<p>California Pacific Medical is a Sutter Affiliate. Enough said. They are hands down the most expensive (by several magnitudes) California medical provider. Go to Stanford, to to UCSF heck go to Kaiser if you can but stay the heck away from anything Sutter related. Their charger rates ARE their negotiated rates! When Calpers tried to get a handle on the rising costs associated with use of Sutter and affiliates this medical group threatened to pull out of Calpers networks (in many locations Sutter is the only game in town). An agreement was finally reached when Calpers agreed to be put under a gag order.</p>
<p>In my county Sutter is the big player, they have bought up hospitals and what used to be private doctor groups. They are the only game in town. According to Covered CA, we are in the top most expensive counties and BC/BS does not offer a PPO option - precisely because they are excluding Sutter from their in-network providers.</p>
<p>On thing that absolutely is needed is a front office chart showing comparative costs for providers. You walk in, see that a routine strep culture runs - say $300 at Sutter, you can choose to go to a different provider where the chart shows the same procedure with a charger rate of $175. Obviously that won’t work for ER issues, but for planned care…an informed consumer is a better consumer. ACA does nothing to inform consumers of costs. If anything the Medicare expansion and subsidies handed out like candy corn at Halloween further hide the real costs.</p>
<p>As for the luxuries now offered by hospitals and the associated rising costs …its right in line with what is happening in our Colleges. What used to be a room with the essentials for completing a task (healing a patient, giving a student a place to sleep and eat) has now become an opportunity to provide so many bells and whistles that the cost MUST go up.</p>
<p>26k for a surgical gall bladder removal at one hospital (assuming the figure is correct,) versus Healthcare Blue Book quoting 17k in Ann Arbor. Any wonder the insurers balk?</p>
<p>In one study, the researchers called up twenty hospitals and asked for the prices for parking, and for an ECG. In each case, they said they were uninsured and would be paying the bill themselves. See the result, in the chart reported here:</p>
<p>I don’t think Sutter Hospitals are choosing to “compete” based on amenities. As dietz points out, in a lot of places they’re the only game in town, so there is no competition.</p>
<p>Rather, they are choosing to jack up prices based on amenities. They put in these hotel-like amenities, and use them to justify charging five times as much for a gall bladder operation.</p>
<p>JH is asking someone not in network to pay the entire bill upfront for brain tumor care. Not sure even the regulated ones are all that regulated.</p>
<p>Argbargy, we dont have a free market in healthcare. I am using the term free market loosely. We have a hybrid sysytem of for profit and not for profit care.</p>
<p>How can we have a free market? Patients dont know the prices of procedures. Doctors dont know all the costs.</p>
<p>This is a fact. This is a fact. If we had a true free market in healthcare in this country, the poor and the sick would not get coverage because covering the poor and the sick are not profitable.</p>
<p>We are down to 4 major airlines like texaspg said. What a joke!</p>
<p>To me, arg is making the point that some expect certain levels, may prefer one facility over another for non-critical reasons, and either accept the pricing or not be concerned, if their insurance covers it. That’s the thing: in many cases, insurance was covering and some are aghast that their pricey hospital is now out of the loop.</p>
<p>I don’t know what happens if you don’t have the money but it’s increasingly common to be asked for a deposit before treatment. Heck, that happened when I had one of my kids 12 years ago. The hospital called and asked for a $1000.00 a week before my due date. The doctor was shocked when I mentioned it to him. Also, son was asked for his debit card at an ER before getting stitches this summer. We had insurance.</p>
<p>What will happen now I do not know since many of these ACA plans have some high deductibles.</p>
<p>I’d want to know the circumstances before assuming it’s just JH or that this is a rare exception. I’m aware of fundraisers in the past for kids or adults who couldn’t afford a major, highly expensive, life-saving procedure, when insurance didn’t cover it or enough of it.</p>
<p>I’ve told this story before, but Cedars Sinai asked a friend’s sister to pay for her husband’s surgery in full after they had put him under anesthesia and before they started the surgery. She called my friend in a panic, and he was able to come up with the tens of thousands of dollars, but ever since then my contempt for Cedars is undimmed.</p>
