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How New York Hospitals Charge the Mostto Those Least Able to PayMarch 2006
Public Policy and Education Fund of New York
Hospital Bill
 __________________________________ 
You owe $55,243.00 forappendectomy*
*But HMOs only pay $2,500.00
Wall Street Journal 
3/17/03
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The Great Hospital Heist page 1
The Great Hospital Heist:
How New York Hospitals Charge the Mostto those Least Able to Pay
Introduction
This report draws on data from the New York State Department of Health to calculate theamount that hospitals in New York overcharge uninsured patients and other patients who areunable to pay their full hospital bills. “Overcharges,” as used in this report, are the amounts thatthe hospital charges greater than the reasonable cost of providing care, according to thehospitals’ own reporting to the New York State Health Department.Hospitals in New York and around the country establish a charge rate, comparable to alist price, for hospital services. However, very few of a hospital’s patients ever pay the chargerate. As a spokesperson for the American Hospital Association explained on the CBS news show
60 Minutes
on Sunday March 5
th
, 2006, “Actually, what hospitals charge for a service is thesame for everybody, whether they have insurance or not. What’s confusing for everybody is thatwhat a person ends up paying in this country can be very different.”Medicaid, Medicare, and most private insurance plans actually pay rates that aresignificant discounts off the charge rate. Insurance companies negotiate the discount withhospitals. Medicare pays hospitals at rates established under federal law and Medicaid pays ratesestablished under New York State law.The only patients who are expected to pay the charge rate are uninsured patients and thefew patients who are covered by insurance plans that have not negotiated a hospital discount.These patients are generally known as “self-pay” patients.Hospitals in New York are required to report the total amounts they charge for inpatientand outpatient care to the New York State Department of Health (DOH). Hospitals are alsorequired to report the reasonable cost of providing care for purposes of calculating Medicaidrates. Using this information, DOH calculates a conversion factor for each hospital, which is theratio of cost to charges.
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The Great Hospital Heist page 2Hospitals in New York receive $847 million annually from the State to compensate themfor bills that have not been paid by patients. These funds are generally referred to as ‘bad-debtand charity care’ funds or BD&CC. Inpatient and outpatient BD&CC charges are accounted forseparately. In order to calculate how much each hospital is due from the BD&CC fund, hospitalsreport to the Department of Health the total amount of hospital charges for which the hospital didnot receive payment. Bad debt is defined as amounts that are considered “uncollectible”. If anamount previously written off is later collected, it is reduced from bad-debt in future reports.Charity care, which is called “free care” in the DOH data, is the reduction in charges madebecause “the patient is indigent or medically indigent.” (Note: “Courtesy” discountsto physicians, employees, hospital board members, etc. cannot be charged to BD&CC
.
)
1
 The Department of Health applies the individual hospital conversion ratio to thathospital’s total BD&CC charges to calculate the actual cost to that hospital for providingBD&CC. A complicated formula is then used to distribute the $847 million – the formula andamount are set by legislation – from the BD&CC pool fund to the individual hospitals; the funddoes not cover the full cost of BD&CC for most hospitals.This report uses the DOH data on BD&CC charges and costs to calculate the aggregateamount that hospitals charge in excess of the actual cost of providing care to patients who areuninsured or can’t afford to pay their bills. We call these amounts, ‘overcharges.’
Findings
The Public Policy and Education fund of New York (PPEF) analyzed the data reported by210 hospitals throughout to the New York State Department of Health for 2003, the most recentyear for which data were available. Based on these data, there are a number of findings aboutovercharges to self-pay patients in New York.INPATIENT OVERCHARGE RATE
!
On average, New York State hospitals charge self-pay patients 2.3 times more than thecost of providing inpatient care.
The cost of providing care is only 43% of the amountcharged for inpatient care.
!
The inpatient overcharge rate varies dramatically among hospitals.
o
Parkway Hospital, one of only two for-profit general hospitals reporting to theDepartment of Health, had the highest overcharge rate for inpatient care, chargingpatients 7.3 times the cost of providing care.
o
9 hospitals charged more than 4 times the cost of providing inpatient care.
1
NYCRR Title 10, Section 86-1.11(g)(1)(i)(a &b)
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