Some Hospitals Set Their Charges at 10 Times Their
Costs, Says Nurses United
National Nurses United warn of ongoing harm
for patients needing care
Jan. 29, 2014 - With growing national attention to hospital
pricing practices, new data released earlier this month by
the nation’s largest nurses organization showed that
hospital charges continue to skyrocket with some U.S.
hospitals charging more than ten times their cost – nearly
$1,200 for every $100 of their total costs.
“Such inflated practices continue to price far too many
Americans out of access to needed medical care or expose
them to financial ruin. It’s long past time to rein in the
price gouging, and recognize that a healthcare system based
on profiteering puts all of us at risk,” said Jean Ross, RN,
co-president of National Nurses United, whose research arm,
the Institute for Health and Socio-Economic Policy,
conducted the research.
NNU and IHSP list the 100 most expensive hospitals,
top 10 for each state, and the 50 most expensive hospital
hospitals charge more than $1,000 for every $100 of
their total costs (a charge to cost ratio of 1,000
percent) topped by Meadowlands Hospital Medical Center
in Secaucus, NJ which has a charge to cost ratio of
most expensive U.S. hospitals have a charge to cost
ratio of 765 percent and higher – more than double the
national average of 331 percent.
enactment of the Affordable Care Act, hospital charges
recorded their single biggest jump, a 22 percentile
point increase from fiscal year 2010-2011 to fiscal year
2011-2012 in the past 16 years for which the IHSP has
analyzed the data.
Six of the
nine most expensive hospitals are part of two big
chains, Community Health Systems, Inc. and Health
Management Associates which are currently pursuing a
controversial merger that critics charge would further
drive up prices.
hospitals continue to dominate the list of those with
the highest charges. For-profit corporations average
charges of 503 percent of their costs, or $503 for every
$100 of total costs.
contrast, government-run hospitals, including federal,
state, county, city, or district operated hospitals,
with public budgets and boards that meet in public,
exercise far more restraint than for-profit or
non-profit corporate chains. Average charge ratios for
government-run hospitals are just 235 percent of their
oversight or regulation seems to help constrain
excessive pricing. Maryland, probably the most regulated
state in the U.S., has the lowest average charges of all
the states among its 10 most expensive hospitals.
are based on publicly available Medicare Cost Reports as of
June, 2013, covering the federal fiscal year that ended
September 30, 2012.
Top 10 Most Expensive
Hospitals in the U.S.
(by total charges as a percent of total costs)
1-Meadowlands Hospital Medical
Center, Secaucus, NJ – 1192%
2-Paul B. Hall Regional Medical Center, Painsville, KY
3-Orange Park Medical Center, Orange Park, FL – 1139%
4-North Okaloosa Medical Center, Crestview, FL – 1137%
5-Gadsden Regional Medical Center, Gadsden, AL – 1128%
6-Bayonne Medical Center, Bayonne, NJ – 1084%
7-Brooksville Regional Hospital, Brooksville, FL –
8-Heart of Florida Regional Medical Center, Davenport,
FL – 1058%
9-Chestnut Hill Hospital, Philadelphia, PA – 1058%
10-Oak Hill Hospital, Spring Hill, FL – 1052%
The IHSP has analyzed hospital charge
data for years, noting prices, and a correlating spike in
hospital profits, that hit a record $53 billion nationally
for 2011, according to American Hospital Association data.
Hospitals, notes NNU, are not the only culprits in the
healthcare industry. Excessive prices are a feature of
nearly every sector in the privately run healthcare
industry, including pharmaceuticals, medical suppliers,
insurance companies, medical labs, outpatient clinics, and
In the past, hospitals have claimed that the actual charges
don’t matter, and that few pay the list price. “But it’s a
defense that defies logic,” said Ross. “The higher the
starting point on a charge, the higher the ultimate
reimbursement.” Uninsured individuals with far less
bargaining power are too often hit with the full list price.
As Glenn Melnick, University of Southern California health
economics professor told Elizabeth Rosenthal of the New York
Times December 3, hospitals “set prices to maximize revenue,
and they raise prices as much as they can – all the research
The effect on the uninsured or underinsured is often
Hospitals increasingly tack on steep co-pays, require cash
up front before administering care, use Medical Credit
Scoring to determine if patients are a payment risk, and
hound patients for payment afterwards. All while skimping
on the supposed offset of providing charity care. A 2012
IHSP research study found California hospitals reap $1.8
billion in public subsidies beyond what they provide in
A June, 2013 report by NerdWallet Health said bankruptcies
from unpaid medical bills will affect nearly 2 million
Americans this year, and 20 percent of Americans under age
65, including those with health insurance, struggle with
high medical bills.
These practices are a reminder of an ongoing hole in the
Affordable Care Act, which has few provisions to effectively
curb price gouging, nurses say.
The ACA actually contains language permitting the IRS to
remove a hospital’s tax-exempt status if it tries to charge
patients who need financial aid more than the average amount
paid by insurers or Medicare, Stephen Brill reported in Time
in early December. But the Obama administration, he noted,
stalled on developing the needed rules, and with hospital
industry opposition, “no final rules have been issued.”
“The lesson here is that the critical work of real
healthcare reform is far from complete,” says Ross. “As long
as our health continues to be held hostage by hospitals and
other corporations more focused on profits than care,
Americans will be at risk.”
“Nurses will never stop fighting for transformation of our
inequitable healthcare system to one based on patient need
and quality care for all. The numbers for bankruptcy and
financial run from medical bills plummet at age 65 when
people qualify for Medicare. The best solution is to expand
and update Medicare to cover everyone, and take the
financing of healthcare out of the hands of the profiteers,”
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