Every three to six months, Margie Amspacher goes to the same hospital in Newberg for the same blood test. She has type 2 diabetes.
"You need to have that hemoglobin A1C checked," she explained.
It usually costs her $42. But this summer, she changed doctors and went to a new hospital in Forest Grove. Same blood draw, different bill.
"I got my bill and I went 'Wow, there's quite a bit of difference," Amspacher said.
The Forest Grove hospital charged her $80 instead.
"That's kind of odd, especially when one test was twice as much!" Amspacher said. "It was basically the same test."
The bill bombshell left Amspacher feeling left in the dark by the very profession she serves. Amspacher's been a nurse for 30 years.
"I'm a health care professional and this should be pretty easy to figure this stuff out and -- I've got a little background, a little knowledge," she said. "I can't imagine what it would be like if I didn't have that."
For years, hospitals have kept their price lists - known as chargemasters - closely guarded secrets. However, this summer the Centers for Medicare and Medicaid Services for the first time made public the prices that 3,300 U.S. hospitals charged in 2011 for common procedures. The list included the 100 most common inpatient procedures and the 30 most common outpatient procedures.
The figures showed the average price charged by each hospital, as well as the lower amount actually paid by Medicare.
COST OF CARE
KATU pored over the data and found that what happened to Amspacher happens to countless other patients in Oregon and Washington - and not just for simple blood tests. Our research revealed local hospitals are charging wildly different prices for procedures ranging from x-rays to major surgery.
In a community that prides itself on outdoor adventure, injuries and trips to the hospital come with the territory.
Let's say you crash your bike and end up with bad back pain. If you walk into Legacy Emanuel Medical Center in Northeast Portland, the average bill will be $34,715, according to the federal data. If you go to Oregon Health and Science University (OHSU) in southwest Portland, the same treatment averages $19,616. At Providence St. Vincent in Washington County, the bill averages $15,774. But if you go to Salem Hospital, the price averages $12,585. That's as much as a $22,000 difference depending on which hospital you go to for treatment.
Now, let's say you have chest pain. At OHSU, treatment for chest pain will set you back, on average, $9,827. But if you drive the 15 minutes to Legacy Good Samaritan, the same treatment is $13,517.
Even within the same hospital network we found price disparities. Take joint replacements - a common surgery for a lot of Northwest sports enthusiasts. At Legacy Emanuel, the surgery averages $46,621. The same procedure at Legacy's Salmon Creek facility in Vancouver is $31,892. That's a difference of roughly $15,000 - enough money to buy, say, a 2014 Ford Focus.
"It's very hard for anybody to discern - have any sense of rhyme or reason -- as to why at one hospital it costs twice or three times as much for the same service as it does in another place," said Ron Pollack, Executive Director of the Washington, D.C.-based patient advocacy group Families USA.
Pollack has been critical of health care pricing in part because he said higher costs don't necessarily translate to better quality of care. He also argues hospitals regularly leave the uninsured populations paying the largest bills because. Plus he says, there is virtually no oversight of hospital pricing.
The chief operating officer of the Oregon Association of Hospitals and Health Systems, Andy Van Pelt, argues the federal database only tells part of the story.
"I would say, you really have to ask that specific hospital because to look at a raw data set and not understand the context of how those charges were established, I would have the same conclusion," Van Pelt said. "It really comes down to understanding that specific hospital's purpose within their community, the demographic they're serving and why their cost structure is the way it is."
Providence Health and Services, for example, has a flexible cost structure. In a statement to KATU, Providence spokesman Gary Walker wrote, "Providence automatically discounts our charge to uninsured patients who qualify under our financial assistance policy."
In the statement, Walker continues, "We have a single chargemaster for all Providence hospitals in the Oregon region, but it's best to think of this just as a starting point. A variety of factors could make a difference in the rates shown for each hospital, including market demographics (age, income, number of commercially insured patients, Medicare patients and self-pay/uninsured), range and number of services offered, costs unique to a certain facility, availability of specialists (or lack thereof) - and those are just a few examples."
Some hospitals provide specialty care like a burn or trauma center and some, like OHSU, invest heavily in state-of-the-art technology.
Patient volume is also a factor. A small rural hospital that does a dozen joint replacements a year may have higher average costs than a hospital in a big city that does hundreds.
Van Pelt explained, "One community might have a really high Medicaid or Medicare population. Another might have a really high uninsured population so they're in this constant balancing act and how do you make health care viable in that community based on the patient population and the services that community is seeking."
AFFORDABLE CARE ACT
Still, even Van Pelt admits it's an antiquated system.
"Our members would say, the hospitals in this state would say, we have an unsustainable model for delivering health care," Van Pelt said.
With more Americans insured under the Affordable Care Act, Van Pelt believes a lot of hospitals will look to stop shifting costs to the insured, meaning a more equitable approach to pricing.
"We're at this crossroads of past meeting future and we're in this transition period, and unfortunately it doesn't happen overnight," he said. "Our goal is: we see the cost of health care stair-stepping down over time."
Frustrated with the system herself, Amspacher now doubles as a patient advocate helping others navigate the complicated health care web.
"That's just the way it's always been, but that doesn't mean it's the way it has to stay," Amspacher said. "This transparency that's coming into place, I think that is going to make a big difference for consumers."
UNDERSTANDING THE DATA
The data was released by the Centers for Medicare and Medicaid Services for the first time in May and June of 2013.
According to its website, CMS.gov: "As part of the Obama administration's work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what providers charge for common services. These data include information comparing the charges for the 100 most common inpatient services. Providers determine what they will charge for items and services provided to patients and these charges are the amount the providers bill for an item or service."
The KATU On Your Side Investigators have extracted data for Oregon and Washington specifically:
- Oregon cost comparisons: Excel file or Google doc
- Washington cost comparisons: Excel file or Google doc