What Does ER Stuff Cost?

[docB]

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I’ve have no real idea what stuff in an ER costs. I have some vague assumptions but no real data. Asking around I find that most docs don’t know either. Isn’t that weird. It gets more confusing if you start talking about cost vs. billing on various items. Does anybody have any real info? Here are some examples of things and what I suppose they might cost (cost, not bill):
Central line kit $250
Foley kit $100
LP kit $150
ET tube $15
Suture $5
Syringe $1
Needle 18g $1
Plastic vag spec $2

Total wild guesses.

 

[DrQuinn]

Actually i did some research on this at my hospital (Tampa General Hospital), a private hospital. I have the info, have to find it... but very surprising.

I got the hospital CHARGES, nto actual cost... but:

CBC ~ $365
H/H ~ $400 (surprising!)

CT Abd/Pelvis w/ IV/PO contrast = $4200 (not including interpretation costs)
L spine plain films = $800
Skull Films (I've never ordered one) = ~$1200
Knee plain xray = ~$700

Crazy!

Q

 

[BKN]

I’ve have no real idea what stuff in an ER costs. I have some vague assumptions but no real data. Asking around I find that most docs don’t know either. Isn’t that weird. It gets more confusing if you start talking about cost vs. billing on various items. Does anybody have any real info? Here are some examples of things and what I suppose they might cost (cost, not bill):
Central line kit $250
Foley kit $100
LP kit $150
ET tube $15
Suture $5
Syringe $1
Needle 18g $1
Plastic vag spec $2

Total wild guesses.

DocB,

One of the courses is my master's programs was health care economics research. I only thought I knew how crooked medical economics were.

After learning about step up and step down accounting, DRGs, cost to charge ratios and on and on, I found:

1. Nobody knows what anything costs
2. You are free to charge whatever you want and the govt or insurer are free to pay whatever they want.
3. The hospital accountant will spread the losing depts costs across the winning departments until the most profitable center looks like the worst loser.
4. Cost to charge ratios are fantasy
5. Most importantly, if you walk into an ED in America without insurance and you actually intend to pay them, tell them you'll only pay them their lowest negotiated rate. Why should you pay more than the Government?

Oh and by the way- the reason you're making total wild guesses on common stuff is that the hospitals are all members of large buying groups. Costs vary by negotiation. Individual Doctor's offices pay more. (and veterinarian pay less. 🙂 )

 

[BKN]

Actually i did some research on this at my hospital (Tampa General Hospital), a private hospital. I have the info, have to find it... but very surprising.

I got the hospital CHARGES, nto actual cost... but:

CBC ~ $365
H/H ~ $400 (surprising!)

CT Abd/Pelvis w/ IV/PO contrast = $4200 (not including interpretation costs)
L spine plain films = $800
Skull Films (I've never ordered one) = ~$1200
Knee plain xray = ~$700

Crazy!

Q

Yeah, Quinn, it's insane. But as i said, nobody but a fool would pay $400 for an H/H. The actual amount the govt pays is probably $5. (I'm guessing, I know it was $3 back in the 90s in our neighborhood.) Our lab says they do it for less than $1. Same with the rest of the stuff, no one knows the costs, thus the cost to charge ratios are false and finally nobody pays the charges. the whole thing is an attempt to keep the system afloat with the appearance of something like a free market, to meet American philosophy.

What we actually have is a monopsony (one buyer, many sellers). The feds pay more than half the health bill for the the country. We actually deserve this- back when you were a gleam in Daddy quinn's eye and I was in med school we treated the govt as if we had a monopoly, and the politicos have been punishing us ever since.

Of course they wouldn't see it that way. They'd say that we're spending twice as much of the GDP on healthcare as any other nation and getting less for it.

 

[NinerNiner999]

Yeah, lab tests are probably the single biggest racket in any hospital system. Pathologists get $ from every test ordered in the hospital (assuming their group or practice manages hospital labs) in the same way radiologists get paid for each read.

 

[southerndoc]

Keep in mind that it costs $1 to buy the kit to run a CBC, but when you factor in the cost of the $300,000 lab machine, the cost is much more expensive.

However, it definitely should make all of us hesitant to routinely order that chem-7 just because we are ordering the CBC.

