Hospital pricing stats say San Diego County a bargain

By: GIG CONAUGHTON - Staff Writer | Saturday, May 20, 2006 4:22 PM PDT ∞

San Diego County hospitals are a bargain, according to the first batch of state statistics designed to let people see how much hospitals charge for their most commonly performed procedures.

The statistics ---- lists of how much hospitals charge for the 25 most commonly performed inpatient treatments, such as heart failure, appendectomies and delivering babies ---- show that San Diego County hospitals' prices are generally much cheaper than the state averages.

However, the information comes with a handful of caveats:

First, good luck finding it. The statistics' release was required by a new law that went into effect Jan. 1 with the idea of helping consumers. Despite that, the statistics are buried well out of the public's eye, on a crowded state Web site.

Second, the inpatient procedures listed are confusing and broad, making it difficult for the general public to understand what they actually are.

Finally, at least one hospital group in San Diego County said the statistics are worthless ---- because they don't really reflect what hospitals actually charge patients.

Removing the mystery

Assemblyman Dario Frommer, D-Glendale, has worked for three years to get the hospital-pricing information published. Health care costs and hospital prices, he said ---- unlike other goods and services ---- are a mystery.

"You know, you can take your car to a mechanic, and he has to give you a written estimate for what it might cost," he said. "You go to have major surgery, and most people don't know anything about what it will cost. Not until they get a bill."

Frommer said that the idea behind his law was to give people a chance to comparatively shop among hospitals when they need medical help, and to help reduce the sticker shock thousands of patients feel every year.

But he's not happy at all about how the information has been published by California's Office of Statewide Planning and Development.

The information is buried, without fanfare or meaningful directional signs, on the agency's Web site.

"It's almost like they're deliberately obscuring access to the data," Frommer said recently. "It's hard to imagine a way of providing this information that would be more confusing than what (the state) has done."

The inpatient information, which covers procedures where people are hospitalized for at least a day, is just the first batch of information the law will require. The state agency is scheduled to release a second batch of hospital prices ---- for outpatient procedures where patients can leave the hospital within 24 hours ---- in July.

Cheaper (The numbers)

The 25 areas themselves included treatments for chest pain; strokes; internal bleeding; re-attaching severed limbs; rehabilitation from surgery; illnesses or injuries; hysterectomies; kidney failure; C-sections; pneumonia; and other problems.

The first thing that jumps out when looking at the new statistics is that, generally speaking, hospitals in San Diego County charge a lot less than others around the state. An average price for each of the 25 inpatient areas was created by combining 2004 prices ---- the latest available ---- submitted by California's roughly 470 hospitals.

In North County:

- Escondido's Palomar Medical Center's reported prices were less than the state average in 21 of 23 areas. Not all hospitals reported prices in all 25 areas because they didn't do enough of them to register.

- Poway's Pomerado Hospital's prices were less than the state average in 20 of 22 areas.

- Oceanside's Tri-City Medical Center prices were less in all 25 areas.

- Scripps Memorial Hospital in Encinitas prices were less in 17 of 23 areas.

- Fallbrook Hospital's prices were less in 20 of 23 areas.

To give a better idea of the differences, the most commonly performed inpatient procedures were for delivering a baby with no complications ---- a combination of two prices: one charge for the mother, and a second for the baby.

The average state price for that combined procedure was $11,386.

At Palomar, the price for having that baby was $8,088, 29 percent less than the state average.

At Pomerado, the price was $9,989, 12.3 percent less.

At Tri-City, the price was just $4,748, 58 percent less.

At Fallbrook, the price was $10,253, 10 percent less.

And at Scripps Encinitas, the price was $8,217, 28 percent less.

Local hospital officials had little to say about why the prices varied so much.

In fact, they said, this is the first time that they'd been able to see what other hospitals charged for services. Hospitals are barred by law from sharing prices and costs.

"It could be considered restraint of trade," Ondrea Labella, director of patient business services at Tri-City, said.

Confusing

The statistics that have been released, however, are still likely to be very confusing for most people, even if they can find them.

That's because the 25 inpatient "procedures" that the prices are attached to are not procedures at all. They are, instead, pricing categories that the federal government created in the 1970s to try to reign in Medicare spending.

They're called "diagnostically-related groups," and can be narrowly, or broadly, defined ---- meaning they can cover a wide range of treatments and prices, making it harder to pin down a "true" average price.

For example, the 25th most commonly performed diagnostically-related group is appendectomies.

But the 10th most common is "rehabilitation" ---- which can range from recovering from surgery, to elderly patients doing physical therapy for new joints; or getting muscle and balance training before being discharged.

In addition, the diagnostically-related group "procedures" are listed in medical terms.

Some groups are self-explanatory. The 22nd ranked group is bronchitis and asthma in teens.

But the 20th is "percutaneous cardiovascular procedure with drug-eluting stent without acute myocardial infarction."

That's a procedure to repair a damaged artery by inserting a "stent" ---- a drug-coated metal sleeve used to prevent blocked arteries from collapsing.

Worthless?

A handful of officials from ScrippsHealth said last week that they believe the statistics are worthless ---- that they don't reflect what consumers would pay, and would mislead people.

ScrippsHealth operates five hospitals in San Diego County, including Scripps Memorial Hospital in Encinitas and La Jolla's Scripps Green Hospital.

Scripps officials said the system would never allow consumers to do hospital-to-hospital price comparisons.

"Diagnostically-related groups don't have anything to do with the charges (prices)," Mollie Drake Scripps' director of access management. "They'd be completely useless to the average consumer at this point, and would let them draw the wrong conclusions."

Drake said that was because one doctor or hospital might do one set of diagnostic tests on a patient categorized in a diagnostically-related group, and a second doctor or hospital could do a completely different battery of tests for the same group.

In addition, Scripps officials said every patient has his own medical problems that could complicate how they are treated, raise their treatment prices, and render "average" prices misleading.

A heart patient with diabetes would be treated, and charged, differently than a heart patient without diabetes.

However, other local hospital officials said they thought that the new statistics did have value, that they could provide consumers a window into hospital prices ---- and allow them to shop around if they wanted.

"We think it's good for the consumer," Debbie Binczewski, charge services master for Palomar Pomerado Health, which runs Palomar Medical Center and Pomerado Hospital, said.

Frommer, meanwhile, who started the whole process by pushing for California's "Payers Bill of Rights" in 2003, said he planned to keep pushing for more openness.

"I think we need to bring transparency to this industry," he said. "There's no rationale to a lot of it (prices). There are great discrepancies, and I think it's important to try to understand why."

Contact staff writer Gig Conaughton at (760) 739-6696, or gconaughton@nctimes.com. To comment, go to nctimes.com.