NC hospitals' average charges by procedure
Using the dropdown menu below, select one of the top 100 procedures to find out how much North Carolina hospitals charge, on average. The WRAL Investigates team also looked beyond the charges to see what other data is available. Medicare scores hospitals on quality of care and patient surveys. WRAL gathered total performance scores for every hospital in the state that submitted information and divided the performance total into the price of certain procedures to find out which hospitals offer the best care for the charge, according to Medicare data.
W/O CC = Without complications
W/O CC/MCC = Without complications/major complications
W CC = With complications
W MCC = With major complications
Note: Quality data for hospitals in the Vidant system are missing from the procedure database below due to a system-wide name change that doesn't match the charge database. Please see their quality data online at https://data.medicare.gov/Hospital-Compare/Hospital-Value-Based-Purchasing-HVBP-Total-Perform/ypbt-wvdk.
Hospital responses to WRAL Investigates' story:
Carolinas HealthCare System
Carolinas HealthCare System supports efforts that provide patients with useful information on quality, access, service and price. Comparing hospitals solely on price, even for like procedures, provides an incomplete picture. Often, these comparisons don’t take into account the differences between healthcare systems, the healthcare coverage held by the patient and the patient’s own medical condition. Carolinas HealthCare System continues to seek ways to provide greater transparency and recommends that patients weigh all factors before making a healthcare decision to ensure they receive care that meets their expectations.
- The Medicare inpatient gross and net payment information published by CMS does not reflect the actual amount paid by patients with commercial insurance, which can vary depending upon the patient’s healthcare coverage, including deductibles and copays. This amount differs very much from Medicare’s determination of patient liability.
- Each patient's medical condition is different and, if there are other medical issues or complications involved, costs can rise. A longer-lasting surgery will cost more, as will a stay in an intensive care unit versus a regular hospital room.
- Carolinas HealthCare System is working with NCHA and is serving as a member of the workgroup to advise the N.C. Department of Health and Human Services on the development of the rules for HB 834: “Transparency In Health Care Cost.” It is important that any data provided to the public be meaningful, which the raw data from the CMS website is not.
Catawba Valley Medical Center
Catawba Valley Medical Center’s position on the subject at hand is in line with the North Carolina Hospital Association.
The NCHA has said, “Affecting the actual cost of hospital care was not the intention of the law. The purpose for publicly posting prices was to provide patients another source of information to use in choosing where to have care.
“The North Carolina Hospital Association has for many years provided hospital charges for the top 35 diagnostic related groups on our website. DRGs are used by the government in paying for the care of their insureds and beneficiaries. This information continues to be available to the public.
“No single source of information is adequate for making the decision about where to seek hospital care. We also suggest patients look at quality data posted on the NC Quality Center website.”
Ronald A. Paulus, MD, President and CEO, Mission Health:
We applaud the Centers for Medicare and Medicaid Services (CMS) for releasing the pricing information in May and the North Carolina General Assembly for driving transparency for consumers, so they can compare value across institutions. Mission Health embraces these efforts. We are working closely with the North Carolina Division of Health Service Regulation to implement this program to provide the list of payments for the most common 100 inpatient hospitalization diagnoses, the top 20 ambulatory surgery procedures and the top 20 diagnostic procedures.
Mission Health's value has been well known for a long time and this list simply underscores what we and objective observers have known: Mission Health provides an incredible value for the communities it serves. Simply put, Mission is the only nationally ranked Top 15 Health System* and Top 100 Hospital* in North Carolina that achieves nationally recognized outcomes while charging only 60 percent of the national average for comparable cases and receiving less or equal to national average payments. Last week, Mission Hospital was identified among the nation’s Top 50 Cardiovascular Hospitals* and is the only North Carolina hospital to receive this designation for inpatient heart care, further validating the superior clinical outcomes at Mission Health.
- A major cardiovascular procedure at Mission Health costs about 40 percent less than a comparable procedure at Duke University Hospital.