<p>dstark - I had asked the person to post here in the past but she has not responded. She keeps us updated on a parents of … thread about what is going on with her. Essentially she is trying to find other choices but for some reason has time until fall to do something?</p>
<p>Our system has a large disconnect between cost and price. The factory charges $350 for the titanium rod used in a hip replacement. The patient pays $38,000. $40 worth of Adriamycin becomes a $20,000 chemo drug. 20 minutes with an anesthesiologist costs $4000. </p>
<p>We know the CEO of one of the local hospitals. He has mastered spotting these cost/price gaps and building new wings to take full advantage. Until someone is willing to work on the disparity, these insurance rates are not coming down.</p>
<p>The Sutter hospitals affect Sutter’s overall numbers. Even if the individual facility itself has no nearby competition, Sutter itself does. Therefore, Sutter wants it numbers to look good in the aggregate. That sounds like it would be a good thing for patients, but in reality it’s only a good only in a particular way. </p>
<p>There are a number of metrics that hospitals watch. Obviously they watch the financials (cash on hand, average days of admission per patient). For us patients, though, there are two main types of metrics: patient satisfaction and outcomes. </p>
<p>Unfortunately, non-professionals don’t really have a good way to judge the quality of medical outcomes. In fact, professionals have a hard time too. Patient satisfaction, however, is clear and is the primary way to keep a patient choosing hospital A over hospital B when they have a choice. </p>
<p>Therefore, the result is that we tend to choose hospitals based on how nice the rooms are and whether they have a bank and a MacDonalds in the lobby, more than we look at the medical quality. And if Sutter can charge more based on flat screens instead of old TV’s, they can and will.</p>
<p>Some of these examples show why we need someone to challenge pricing. If it’s not the consumer or our state regulatory agencies, isn’t it better to at least have insurers negotiating? For total hip replacement, Healthcare Blue Book quotes 25.5, including hosp, implant, physician and anesthesia. They quote the implant at 8k and say it can vary based on material. But I don’t know what is actually included in that- just the piece, itself? Or something related to its prep and placement?</p>
<p>Here is the list of places with plush amenities from the article. They all seem to be in competitive markets. </p>
<p>St. Joseph’s Hospital in Highland, Ill - just outside of St. Louis
Cedars-Sinai in Los Angeles<br>
Henry Ford West Bloomfield - Detroit metro
Benjamin Russell Hospital for Children, Birmingham, Ala
Capital Health Medical Center, Pennington, N.J - Trenton area
Baylor Medical Center at McKinney
Mount Sinai Medical Center
Ann & Robert H. Lurie Children’s Hospital of Chicago
St. Dominic Hospital Jackson, Miss - within a mile of Baptist Hospital and University of Mississippi Health Care</p>
<p>But argybargy, how many people who go to those hospitals are actually in any sense “choosing” to go there? Most hospitalized people go to their doctor, and then they get sent to a hospital. Nobody asks where they want to go. At least, the time I went to the hospital my doctor saw me in her office and said, “I’m sending you to the hospital.” I didn’t get any choice of which hospital.</p>
<p>From the article:
"In a highly competitive field, patients — sometimes now referred to as “guests” — appreciate amenities. The tactic works. “We found that patient demand correlates much better to amenities than quality of care,” said Dr. John Romley, a research professor at the Leonard D. Schaeffer Center for Health Policy and Economics of the University of Southern California, "</p>
<p>In my experience you usually have a choice. That why people care about the networks. </p>
<p>This is especially true for maternity where prospective parents often tour multiple “birthing suites” at various hospitals.</p>
<p>CF, up to now, my family did get a choice- my mother always preferred UCLA (60 miles, through traffic) rather than her local, well-rated hospital. Where I live, I had a choice for scheduled procedures. Often, the choice was about which could schedule you when. </p>
<p>A set of local hospitals (not all) merged under the same master umbrella. Now, procedures of one sort are focused at one (say, most intense cardiac cases) while others are at another (say, orthopedic surgery.) So, you don’t get a choice, among those two. (ER is either.) But, I could still go outside that umbrella, choose to go to hospital Z, 6 miles up the road, also well-rated, if they perform the procedure and my doc is associated.</p>
<p>Or an outpatient facility, if that’s appropriate. Probably not the same in all areas. Like some others here, I may live in a bubble.</p>