that I'm a *****, she's dropping some golden wisdom on me that I'm foolishly ignoring, and I'm only now going to become a victim of my own choosing. Nevermind the fact that she's about 80 lbs overweight, sneaks out for "breathing treatments" (a.k.a. puffs on the cancer stick) between cases and on breaks, and is generally 10-15 years older appearing than her actual age.

I continue on, somewhat rhetorically, "Do you honestly believe that OSHA, the Department of Health, and every other agency that supervises hospitals is going to let us wipe down the operating room surfaces with a carcinogenic substance?"

"Fine," she says more meekly now, "have it your way." I note a crack in the veneer of certainty.

Between cases, I go to the lounge and download the MSDS (that's the "materials safety datasheet", for the uninitiated) on all the active substances listed on the container. Nowhere on that list of substances are any of the components labeled "carcinogenic", even in laboratory animal tests. I find her later, and hand it to her.

"Sandy," I tell her as I do so, "I just want you to be informed. This stuff can be a skin irritant, but I've never had a problem with it. That's why whomever told you to wear gloves did so. Certainly, nothing in it is carcinogenic."

"Listen," she won't let it go, "I'm just telling you what we were told during our inservice when we started using these a coupla years ago. That nursing supervisor clearly said that these cause cancer."

"Well, I'm now informing you that they don't." And, with that, I walked away.

It wasn't two weeks later that I heard a different nurse say the same thing to me. And, we went through the process all over again.

Now, I realize that many of you might think that I'm exercising the ritual of beating my head against the wall here. But, I will tell you this: it is your responsiblity, in matters of fact, to inform people when they are wrong either in a way that is overly repressive or in matters where something otherwise dangerous might occur. This is how people learn and "urban myths" are dispelled. You won't get through to everyone, but not only did people overhearing our conversation in that OR get it, other people sitting at the lounge table when I handed her the MSDS got it. You may be perceived as somewhat of an opinionated ******* in the process, but next time guess who people are going to trust, respect, and listen to in a crisis (which may not be a good thing all the time)?

Long story short, I no longer hear this "urban myth" repeated in our OR. Sure, people should generally wear gloves when they handle these wipettes because they can cause skin irritation. But, they definitely do not cause cancer.

It is amazing the chicanery some will employ (the nursing supervisor who did the inservice, who I fully believed Sandy when she stated that the staff was told the that the wipes cause cancer... whether this supervisor actually believed that herself or not) to get people to comply with what they perceive to be the right thing to do.

So, let's not let that happen here until someone supplies us with some clear facts on what these pre-filled saline syringes actually cost. Don't repeat the rumor. Speculation does nothing but foster misinformation. And, misinformation becomes far too easy to repeat.

It may very well be that this nurse was told these things cost $10 per unit so she wouldn't be wasteful with them. But, lying to people in order to draw on some inner sense of right and wrong - or by instilling fear - simply to get them to comply, to me, is the basest form of human motivation and control.

-copro

 

[Bertelman]

Years ago when I cared less about my own mortality, I would wear open-toed flip-flops with socks in the OR. Mind you this was before med school, when I was a tech basically turning over dirty rooms, occasionally helping in a trauma or with line placement.

Nurse Ratched (woven bag and all) informed me it was against hospital policy to wear such footwear. I stood my ground. WIthin 30 minutes, the nurse manager found me in the OR - yes, she crawled out of her office - and informed me that although I was allowed to wear this footwear, I would take all liability of a sharps stick if something were to happen. After she left, I probably made some smart-ass comment suggesting other people shouldn't be dropping scalpels.

Was it foolish? Maybe. I know I wear leather shoes now, as I am more in the line of fire. Either way, I believe there are probably as many myths in the OR as there are true regulations. I may be wrong, though, because there are an ungodly amount of regulations.

 

[geogil]

well $10 seemed astronomically high, thanks for confirming it is not, in fact, the true price.

 

[huktonfonix]

well $10 seemed astronomically high, thanks for confirming it is not, in fact, the true price.

No one CONFIRMED this. The only way for you to do this is look it up (ask your supply department, call the supplier, etc). As a med student, resident even when your attendings tell you something, you should look it up and verify the information. Hell, you should do this no matter what level you are.

 

[sevo85288]

you can call vendors to ask for prices. these are not secrets. some prices vary by contract/volume.

1 L NS/LR is less than one dollar. Hospital charges vary. HMO/PPO/Medicare will not pay for saline/LR. it is part of the bundled care for the patient. on occasion a private insurer of self pay dude will get these charges and pay.

single syringes of flush, or empty sterile syringes or alcohol wipes are not billable items for most hospitals. these are bundled items.

a lot varies by region and carriers. In CA this stuff is bundled.
Blood is a different story. there is mark up in blood; but they have to fund the blood bank, pay the employees, buy the equipment etc...this costs money; hence the mark up....

 

[proman]

Blood technically costs nothing. The fees are for the storage processing and associated tests. I'll try to get our exact cost/charges. As for the flushes, when I was a medic I priced these out. A box of 10 cost about $8 so it was cheaper to go with them than get separate needle, syringe and vial of saline (total about $1.30).