- For implanting a permanent cardiac pacemaker, Mission Health's fees are about 19 percent below Carolinas Medical Center and about 60 percent less than at Duke University Hospital, the latter representing a $53,205 difference.
- This CMS report supported the results of a five-year assessment of Mission Health’s compliance with the Certificate of Public Advantage (COPA) which found our cost per case to be $426.00 less than other hospitals in our peer group.
When combined with other readily available data (e.g., Hospital Compare, Value-Based Purchasing, Truven Analytics ratings, etc.), such pricing lists can be useful for consumers to make the best, most informed choices about their healthcare. However, it is important to understand that list prices such as those provided in the CMS report are simply not reflective of a patient’s actual payment rate, which reflects negotiated rates with payors like Medicare, Medicaid and a patient’s insurance company, or discounts related to charity care. Payor rates can differ based on a variety of individual factors, including patient’s age, unique clinical needs and varying approaches to surgery, anesthesia, and implant costs. These factors can lead to seemingly large pricing differences from facility to facility.
Prices reflected on hospital bills, for example, represent the total cost of operating the hospital, not just the discrete services provided to individual patients or those services “allowed to be billed.” In fact, many of the largest costs such as nursing salaries or the costs of facilities within which care is provided are not “billable” because of the rules established by insurance companies and governmental payors. It would be impossible to keep the doors of hospitals across the nation open if these costs were not reimbursed in some manner.
These unusual billing rules established by insurance companies and governmental payors result in charges that take into consideration all costs associated with providing the services. This could be compared to dining at a restaurant, where the cost of a meal is not the same as the cost of buying the same food from a local farmer. Also, hospital charges, by definition, must cover a portion of the cost of uncompensated care provided to many patients, and the costs of staff and technology required to meet the needs of patients and the community. Even so, Mission Health’s charges fall well below state and national average charges, according to the CMS report.
Mission Health’s pricing “philosophy” is that we seek to set the lowest prices that we reasonably can, consistent with our ability to continue to effectively serve our communities in a high quality manner. Of equal importance, Mission Health focuses particularly on creating value – explicitly recognizing that consumers care about far more than price. As with other aspects of our lives, as consumers and patients we care about price of course, but we care equally or even more about the quality of the service, about our outcome, about the experience that we have and whether we can effectively place our confidence in others, particularly when we are at our most vulnerable.
We encourage patients to research quality of outcomes, patient satisfaction, infection rates, and the provider’s adherence to best clinical practices. Unfortunately, medical care services are often very complex and technical in nature, and more needs to be done to describe care, costs and quality in layman’s terms. This pricing transparency is a start to a very long and important journey.
*Truven Health Analytics
The purpose for publicly posting prices is to provide patients an additional source of information when choosing a healthcare provider. We want people to understand there are a number of factors that influence how hospitals determine pricing for various procedures. In addition to general overhead and operating costs, other factors – including the complexity of the procedure and the severity of the illness or injury – contribute to the costs of providing care. Novant Health supports transparency in medical costs and is committed to helping people understand their financial obligations as it relates to their healthcare. We offer patients a financial navigator service which allows people to get an estimated cost of a procedure before receiving care. We believe this is just one factor to be used when choosing where to go for care. In addition to pricing information, we also encourage patients to look at quality data posted on the Novant Health website or the NC Quality Center website.
Health care finances are incredibly complicated, with wide variation in prices determined by many different factors. Rex provides a number of procedures and services at a financial loss, but we strive to maintain long-term financial stability in order to invest in costly medical and information technology that improves care for our patients.
Hospital “charges” are akin to the MSRP on automobiles or the Room Rates posted on the hotel doors. Hospitals are actually paid based on predetermined rates assigned to Diagnosis-Related Groups, or DRGs, which are the groupings for healthcare services (vaginal delivery, C-section delivery, hip replacement, knee replacement, pneumonia, etc.).
Medicare and Medicaid dictate these rates for all hospitals across the nation. They vary by factors that include location within the country, whether the hospital is an Academic Medical Center and more. Likewise, insurance companies negotiate rates for these same DRGs with each hospital.
