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BEST OF 2016- Hospital Prices Vary Widely for Chemotherapy, Coronary Bypass

But vagueness about procedures and complexity make comparisons difficult, limit broad conclusions
July 13, 2016

For the first time, information is emerging about how much hospitals are paid for care they provide to patients with commercial health insurance. Data released earlier this month shows sizable variations in how much a single hospital might receive for performing the same procedure with multiple patients – as well as big differences from one hospital to the next.

The data released earlier this month covers payments made in 2014, and was gathered as a result of state legislation passed last year. According to a summary report prepared by the Oregon Health Authority, the data can help patients and providers make better choices about care.

And yet this new transparency also shows just how hard it can be to get to the bottom of what things cost at Oregon’s hospitals. The exact amount each commercial health insurer pays for each procedure is a closely held secret, so the data released by the state uses averages across broad categories.

“Inpatient chemotherapy” is one such category: defined as Inpatient chemotherapy that’s provided "when the patient is too sick to return home after the treatment session, or the side effects of the Inpatient chemotherapy are so severe they require at least an overnight hospital stay," the new Oregon figures tell us that private insurers are billed a median of $14,674 for inpatient chemotherapy, with most procedures costing between $9,800 and $19,760 – but the data does not distinguish how severe each case is, or what might lead to that billing amount.

And without more detail, it’s impossible to get a concrete feel for whether commercial insurers are being billed fairly compared to what government programs pay – even though quite a bit of information is available about just what the government pays, as well.

The Centers for Medicare and Medicaid’s Medicare payer database discloses three different categories of Inpatient chemotherapy spending: 1-Inpatient chemotherapy with acute leukemia or with high dose chemo agent, with major complications; 2-Inpatient chemotherapy without acute leukemia as secondary diagnosis, with complications; 3-Inpatient chemotherapy without acute leukemia as secondary diagnosis, with major complications.

The data do not reveal which of these three categories applies to which types of cases in the commercial payer database, which means the data is not detailed enough to compare and contrast. And there’s no information about what patients who pay out of pocket might be charged.

Despite those limits, The Lund Report is attempting to understand which hospitals charge more and which charge less for major procedures – and whether there’s a connection between what the Medicare program will pay and what commercial health insurers are charged. We’re looking at three categories of data in the state commercial payer database: coronary bypass, percutaneous transluminal coronary angioplasty and Inpatient chemotherapy. And we’re doing our best to compare and contrast the costs to commercial insurers to the costs to Medicare.

In some cases, we will not be able to look at all three types of procedures: the state only makes payment information available when at least 10 patients were treated for that condition, and the federal CMS data follows the same rule there. But even if the data is incomplete and imperfect –it is a start.

A statewide commercial payments benchmark:

  • Inpatient chemotherapy: Median payment $14,674, with most between $9,834 and $19,758.
  • Coronary bypass: Median payment $65,606, with most between $37,793 and $86,999.
  • Percutaneous transluminal coronary angioplasty: Median payment $27,227, with most between $13,711 and $34,852.

Adventist Medical Center

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $21,005, with most between $17,569 and $23,143.

Federal Medicare data do not disclose Medicare payments to Adventist for these procedures. CMS only reports payment data when 10 or more procedures are conducted at a single hospital, and it would not be easy to draw conclusions about specific patietns.

Asante Rogue Valley Medical Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $30,887, with most between $5,061 and $44,981.
  • Coronary bypass: Median payment $67,089, with most between $15,367 and $83,266.
  • Percutaneous transluminal coronary angioplasty: Median payment $20,408, with most between $15,320 and $34.727.

Federal Medicare data provides some context.

Asante Rogue received an average of $13,506 in Medicare payments for each patient receiving chemotherapy without acute leukemia as a secondary diagnosis, and with complications – the highest such reimbursement in the state. There’s no available data about how much Asante received for more complex chemo cases.

CMS breaks coronary bypasses into multiple categories. Asante Rogue received an average Medicare payment of $61,648 per coronary bypass with cardiac catheterization with major complications; an average of $29,021 per coronary bypass with cardiac catheterization without major complications; and an average of $23,236 per coronary bypass without cardiac catheterization without major complications.

Asante Rogue received an average of $12,187 from Medicare for each angioplasty without coronary artery stent and without major complications.

