Hospitals around the Lowcountry are billing Medicare at vastly different prices for the exact same procedures, according to data published Wednesday by the federal government.
By the numbers
These dollar amounts reflect the average price that three hospitals billed Medicare for procedures in 2011.Major joint replacementRoper Hospital $36,121Medical University Hospital$48,013Trident Medical Center$85,672Pulmonary embolism (clot)Medical University Hospital$16,773Roper Hospital$27,842Trident Medical Center$31,039Permanent pacemaker insertionMedical University Hospital$38,902Roper Hospital$51,084Trident Medical Center$98,352Source: Centers for Medicare & Medicaid Services
For example, in 2011, Trident Medical Center billed Medicare an average $98,352 to insert a permanent pacemaker, while the Medical University of South Carolina billed $38,902 for the same surgery.
The Centers for Medicare & Medicaid Services published the financial data on its website Wednesday for more than 3,000 hospitals around the country. It is meant to “show significant variation across the country and within communities in what hospitals charge for common inpatient services,” a press release from CMS said.
Locally, Trident Medical Center, part of a for-profit health care system, charged Medicare higher prices than any other hospital in the area. Records from nearly 100 common procedures there show the hospital billed at higher rates than the national average on all but three procedures.
The amount a hospital bills Medicare for a procedure does not necessarily reflect how much Medicare actually reimburses the hospital for that procedure, or how much a patient needs to pay.
For example, even though Trident charged nearly $100,000 to insert a pacemaker, Medicare reimbursed the hospital an average of $12,386 for the procedure.
A spokesman for Trident Health said CEO Todd Gallati was not available to be interviewed about the data.
The hospital released the following statement: “What patients pay has more to do with the type of coverage they have than charges. Government programs like Medicare and Medicaid determine how much they reimburse hospitals. Insurance plans negotiate their payments. Everyone else is eligible for our charity care program or they receive our uninsured discounts, which are similar to the discounts a private insurance plan gets.”
Requests for comment from MUSC and Roper St. Francis Health Care were not returned.
The S.C. Department of Health and Human Services released a report in April showing that Trident Medical Center made a higher profit between 2008 and 2011 than any other hospital in the state — about $223 million over the four-year period.
HHS Director Tony Keck said the data released by the federal government Wednesday underscores a serious flaw in the health-care system.
“This is really good because it's forcing the hospitals to answer some really tough questions about why are your charges twice what the hospitals next to you are,” Keck said. “It's starting to raise people's eyebrows.”
Information about St. Francis Hospital, Mount Pleasant Hospital and East Cooper Medical Center also was included in the online report, which omitted data from procedures that were conducted 10 or fewer times in 2011 at any facility.
Reach Lauren Sausser at 937-5598.