Have you ever walked out of a hospital visit with a smile only to look at the medical bill and frown?
New data shows that you’re not the only one, and there are some interesting imbalances tilting against you in regards to health care billing and Medicare reimbursements.
This data, regarding more than 3,000 hospitals across the United States that receive Medicare Inpatient Prospective Payment System (IPPS) for the one hundred most common in-patient diagnoses upon discharge, has been analyzed and published.
The Medicare Severity Diagnosis Related Group (MS-DRG) of the 2011 fiscal year was used for this research with the explicit underlying goal of increasing the awareness of the public in a way that increases systemic accountability and ultimately improves clinical outcomes.
This emerging news is controversial and reveals a substantial disparity in medical costs for the same diagnoses and medical services both across the nation and even also between hospitals within specific communities. In other words, the White House has shared with the public concrete knowledge that similar diagnoses and disease managements are being charged differently by different institutions, a fact that is unlikely to be explained by quality-of-care or better health outcomes.
While these systemic inequalities may be interesting to know, it is also important to note that this new data is describing only charges and not reimbursements of Medicare to the different hospitals. Medicare provides relatively similar payments to all hospitals for similar procedures based on the MS-DRG. So some hospitals are charging more despite what Medicare reimburses.
Furthermore, there are certain diagnoses with more consistent charges and fee schedules nationwide (example: Heart attacks) than others (example: Hip replacement). The two major reasons for variable payment schedules among hospital are: 1. Being a teaching hospital and 2. Providing care to a higher percentage of individuals from a lower income.
Again, what is disclosed here is a demonstrative list of the charges of the top 100 diagnoses upon discharges. And when you, as a Medicare recipient look at the information and ask, “what does that have to do me?” the most important thing to do is to get contract with a health insurance provider that will advocate for your best care and quality of care with the smallest out-of-pocket expenses possible.