Bay Area Hospital

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $21,234, with most between $10,760 and $30,861.

Federal Medicare data says that Bay Area Hospital received an average of $10,459 in Medicare payments for each patient receiving chemotherapy without acute leukemia as a secondary diagnosis, and with complications. There’s no available data about how much Asante received for more complex chemo cases.

Federal Medicare data do not disclose coronary bypass or angioplasty payments to Bay Area Hospital.

Good Samaritan Regional Medical Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $28,242, with most between $23,284 and $36,361.
  • Coronary bypass: Median payment $90,385, with most between $41,546 and $118,189.
  • Percutaneous transluminal coronary angioplasty: Median payment $36,054, with most between $20,835 and $46,682.

Federal Medicare data do not disclose chemotherapy or angioplasty payments to Good Samaritan.

CMS says that Good Samaritan received an average payment of $37,228 from Medicare for each coronary bypass without cardiac catheterization and without major complications.

Kaiser Sunnyside Medical Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $17,717, with most between $17,646 and $18,787.
  • Coronary bypass: Median payment $77,087, with most between $60,880 and $116,993.
  • Percutaneous transluminal coronary angioplasty: Median payment $32,486, with most between $30,172 and $32,686.

Federal Medicare data do not disclose payment details about these procedures at Kaiser Sunnyside.

Legacy Emanuel Hospital and Health Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $19,109, with most between $9,960 and $19,734.
  • Coronary bypass: Median payment $40862, with most between $15,422 and $74,765.
  • Percutaneous transluminal coronary angioplasty: Median payment $18,894, with most between $11,311 and $27,907.

Federal Medicare data do not disclose payment details about these procedures at Legacy Emanuel.

Legacy Good Samaritan Hospital

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $19,788, with most between $13,572 and $29,266.
  • Coronary bypass: Median payment $49,222, with most between $17,418 and $78,639.
  • Percutaneous transluminal coronary angioplasty: Median payment $14,353, with most between $7,183 and $23,805.

Federal Medicare data do not disclose chemotherapy or angioplasty payments to Legacy Good Samaritan.

Legacy Good Sam received an average of $24,556 from Medicare for each coronary bypass without cardiac catheterization and without major complications.

Legacy Meridian Park Hospital

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $17,757, with most between $5,095 and $29,595.

Federal Medicare data do not disclose payment details about these procedures at Legacy Meridian Park.

McKenzie-Willamette Medical Center

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $36,378, with most between $26,464 and $39,637.

Federal Medicare data do not disclose payment details about these procedures at McKenzie-Willamette.

Mercy Medical Center

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $27,671, with most between $19,182 and $37,580.

Federal Medicare data do not disclose payment details about these procedures at Mercy Medical.

OHSU Hospital

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $13,529, with most between $8,748 and $15,488.
  • Coronary bypass: Median payment $70,979, with most between $33,927 and $78,928.
  • Percutaneous transluminal coronary angioplasty: Median payment $23,821, with most between $12,858 and $25,156.

Federal Medicare data says that OHSU Hospital received an average of $11,890 in Medicare payments for each patient receiving chemotherapy without acute leukemia as a secondary diagnosis, and with complications. It also received an average of $22,112 in Medicare payments for each patient receiving chemo without acute leukemia as secondary diagnosis, but with major complications. And the hospital received an average of $66,533 for each patient receiving chemo with acute leukemia or with high dose chemo agents, with major complications.

OHSU Hospital received an average Medicare payment of $63,011 for each coronary bypass with cardiac catheterization and major complications, and $45,410 for each coronary bypass without cardiac catheterization and with major complications.

OHSU Hospital received an average Medicare payment of $24,040 for each angioplasty without coronary stent with major complications; and $18,763 for each angioplasty without coronary stent without major complications.

Providence Portland Medical Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $19,908, with most between $9,611 and $31,515.
  • Coronary bypass: Median payment $66,647, with most between $37,273 and $83,522.
  • Percutaneous transluminal coronary angioplasty: Median payment $27,429, with most between $15,980 and $33,841.

Federal Medicare data says that Providence Portland received an average of $8,890 in Medicare payments for each patient receiving chemotherapy without acute leukemia as a secondary diagnosis, and with complications Providence Portland also received an average of $58,773 in Medicare payments per patient receiving chemotherapy with acute leukemia or with high-dose chemo agents, with major complications.