My hospital requires us to order CBC, platelets, electrolytes, BUN/creatinine, and glucose separately. I have yet to find out why, but I'm assuming it's because insurance companies routinely pay for each one separately.

 

[DrQuinn]

In researching the costs that I had, it would have taken act of Congress or Elvis himself to get the actual hospital costs. No one would give them to me.

Interestingly, when I went to the CT department of radiology, the head guy was xeroxing the charges for rad stuff... then he said "make sure you burn this when you're done with reading it, I don't want this to get into the wrong hands."

Then, when I called the local radiologist group to see if I could get a list of their charges, they had to "get back to me." A few days later, the person I contact emailed me and said "I spoke to our CEO and it has to be approved at the next Board meeting to give you this info."

WTF? Its like its a huge secret.

Oh well, I'm too lazy to really figure out what's going on... I just want to survive trauma SICU.

Q

 

[SoCuteMD]

CT Abd/Pelvis w/ IV/PO contrast = $4200 (not including interpretation costs)

Q

I got off easy - my Abd CT w/ contrast at Duke was only 2000 or so...I could dig up the bills somewhere.

Interpretation was about 1000.

If I'd known, I would have flown to Tampa to have it done. It was car accident related and the other lady's auto insurance company had to reimburse every penny!!

 

[Apollyon]

I got off easy - my Abd CT w/ contrast at Duke was only 2000 or so...I could dig up the bills somewhere.

Interpretation was about 1000.

If I'd known, I would have flown to Tampa to have it done. It was car accident related and the other lady's auto insurance company had to reimburse every penny!!

Ha! I'm going to dig up your file online (and then get fired for accessing your information - they ARE that tight with the protected info).

To southerndoc, re: the $300K analyzer: of course, that cost is amortized, and, at $300 a crack, how many beds at your hospital? Ours is licensed for 811 (which includes psych beds and newborn bassinets - bed you didn't know that the newborn nursery is included in the bed count), so, even if half get a CBC twice a week, the whole cost is written off in ~1 1/2 weeks. The rest is profit.

It's all a huge racket - I've been told that the blood bank at Duke is the busiest in the US - by a factor of 10 ahead of the second in line (due to the heme/onc patients - although I don't know what we're doing here that Memorial-Sloan Kettering or MD Anderson or Roswell Park are not). I KNOW they ain't doin' it for free.

 

[ERMudPhud]

I’ve have no real idea what stuff in an ER costs. I have some vague assumptions but no real data. Asking around I find that most docs don’t know either. Isn’t that weird. It gets more confusing if you start talking about cost vs. billing on various items. Does anybody have any real info? Here are some examples of things and what I suppose they might cost (cost, not bill):
Central line kit $250
Foley kit $100
LP kit $150
ET tube $15
Suture $5
Syringe $1
Needle 18g $1
Plastic vag spec $2

Total wild guesses.

While its true that costs probably vary wildly from place to place check out this web site.http://www.1stergo.com/c/medical/Medical.html

foley kits are only a few dollars as are foleys but vag specs are like $8. ETT were only $4. syringes and needles were around 0.25. I couldn't find central line or LP kits yet. surgilube is $1 and ounce! IV catheter were $3

 

[docB]

In researching the costs that I had, it would have taken act of Congress or Elvis himself to get the actual hospital costs. No one would give them to me.

I'm in Vegas so ironically I know exactly how much an act of Congress would cost and getting Elvis around here is really easy. I'm sure BKN is right that the whole cost/charge thing is purposefully obscure because it allows the greatest markups while maintaining plausible deniability against price gouging. Phud's wholesale prices make me sure that hospitals are paying less than those prices since they are buying in bulk.

 

[Jeff698]

Back in my med student days, I had a patient during a clinic month that I was sending for a CT scan. This poor guy didn't have health insurance but was very proud of the fact that he paid for everything in cash, upfront. He didn't want the CT scan if he couldn't pay for it in the same way. He was adamant that we didn't want to owe anyone anything.

You should have seen the look on this poor guy's face when he finally understood that not only did I not know what a CT scan would cost, I (and everyone around me) would be incapable of actually finding out.

Very sad. I was probably the only person in the theatre who didn't laugh at the line in Independence Day about why the government paid $500 for a hammer.

