In 2013, the most common reason for a Medicare beneficiary to be admitted to one of CoxHealth’s hospitals in Springfield — and the second-most common reason for admission to Mercy Springfield — was code 871.
That’s the shortcut name for a particular treatment for septicemia or severe sepsis, or infection of the blood.
The list price for that treatment at Mercy that year was $43,630.99.
That’s 24.3 percent higher than the list price at CoxHealth that year — $35,100.38.
And the gap between the two predominant local health care systems was larger for some procedures. Code 207 — respiratory system diagnosis with more than 96 hours of ventilator support — had a list price of $101,901 at CoxHealth, compared to $179,127.88 at Mercy.
In general, the list price for the most common procedures tends to be higher at Mercy Springfield than rival CoxHealth, according to a News-Leader review of Medicare payment data released earlier this month. But list prices at both fall tend to be below state and national averages.
The data was released by the Centers for Medicare and Medicaid Services for the third straight year in an effort to increase transparency, according to the Obama administration.
The combined sticker price for 95 of the 100 most frequently-billed discharges adds up to $3.53 million at Mercy, 14.6 percent higher than CoxHealth’s total of $3.08 million. Mercy has the higher list price for 68 procedures, with Cox higher for 27. (Five discharges don’t have data from both health systems, due to a limited number billed at one or both).
A News-Leader reporter requested comment from Mercy and CoxHealth regarding the data and the findings on Monday. Spokeswomen for the two systems separately responded Friday afternoon, and recommended contacting the Missouri Hospital Association.
“Missouri Hospital Association is probably the best agency to explain the data you’re trying to understand,” CoxHealth spokeswoman Michelle Leroux said in an email. “As for the public it’s always a good idea for them to find out from their payer (insurance company) what the company will charge them for specific procedures or how much is covered by their insurance company.”
The hospital association’s vice president for media relations did not immediately respond to a message requesting comment.
Most people don’t pay hospitals’ list price, as a result of having Medicare or private insurance; insurance companies typically negotiate with health systems and pay a lower price. But list prices can still directly affect the uninsured — although those individuals are often candidates for financial assistance — and also can affect those using hospitals outside their insurance network.
The latter might become more common than it has been.
Gordon Kinne, president and owner of Springfield-based employee benefits company Med-Pay, said Wednesday that insurance companies have taken plans in diverging directions in recent years. Some more expensive plans being offered have a larger network than commonly seen in the past, sometimes with multiple tiers of coverage. But other plans, often being offered to cost-conscious customers through federal and state exchanges, have a narrower range of hospitals and doctors included, allowing for lower monthly premiums.
“Any source that provides transparency in procedure pricing is a valuable tool for consumers to have,” Kinne told the News-Leader.
And for those with private insurance, the list prices “at least give the consumer an indication of what the insurance company is going to pay,” Kinne said.
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