However, hospital leaders and consumer rights groups say there is little to be gleaned from the data.

Virtually no one pays the billed price, financial officers at local hospitals say. All other prices are set by the government, negotiated by insurance companies or forgiven, at least in part, by hospitals.

“It’s helpful for consumers to have, but it’s limited,” said Joe Ditré, executive director of Consumers for Affordable Health Care. The information is broken down into diagnostic categories and is tough to decipher.

For example, a 2011 patient at Central Maine Medical Center treated for heart failure and shock with complications saw an average bill of $12,939. However, Medicare paid an average reimbursement of $6,365, according to the just-released data.

Overall, local hospitals billed similar amounts for the same treatments. But none was the same.

At St. Mary’s Regional Medical Center in Lewiston, the same treatment carried an average bill of $15,140 and a Medicare reimbursement of $6,698. And at Franklin Memorial Hospital in Farmington, the bill was $16,154, of which Medicare paid $7,642.

In Portland, Maine Medical Center’s average bill was $16,637 with a reimbursement of $7,636. At Mercy Hospital, also in Portland, the numbers fell to $15,860 and $6,280.

The data were part of a national initiative aimed at making hospital billing more transparent.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Health and Human Services Secretary Kathleen Sebelius said Wednesday in a prepared statement. “This data and new data centers will help fill that gap.”

Maine did well in comparison with other states, typically falling well below the national average in bills and reimbursements for a variety of problems.

“We’re efficient when compared to the rest of the country,” said Steven Michaud, president of the Maine Hospital Association. He asked that people not read too much into hospital-to-hospital comparisons.

“They’re literally irrelevant,” he said.

The differences in costs are as varied as the patients who received care, said Wayne Bennett, the Farmington hospital’s chief financial officer.

“Everybody’s bill is different,” Bennett said. “It’s not like there’s one price for a procedure.”

Hospital billing is like picking from an a la carte menu with thousands of items. Different drugs, different lengths of care and many other variables change the math, he said.

Not included in the new government data are various rates paid by insurance companies, which pay negotiated prices that are less than the billing price but higher than the Medicare rate.

People who are uninsured often pay a small fraction, if any, of their bills.

“There’s probably someone in America who has money and comes and takes the self-pay discount (the average rate reimbursed by the insurance company) and pays and has chosen not to buy insurance,” said Matthew Cox, chief financial officer at Central Maine Medical Center. “But most people who don’t have insurance don’t have money.”

Hospitals with a larger percentage of Medicare and Medicaid patients set their rates higher in hopes of making up some of their real costs, said Carolyn Kasabian, chief financial officer at St. Mary’s Regional Medical Center.

She said she is proud of her hospital’s role as a safety-net institution, but it adds stress.

“At the end of the year, you have to make sure you’re in the black,” she said.

Though the complexity of it all makes it difficult to compare value among hospitals, their CFOs are seeing a rise in price shoppers.

CMMC receives dozens of calls each day from people looking for an estimate on a given procedure. Officials all said they encourage such inquiries.

“We have to make it easier for people,” said Michaud, of the Maine Hospital Association. “We have to do a better job of it.”

Ditré, the watchdog from Consumers for Affordable Health Care, agreed.

The government’s release of data is a small step in the right direction, he said. Hospitals have been too secretive of their billing for too long.

“It’s all black-box stuff,” he said. “This is the beginning of getting those charges out of the black box.”

dhartill@sunjournal.com

Copy the Story Link