The care and services patients receive at hospitals are very individualized. Two patients having knee replacement surgeries might spend different amounts of time in the operating room; receive vastly different types of implants, anesthesia, drugs and other medical supplies; and require different types and amounts of personalized therapies during their hospital stay. Those varying factors can lead to a wide range of charges.
Rex has long had an open and transparent billing process, as well as a generous charity care policy. Patients can obtain an estimate before any procedure, and are provided with an itemized, easy-to-understand bill. Our financial counselors will work directly with patients to help them through the billing process and explain anything they don’t understand.
Here are some resources for Rex patients:
- Rex Patient Financial Services representatives are available at (866) 687-7674 or firstname.lastname@example.org.
- Patients can request an itemized bill by calling (919) 784-3382, Monday - Friday, 8 a.m. - 4 p.m.
- For more information about RexAssist, Rex’s Financial Assistance Program, and other “Frequently Asked Questions,” patients can visit rexhealth.com/patient-billing.
Vidant Health, a mission-driven, not-for-profit corporation, owns, leases or has a majority membership interest in nine eastern North Carolina hospitals. The health system includes Vidant Beaufort Hospital, Vidant Bertie Hospital, Vidant Chowan Hospital, Vidant Duplin Hospital, Vidant Edgecombe Hospital, The Outer Banks Hospital, Vidant Medical Center, Vidant Pungo Hospital, Vidant Roanoke-Chowan Hospital, Vidant Home Health and Hospice, Vidant Wellness Centers, Vidant Medical Group and is affiliated with the Brody School of Medicine at East Carolina University. You can find more information on the web at www.vidanthealth.com.
1. Hospital charges are based on both historical data and negotiated payments. In addition, uncompensated care, which continues to rise, is figured into overall hospital costs. In order to assure that every patient who seeks treatment is able to receive the treatment they need, hospitals must shift costs.
2. What hospitals charge for care rarely reflects what they will actually get paid by government or private insurers. As mentioned before, Medicare and Medicaid pay less than the cost of caring for patients. On average, hospitals received payment of only 91 cents for every dollar spent by hospitals care for Medicare patients in 2011. Seventy percent of the patients who seek treatment within the Vidant Health system are insured by government programs. We serve a 29-county region that includes 1.5 million people, living in very rural communities.
Also, a hospital that provides highly-specialized services such as emergency room care 24 hours a day, seven days a week, and community outreach services, trauma or burn units has a different cost structure and pricing that one that does not.
3. For years, Vidant Health hospitals, in conjunction with the North Carolina Hospital Association, have contributed information to the posted pricing information for the top 35 diagnostic related groups (DRGs) on the NCHA website. The passage of HB834 means we will expand the number of DRGs we will now report. We believe that patients should look at additional sources of information when making decisions as to where to seek care. We always recommend that patients research quality scores of specific hospitals. Vidant Health hospitals publicly report quality scores on each entity's website (vidanthealth.com). Educating and informing patients is an investment in our future and in our ability to enhance the quality of life for the people and communities we serve.
WakeMed Health & Hospitals
WakeMed understands and supports the importance of being transparent regarding pricing and quality outcomes. In order to improve efficiencies and lower health care costs, we must be transparent with policy makers and consumers. It is important to remember that when dealing with medicine there is not a one-size-fits-all solution. Physicians and hospitals must maintain a level of flexibility to make decisions that best meet the patients’ needs.”
Wayne Memorial Hospital
Every hospital looks at different services in order to maintain a margin that will allow them to meet their mission to serve their community. That margin and mission varies from place to place. Also, depending on location, the hospital payer mix differs. One hospital may have a higher number of Medicare, Medicaid and non-insured patients than the hospital just across the county line, and those hospitals have to compensate for that. Also, keep in mind that, typically, although there may be variances in charges, there are fewer variances in what hospitals are actually paid by insurers and the government.