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Local healthcare pros weigh in on hospital pricing
by Caroline Young
May 23, 2013 04:20 PM | 3608 views | 0 0 comments | 19 19 recommendations | email to a friend | print
Heated healthcare discussions have recently risen throughout the country, questioning hospitals’ patient costs. Several reports indicate a drastic difference among hospitals offering specific procedures at staggering prices.

However, Georgia Hospital Association spokesman Kevin Bloye said people should take hospital procedure list prices with a grain of salt.

“Everyone’s fixated on what hospitals are charging and what these list prices are,” he said. “The overwhelming majority of patients, if not all, will not pay these list prices.”

Bloye said people in three possible situations, including insured, uninsured and Medicare or Medicaid recipients will all have some type of discount off the list price.

“Once you identify yourself as uninsured, they have fairly generous discount policies for uninsured people,” he said. “The media perception is they just have to pay the full price.”

At Piedmont Hospital in Buckhead, the estimated cost for a typical MRI of the brain (CPT 70551)without insurance totals $3,596. And with Blue Cross Blue Shield HMO, the estimated cost is $388.70.

St. Joseph’s Hospital in Sandy Springs disclosed an estimated technical charge of $2,636 plus an estimated professional charge of $208, for the same procedure, without insurance applied. The hospital declined to disclose the cost with insurance applied.

Bloye said some hospitals’ policies will discount uninsured patients by 10 percent, while others will offer up to 50 or 60 percent off.

“The range is pretty wide. Every hospital has a different cost structures,” he said.

The healthcare cost system is such a “complicated mechanism” locally, Bloye said, because Georgia has nearly two million uninsured people and hospitals also need to make up the difference after Medicaid and Medicare.

“The government pays for healthcare with Medicaid and Medicare. When you add that up, that could be up to 50 percent of their business,” he said. “Medicaid here in Georgia — hospitals get 83 percent of costs.”

Bloye also said teaching hospitals cost significantly more to operate than non-teaching ones, and some hospitals have more specialty services, like a burn center, a trauma unit or a community wellness program, which may be “great for the community but not for the bottom line.”

“They might not make a profit margin on those specialty services,” he said. “It’s important to note that it can be a misperception when the public sees these prices that hospitals are just making all kinds of money at the expense of the population.”

On the contrary, Bloye said 38 percent of all hospitals in Georgia are losing money right now.

“The more the economy suffers, the more uninsured you have and the greater pressure you have on hospitals,” he said.

In an effort to provide “more accessible” healthcare to both the insured and uninsured, a new Alpharetta-based website called HealthGate offers a complete price of a medical procedure upfront. The company initially started in 2012 to give patients “clear pricing with no hidden costs, said HealthGate President Tanya Mack.

HealthGate Chief Operating Officer Al Doeve said the inspiration for HealthGate was a result of “the current turmoil in healthcare markets that is brought about by higher rising healthcare costs.”

“Consumers are becoming more conscious of healthcare and [the] cost of that care,” he said. “Because we are the only medical-focused site that provides savings offers, we’re focused on relationships with providers and consumers.”

Doeve said the company addresses the need for both transparency and quality care for the “ordinary customer.”

“HealthGate goes directly to doctors and clinical practices and individuals to work with them on a cost that covers the medical procedures,” he said. “We work directly with the provider to say, ‘What is the regular billable cost for the procedure? What can you do to work with HealthGate to make the procedure available at a savings to the end consumer?’”

Doeve said HealthGate’s costs come in lower when compared with customary costs because the company relieves the doctor from dealing with administrative overhead.

Customers will receive anywhere from a 25 to 75 percent discount, Doeve, said, on 13 medical specialties through HealthGate.

Northside Hospital in Sandy Springs declined to disclose its MRI and CT scan procedure costs.

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