Across the USA, hospitals tend to charge almost 40% more for identical procedures by the same surgeons when compared with freestanding outpatient surgery centers counterparts. Why?
As experienced healthcare administrators, we are able to examine healthcare costs and pricing information with a uniquely different perspective than our layperson and other industry counterparts. What’s the reason for this huge price and cost difference?
We asked Maria Todd, MHA PhD, our consulting expert for her thoughts on why hospitals charge and expect more for the same identical services and same surgeon. Here’s what she offered as an explanation.
If a patient is kept institutionalized for a longer period of time, risks of hospital-acquired infection (e.g., cross patient contamination, visitor infection, side effects of hospital procedures, including conditions like sepsis, postoperative respiratory failure, pulmonary embolisms, hemorrhages, and other reactions or infections.etc.) increase. These can also occur in the outpatient surgery setting, but either happen or are recorded less frequently because they may be noticed and documented after the patient has left the facility. Patients’ normal sleep and meal patterns are also disrupted. Lack of sleep impedes the body’s ability to repair itself. Movement is decreased which can lead to pulmonary and vascular complications. In the outpatient setting, risks of these types are reduced because length of stay is reduced.
PATIENT SATISFACTION SCORES
ADMINISTRATOR & EXECUTIVE COMPENSATION
STAFF HEAD COUNT
In the hospital setting, in a small hospital, there may be 15 people employed in the revenue management department to handle billing, collections, coding, denials and appeals, refunds, contract analysis and negotiation, renewals, and more. In the ASC the same tasks may be handled by a team of 4-6 people or fewer. In most settings the compensation is higher and benefits package is richer at the hospital. This too, is reflected in pricing and charges.
A hospital’s operating margin refers to the facility revenue after subtracting operating costs such as wages, medical equipment and supplies, rent, and other expenditures. To remain operational, hospitals must be able to pay these fixed costs without going into debt. Adjustments to prices and discounts are one way to balance shortfalls in fixed costs with contracted providers.
Branding is more frequently undertaken and more invested in the process and brand maintenance at hospitals. The public tends to reward esteemed brands with tolerance for higher prices. An unrecognized brand outpatient surgery center will find that no matter how good it is, how warm and friendly the service, a Cleveland Clinic, Johns Hopkins or Mayo “Center of Excellence” is likely to command a higher price and attract heads of state, celebrities, and others who might dismiss a friendly, high-performing, accredited, high-value outpatient surgery center, at any price. But the big box brands spend millions in advertising budget and promotion that the small unassuming outpatient surgical center doesn’t draw in in revenues in a year.
Many hospitals and health systems have over $10 million in bad debts, with 6 percent reporting bad debt of over $50 million. About half of those hospitals indicate they might be able to recover more than 10 percent of what they’re owed, with 9 percent estimating they could recover more than 20 percent. In the outpatient setting the numbers just don’t climb that high and the number of patients willing to pay cash for a lower price on the date of their surgery makes this expensive metric less burdensome, which is reflected in the prices they charge and the discounts they can offer.
KICKBACKS TO PAYORS, TPAs AND OTHERS
Many PPO contracts require that hospitals pay 4-12% of the revenue they receive from a contract as a rebate to the TPA or Insurer for the steered volumes of patients they received. This can be transparently stated in the contracts or in many cases is done behind the scenes. So for example, an employer is told the price at the hospital is $2500 for a procedure. In reality, the hospital has negotiated a fee of $2200 and the $300 difference is skimmed off the trust fund payment to fund the claim settlement – unbeknownst to both employer and provider, but the price reported to the public as the negotiated discount rate is inflated. Copayments and deductibles are also in lockstep so the patient often pays more out of pocket as well because their calculations of copayment and deductibles are based on the $2500 number, rather than the $2200 number.
Here at SurgeryShopper.com, we deal directly with the providers and report their prices as they are without any embedded kickbacks, commissions, and other fees. There are no back-room shenanigans. The price we quote and the amount you pay is the actual price the hospital or outpatient surgery center charges and receives.
In most instances, outpatient surgery centers are more nimble and can more easily and quickly calculate a bundled price for a surgery procedure and can contract with SurgeryShopper.com to be listed in our database and also offer new bundled prices on the fly when requested. Stop here first in your search for transparent bundled prices on surgery you need, then compare what you find by researching individual websites of hospitals and ambulatory surgery centers. But bookmark SurgeryShopper.com so you can make your way back after you’ve satisfied your curiosity. We’re here to help you get the surgery you need at a more affordable price and to help you coordinate any related travel or other assistance you’ll need to access the care you want wherever you need it in the USA.