Valley hospitals’ surgery charges lowest in state
A new study released Thursday spotlighted wide disparities in the cost of surgeries statewide, with charges in the central San Joaquin Valley consistently running below the state median.
In researching variations in hospital charges, the Sacramento-based watchdog California Public Interest Research Group, or CALPIRG, found that the Fresno region’s price tag for common surgeries was 60% of the state median.
Some regions showed charges 2.7 times more than Fresno’s median, which was the state’s lowest.
Californians spent an average of $6,238 each on health care in 2009, 70% higher than just 10 years earlier, the study said. From 2001 to 2009, insurance premiums for California families rose by 113%.
The study was drawn in part from 2010 figures that hospitals were required to report to the state, listing charges for various procedures. Some differences in regional pricing were hard to explain.
- The typical patient in the San Mateo region was charged nearly $48,000 for a Cesarean section. For the same surgery, the typical patient in Fresno was charged less than $13,000.
- The charge for a typical knee replacement surgery performed in a Fresno-area hospital in 2010 was $46,800, versus $127,500 in an Alameda-region hospital. (And yet, the median charge for 82 knee replacements at Sierra View District Hospital in Porterville was $112,675, far above other Valley hospitals. Tulare County hospitals are part of the Bakersfield region.)
- San Jose-area hospitals listed the charge for angioplasty for a typical patient at $144,900, while hospitals in the Bakersfield region listed the charge at $44,400.
With the exception of Sierra View’s knee replacements, Valley surgery charges were comparable.
The report’s authors said they were baffled by the huge differences in what hospitals charge for the same procedure. “It’s actually our point that they should also report what they get paid — not just what they charge — so we know how much things cost,” said Pedro Morillas, legislative director of CALPIRG.
That’s easier said than done, said the California Hospital Association’s Jan Emerson-Shea, vice president for external affairs. In reality, Emerson-Shea said, so many factors figure into hospital pricing that you could end up with “38 million prices for the 38 million people in California — because each is an individual with different health circumstances.” In other words, a gall bladder surgery for someone who is a diabetic would likely cost more than for a patient who does not have diabetes, she said. Thus, the prices that hospitals are required to report for various procedures tell just half, if that much, of the story, she said.
Other factors affecting the size of patients’ bills include their insurance coverage, how expensive a hospital’s specialty services are and the separate doctors’ and specialists’ invoices patients receive on top of the surgery price tag, she said.
“This is not like going down to the auto shop and getting a quote for an oil and lube job,” Emerson-Shea said. And though hospitals hardly post fee schedules on a public menu board, transparency exists through “the good-faith estimate” patients can ask for if they want to know the cost of a procedure, she said.
Morillas, on the other hand, said patients may not trust the hospital’s estimates, and should have a broad range of information at their fingertips. “For something as essential as health care, we need easy access to clear information,” he said. “It absolutely helps if a patient can shop around, not just for the price they pay but for outcomes as well.” Currently, patients have little evidence that a more expensive surgery will lead to a better outcome, he said.
Most of the state’s hospitals report prices charged for care to the California Common Surgeries and Charges Comparison database. Hospitals operated by Kaiser Permanente and Shriners do not report to the database.
Because Kaiser operates under a different business model, and is both insurer and provider with doctors as employees, it is not required to report the same data as the other hospitals, said Emerson-Shea.
CALPIRG created a charge index to compare 12 common surgeries.
There are 27 hospital regions in California. The Fresno region surveys Community Regional Medical Centers in Fresno and Clovis; Saint Agnes Medical Center in Fresno; three Hanford hospitals (Adventist Medical Center, Hanford Community Medical Center and Central Valley General, which have since come under the Adventist Health/Central Valley Network umbrella); Madera Community; and Sierra Kings in Reedley, which joined the Adventist network after the survey.
The Bakersfield region, where the charge for surgeries was 77% of the state median (third lowest), lumps Kaweah Delta Medical Center in Visalia, Tulare District Hospital and Sierra View in Porterville with Kern County hospitals.
Orange County checked in at 73% of the state median, next-cheapest after Fresno. Alameda County (163%) and San Mateo County (162%) had the highest regional surgery costs, according to the survey.