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Data show cost variation for NNY hospital procedures

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North country residents can now find out if they were charged more or less for their hospital procedure than if it were done at a different hospital.

The U.S. Department of Health and Human Services released data Wednesday on hospital charges for common Medicare patient stays. The data, from fiscal year 2011, has been released to provide more transparency.

The cost range of covered charges for a chronic obstructive pulmonary disease procedure at various local hospitals goes from $7,415 at Alice Hyde Medical Center, Malone, to $15,446 at Samaritan Medical Center.

Samaritan, however, charged the lowest cost for a major joint replacement or reattachment with lower extremities without major complications or diseases at $23,177. Massena Memorial Hospital had the highest cost for that at $37,357.

But, the message from some hospitals is the charges do not matter. Charges are also not necessarily what patients will have to pay.

“Charges were much more relevant in the 1980s when reimbursement was based on our cost,” said Krista A. Kittle, Samaritan spokeswoman. “In the late 1980s, the DRG — diagnosis related group — or perspective payment, came into play and they had no bearing on what we get paid. We are reimbursed for that diagnosis versus our cost. It doesn’t matter how much we charge. We always get paid the same rate.”

Those rates, she said, are set by the U.S. Centers for Medicare and Medicaid Services. When commercial insurances come into play, Ms. Kittle said, there is an opportunity to negotiate higher reimbursement rates.

Then, there are the uninsured.

“This whole process hurts them the most,” she said. “They’re responsible for the whole bill. Financial assistance programs are very active here at Samaritan. Last year, we provided $3.9 million in charity care, and that’s to help people who don’t have insurance and the means to pay their bill.”

Ms. Kittle said what hospitals are paid includes a base rate from Medicare, but that payment could increase slightly based on several adjustments. For Samaritan, one is its hospital classification. She said because the hospital is a regional provider and considered critical to the region, “there’s somewhat of a bump in our reimbursement.”

Ben Moore III, chief executive officer of River Hospital, Alexandria Bay, said hospital charges will vary depending on their cost structure, volume of patients and amount of charity care. He also serves as the spokesman for a consortium of seven north country hospitals in a collaborative effort to help reduce the number of unnecessary repeat Medicaid admissions.

Carthage Area Hospital, Carthage, had few procedures listed in the report, and no information was available on the COPD or joint replacement surgeries. If hospitals performed 10 or fewer discharges for a particular procedure, that data was not included in the report.

River Hospital and Clifton-Fine Hospital, Star Lake, which are critical-access hospitals, were not on the comparative data list.

According to a CMS released statement, data was compiled from hospital claims. It looked at the top 100 inpatient stays frequently billed to Medicare by about 3,400 hospitals nationwide that receive payment for inpatient acute-care services under the Medicare Hospital Inpatient Prospective Payment System.

On Wednesday, the Health and Human Services Department also made about $87 million available to states for enhancement of their rate review programs. Data centers will collect, analyze and publish health pricing and medical claims reimbursement data, according to the department’s statement.

The full list of charges may be seen on the CMS website, www.cms.gov.

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