Take care,
Jeff

 

[a_ditchdoc]

I know of the charges for a few items at the hospital I used to work at: Toradol=$69, IV Fluids $50+, Morphine=$8. Of course, my EMS agency purchased these items from the hospital at a fraction of the cost: Toradol= a few bucks, Morphine=80 cents, IV Fluids=$2.

Nedless to say, I was pretty pissed after an appendectomy when I had to pay a few thousand dollars in deductables and charges above average that my insurance company found "unreasonable". So, the insurance company I pay every month got off light, the hospital got paid exactly what they wanted, and I get screwed into paying $69 a dose for Toradol that didn't quite take the edge off of my post appendectomy pain.

If I remember correctly, Tylenol is $8 as well.... just give me the morphine.... 🙄

 

[Seaglass]

We were discussing this the other day. Our LP kit costs $8 and we charge patients ~$100.

 

[Flopotomist]

We were discussing this the other day. Our LP kit costs $8 and we charge patients ~$100.

How much of that $100 is actually collected on average though? If the hospital charges $100 for an LP kit, but only 1/10 people actually pay for it - then a 10x markup seems reasonable. Frankly, I think that it would not be unreasonable to have a finance person meet the patient (after care has been provided, and they are being discharged) and tell them "The cost of your treatment today is $xxx, how much of that would you like to pay right now" Even if the patient only has $20 on them, that is certainly more than many patients pay, plus it reminds people that this care is not free. Just an idea.

 

[EctopicFetus]

We were discussing this the other day. Our LP kit costs $8 and we charge patients ~$100.

I assume the cost of performing the LP is a different line item? I believe Medicare only pays about 1/3 of this "cost".

 

[Seaglass]

Yes, the procedure itself would be a different charge. The huge markup makes me feel OK about cracking open another kit when I need to, remember all these things are manufactured in bulk and are made mostly out of plastic (and probably made in china).

 

[AlienHand]

How much of that $100 is actually collected on average though? If the hospital charges $100 for an LP kit, but only 1/10 people actually pay for it - then a 10x markup seems reasonable.

This arrangement probably seems reasonable to about 9 out of 10 people.

More and more, we're going to see the large corporations that pay the bill for their employees' health care demand that hospitals justify their costs. I know that 5-10 years ago in Cincinnati some of the big employers (Procter & Gamble, General Electric) banded together and asked some pointed questions to the big hospitals in town, like why a cardiac catheterization costs twice as much at one hospital as at another. The hospitals, from what I understand, couldn't really answer the question. I'm not sure how successful the corporations were in driving down the costs, but the day is coming when the health care industry will have to address the issue of costs, which are rising at an unsustainable rate.

 

[Jeff698]

The huge markup makes me feel OK about cracking open another kit when I need to

Funny you mention that. I had to open up a central line kit this morning to get the little security tie-down thingees to sew down an IJ this morning. I was actually feeling a little guilty as I looked at the almost full kit and threw it away.

Take care,
Jeff

 

[Seaglass]

Nah, that kit was like $20 at most. 😀

 

[Annette]

The biggest reason you can't find the billing for items, is because each insurance company has a negotiated price. If the government will pay $800 for a fiberglass cast, that is what they will be billed. If InsuranceCo will pay $400, that is what will be billed. If you pay on your own, the sky is the limit. However, with DRG's, if a patient is hospitalized for a broken arm (not likely to happen), the government will pay X amount to cover all the associated costs (casting material, IV's, pain meds, bed charges, etc.) If the hospital can give care for less than that amount, they earn money. If they can't, then the hospital eats the costs.

Then there are the deals. Someone posted somewhere on the forum that if a hospital buys certain IV pumps, then the company will sell them IV tubing for $0.02 a piece. Drug companies will do similar things to be put on the formulary because the patient is usually discharged on the drug they were placed on in the hospital.

As for having to order BUN, Cr, Na, etc separately, this is called "unbundeling". The hospital can charge more for each test.

Then there are the wonderful "companies within companies". For example, the laundry department becomes a separate entity. Floor #3 needs more sheets? then floor #3 gets charged an extra amount. When the government comes around auditing how much providing care costs, the hospital can figure in the costs of laundry provided by company X (including the profit) in the costs. Sneeky, huh?