Big Swings in Twin States
Lebanon — There are sometimes stark differences among what Twin State hospitals charge for the identical medical procedure, and no consistent variation, with one hospital charging less on one procedure than its peers and more on another.
The comparison in the amount different hospitals in New Hampshire and Vermont charged in 2011 for doing the same thing came to light yesterday when the federal government published the first national comparison of prices charged by more than 3,000 U.S. hospitals for the 100 most common medical procedures. The data showed wide discrepancies, sometimes by as much as tens of thousands of dollars, in what hospitals charge for performing the identical procedure.
Permanent pacemaker implants for Medicare patients with complications cost $36,176 at Mary Hitchcock Memorial Hospital in Lebanon, part of the Dartmouth-Hitchcock system. Fletcher Allen Health Care in Burlington charged nearly $44,000 for the same thing.
Meanwhile, major joint replacement for people with complications were $60,092 at Mary Hitchcock in 2011 and just $46,000 at Fletcher Allen.
On some of the most common procedures, Mary Hitchcock charged far less than the national average. Pacemaker insertions were half the national average, and stent insertions were about 30 percent less, according to data compiled by The New York Times.
Medicare officials said publishing information showing how hospitals charge different rates for identical medical procedures would start a larger conversation about why such variations exist.
Dartmouth-Hitchcock CEO and President Jim Weinstein agreed, but said people would need to be careful when interpreting the comparative data without more information.
“It’s part of the story,” he said. “I’m excited about it, but it’s not the whole story.”
The Medicare data includes larger hospitals that treat acute patients but leaves out many smaller institutions, such as Alice Peck Day Memorial Hospital, Mt. Ascutney and others in the Upper Valley. It also does not include outpatient care services, nor does it take into account the quality of care that the patient received.
Weinstein and his Dartmouth colleagues have long advocated for greater transparency in health care. For two decades, the Dartmouth Atlas Project has tracked regional variations in health care spending.
Medicare’s initiative wasn’t all that different from the work at Dartmouth Atlas, Weinstein said, but it still was a good step forward in understanding how to fix problems in the cost of care.
Without this information, the nation’s health care system is like an airline trying to fly planes without instruments, Weinstein said. Knowing what hospitals charge for the same procedures would be a useful tool to steering health care in the right direction.
“Starting to put some gauges in the airplane allows us to start to know where we’re going,” he said.