Outpatient Hospital Charges Vary Wildly

Jun 4, 2013

Continuing its pressure on the hospital system to make the pricing structure more sensible, the Obama administration on Monday released data on charges for outpatient care. They showed Floridians are charged nowhere near the same amount for similar procedures, depending on their choice of hospital outpatient site.

Orlando Health

The data release for 30 common outpatient procedures showed, for example:

--Orlando Health charged Medicaid on average $9,740 for a biopsy. But Sacred Heart in Pensacola charged considerably less for the same service: about $372.

Despite what the hospitals charged, the state Medicaid program paid each hospital around $300 for the procedure. The program’s average payment is about $543, while hospitals’ average statewide charge is just under $4,200.

These variations could be seen even among hospitals in the same zip code. As the Miami Herald noted,  Jackson Health System charged a bit above $2,900 for an MRI; across the street, the University of Miami billed nearly $5,000.

Meanwhile, Medicaid paid each hospital about $350. (Medicaid payments may vary from hospital to hospital under the current reimbursement system, but the state will change that system in the coming year.)

To be sure, most patients do not pay the amount on the bill, nor do their insurers. But the billed amount matters for two groups: the uninsured -- nearly 4 million Floridians -- and those who pay a percentage of the cost of a procedure under their insurance plan.