Surgery costs vary widely

The price of a com­mon pro­ce­dure varies from $39,000 to $237,000 in L.A.

Los Angeles Times - - BUSINESS BEAT - By Chad Ter­hune and San­dra Poin­dex­ter chad.ter­hune@la­times.com

A short drive in the Los An­ge­les area can yield big dif­fer­ences in price for knee or hip re­place­ment surgery.

New Medi­care data show that In­gle­wood’s Cen­tinela Hos­pi­tal Med­i­cal Cen­ter billed the fed­eral pro­gram $237,063, on av­er­age, for joint re­place­ment surgery in 2013.

That was the high­est charge na­tion­wide. And it’s six times what Kaiser Per­ma­nente billed Medi­care eight miles away at its West L.A. hos­pi­tal. Kaiser billed $39,059, on av­er­age, and Medi­care paid $12,457.

The fed­eral pro­gram also paid a frac­tion of Cen­tinela’s bill — an av­er­age of $17,609 for th­ese pro­ce­dures.

The av­er­age charge na­tion­wide for a ma­jor joint re­place­ment op­er­a­tion was $54,239, ac­cord­ing to fed­eral fig­ures.

Joint re­place­ment surg­eries are Medi­care’s most com­mon in­pa­tient pro­ce­dure, cost­ing the fed­eral gov­ern­ment more than $6.6 bil­lion in 2013.

Over­all, the lat­est data show what hos­pi­tals charged and what Medi­care paid for 100 of the most com­mon in­pa­tient stays and the 30 most com­mon out­pa­tient pro­ce­dures. The in­pa­tient data cover more than $62 bil­lion of Medi­care money.

The Obama ad­min­is­tra­tion first re­leased this type of data two years ago to put heat on hos­pi­tals to ex­plain wildly dif­fer­ent charges for the same treat­ment at med­i­cal cen­ters across the na­tion.

Both gov­ern­ment offi- cials and em­ploy­ers are de­mand­ing more pric­ing trans­parency to spur greater com­pe­ti­tion in hopes that it can help con­trol ever-ris­ing med­i­cal costs.

Mon­day, Medi­care also pub­lished its sec­ond an­nual set of physi­cian pay­ment data.

The high­est-paid spe­cial­ists na­tion­wide were ra­di­a­tion on­col­o­gists, who re­ceived an av­er­age of $403,512 in Medi­care pay­ments. Next were der­ma­tol­o­gists at $331,108 and then vas­cu­lar sur­geons at $329,874.

Medi­care “will con­tinue to re­lease the hos­pi­tal and physi­cian data on an an­nual ba­sis so we can en­able smarter de­ci­sion-mak­ing about care that is de­liv­ered in the health­care sys­tem,” said Niall Bren­nan, chief data of­fi­cer at the Cen­ters for Medi­care and Med­i­caid Ser­vices.

Hos­pi­tals of­ten say billed charges are ir­rel­e­vant be- cause they don’t re­flect what Medi­care or health in­sur­ers ac­tu­ally pay. But th­ese charges can in­flu­ence the ul­ti­mate cost for em­ploy­ers and con­sumers.

Health in­sur­ance com­pa­nies tie some re­im­burse­ments to th­ese list prices. Con­sumers go­ing out of their in­sur­ance net­work or cash-pay­ing pa­tients can face th­ese higher charges.

A spokesman for Cen­tinela Hos­pi­tal, owned by Prime Health­care Ser­vices of On­tario, didn’t have an im­me­di­ate com­ment

Other area hos­pi­tals also had higher-than-av­er­age charges. Cedars-Si­nai Med­i­cal Cen­ter billed Medi­care $123,684, on av­er­age, for joint re­place­ment surg­eries and got paid $15,650.

UC Irvine Med­i­cal Cen­ter charged less, $104,141, but got re­im­bursed more — $20,604.

Bob Chamberlin Los An­ge­les Times

DATA SHOW In­gle­wood’s Cen­tinela Hos­pi­tal Med­i­cal Cen­ter billed Medi­care $237,063, on av­er­age, for joint re­place­ment surgery in 2013. Joint re­place­ment surg­eries are Medi­care’s most com­mon in­pa­tient pro­ce­dure.

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