Providence Portland received an average of $27,346 from Medicare for each coronary bypass with cardiac catheterization and without major complications; and an average of $24,871 for each coronary bypass without cardiac catheterization and with major complications.

CMS does not disclose angioplasty Medicare payments to Providence Portland.

Providence St. Vincent Medical Center

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $21,232, with most between $14,669 and $37,000.
  • Coronary bypass: Median payment $65,073, with most between $31,776 and $66,299.
  • Percutaneous transluminal coronary angioplasty: Median payment $27,991, with most between $14,341 and $33,988.

Federal Medicare data do not disclose chemotherapy payments to Providence St. Vincent.

Providence St. Vincent received an average of $43,274 from Medicare for each coronary bypass with cardiac catheterization and major complications; an average of $31,732 for each coronary bypass with cardiac catheterization and without major complications; and an average of $23,795 for each coronary bypass without cardiac catheterization and without major complications.

The hospital received an average Medicare payment of $24,390 for each angioplasty without coronary artery stent and with major complications; it received an average of $14,375 for each angioplasty without coronary artery stent and without major complications.

Sacred Heart Medical Center at RiverBend

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $12,857, with most between $7,594 and $17,329.
  • Coronary bypass: Median payment $70,900, with most between $50,404 and $93,127.
  • Percutaneous transluminal coronary angioplasty: Median payment $18,846, with most between $6,025 and $29,706.

Federal Medicare data do not disclose chemotherapy or angioplasty payments to Sacred Heart at Riverbend.

Sacred Heart at Riverbend received an average of $35,820 from Medicare for each coronary bypass with cardiac catheterization without major complications; an average of $46,108 for each coronary bypass without catheterization and with major complications; and an average of $28,245 for each coronary bypass without catheterization and without major complications.

Salem Hospital

Commercial insurance payments:

  • Inpatient chemotherapy: Median payment $13,040, with most between $5,069 and $16,459.
  • Coronary bypass: Median payment $65,480, with most between $30,375 and $80,337.
  • Percutaneous transluminal coronary angioplasty: Median payment $30,479, with most between $14,434 and $35,160.

CMS says that Salem Hospital received an average of $8,591 in Medicare payments for each patient receiving chemotherapy without acute leukemia as a secondary diagnosis, with complications.

Salem Hospital received an average of $42,179 from Medicare for each coronary bypass with cardiac catheterization and major complications; an average of $38,925 for each coronary bypass without cardiac catheterization and with major complications; and an average of $24,658 for each coronary bypass without cardiac catheterization and without major complications.

Salem Hospital received an average of $13,358 from Medicare for each angioplasty without coronary artery stent and without major complications.

Sky Lakes Medical Center

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $29,475, with most between $15,987 and $41,422.

Federal Medicare data do not disclose payment details about these procedures at Sky Lakes.

St. Charles Medical Center - Bend

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy costs.
  • Coronary bypass: Median payment $87,808, with most between $22,681 and $106,291.
  • Percutaneous transluminal coronary angioplasty: Median payment $39,227, with most between $25,403 and $44,334.

CMS says St. Charles – Bend received an average of $7,723 in Medicare payments for each patient receiving chemotherapy for without acute leukemia as a secondary diagnosis, with complications.

St. Charles – Bend received an average of $58,389 in Medicare payments per patient undergoing coronary bypass with cardiac catheterization and multiple complications; $30,334 on average per coronary bypass with cardiac catheterization without major complications; and $26,032 per coronary bypass without cardiac catheterization and without major complications.

St. Charles – Bend received an average of $12,492 in Medicare payments for each angioplasty without coronary artery stent and without major complications.

Tuality Community Hospital

Commercial insurance payments:

  • Not enough procedures to report inpatient chemotherapy or coronary bypass costs.
  • Percutaneous transluminal coronary angioplasty: Median payment $29,832, with most between $15,993 and $35,399.

Federal Medicare data do not disclose payment details about these procedures at Tuality.

-- Courtney Sherwood can be reached at [email protected]. Follow her on Twitter at @csherwood.

Editor's note: Incorrect figures were listed for Tuality Community Hospital in an earlier version of this story. The article has been updated to reflect correct information.

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