ND among lowest in Medicare hospital billings

FARGO -- North Dakota ranks among the bottom three states in Medicare hospital billings, according to data made public Wednesday in an effort to invite cost comparisons.

FARGO -- North Dakota ranks among the bottom three states in Medicare hospital billings, according to data made public Wednesday in an effort to invite cost comparisons.

The Center for Medicare Services released the data concerning the 100 most common types of cases, available to the public online, as part of efforts to make health care more affordable and accountable.

A ranking of the data by Sen. Max Baucus, D-Mont., showed that Idaho, Montana and North Dakota were clustered at the bottom of charges.

In Fargo, Medicare data showed modest differences between Sanford Health and Essentia Health in charges for five of the most common types of cases.

Representatives of North Dakota hospitals said the figures are the latest in a long series of reports that show the state provides health care that is among the most affordable and highest quality in the nation.


"We've been talking about this for years," said Jerry Jurena, president of the North Dakota Hospital Association. The association and North Dakota congressional delegation have been highlighting the gaping differences in cost for more than a decade, he said.

Because North Dakota combines some of the lowest costs and best results, "It's the best value for the buck," Jurena said. "Our contention is that North Dakota has got it right."

A Medicare report released with the data showed huge variations in hospital charges. A joint replacement charge, for instance, could range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.

In some areas of the country, charges can vary significantly even among hospitals located near each other. In Denver, for example, the average charge to treat heart failure ranged from $21,000 to $46,000.

The newest figures are the latest indication that health costs in the Upper Midwest are among the lowest in the country, a Sanford Health executive said.

It's unclear whether health consumers comparison-shop for hospital services, Jurena said. Most go where their doctor has privileges. Or, in the case of emergency services, they often go to the nearest hospital.

In North Dakota, only two cities have two hospitals, Fargo and Bismarck.

Comparison shopping for hospital services might be more common in major metropolitan areas, Jurena said.


Also, as the comparisons show, there is a huge gap between what hospitals bill for services and what Medicare pays. The difference often is made up from other payers.

Therefore, the Medicare comparisons are of limited use to consumers, said Ruth Krystopolski, president of the Sanford Health Plan.

Still, the comparisons do show that North Dakota and other Upper Midwest states, including South Dakota and Minnesota, offer some of the best value in health services, she said.

"The value we provide for our services is excellent," she said.

A review of four common hospital cases, including insertion of a pacemaker and major joint replacement, shows that average billings from Sanford and Essentia in Fargo range from 50 percent to 70 percent of the national average.

North Dakota providers are frustrated that their Medicare payments are much lower than most areas of the country.

Perhaps, Jurena and Krystopolski said, national publicity about the huge geographical differences in hospital charges will drive policies to change that.

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