National Nurses United

But while reporting high hospital charges, hospitals routinely claim that such outlandish pricing practices are random, or that the charges don't matter, or that the hospitals are just innocent victims in how high they set their prices. But in the years IHSP has tracked and analyzed the data, it has become clear that the charges are far from random, and major trends repeat over and over, year in and year out (see sidebar). Nurses, of course, are used to dissem- bling by the hospitals, and these efforts to rationalize price gouging register high on the whopper chart. Hospitals claim the charges mean little because Medicare and Medicaid set reim- bursements they will pay, and insurers nego- tiate rates below the list price. But the higher the starting charge, the more the insurer will end up paying. Then the profit- focused insurers, of course, just pass along their higher costs to employers, who shift the burden to employees in the form of higher co- insurance, deductibles, co-pays, and other out- of-pocket costs, or to individual ratepayers. Then there's the uninsured, who typically get billed at full list prices. Hospitals may write off the bill, so they can boast how much they supposedly provide in uncom- pensated care or "bad debt" after inflating the prices. Or they demand payment up front, or turn the patient over to bill collec- tors afterwards. In a 2005 Lewin Group study of hospital pricing practices for the Medicare Payment Advisory Commission, several hospital exec- utives let the truth escape. "Our key goal is to help the hospital meet its profitability and cash flow needs," said one. "Our price updates focus on areas that give us the biggest bang for the buck," said another. Nurses know as well the terrible impact of high charges. As NNU Co-President Jean Ross, RN told ABC's Lupkin, patients often pay for it with their health by skimping on care. "If you are presented with a bill, and you know that bill is something you can't afford, you're not going to go in," Ross said. "The first question—instead of triaging their physical and mental state—is not how ill you are, but what kind of insurance you have," Ross said. "That never was asked before, not when I started nursing. That didn't come up as a question, nor should it." Most RNs can cite similar experiences, patients delaying even life-prolonging treat- ment, such as chemotherapy, or cutting pills in half, or not going for the diagnostic test recom- mended by their doctor. Or paying the high costs and cutting back on other family necessi- ties, like shelter or food. Or facing bankruptcy due to medical bills, still the number one cause of personal bankruptcy in the United States. A Commonwealth Fund study released in November 2013 comparing 11 developed nations found that U.S. adults are the most likely to forego medical treatment due to cost and spend the most out of pocket on care. More than a third, 37 percent of U.S. adults, chose not to see a doctor, follow up with recommended treatment or filled prescriptions due to high cost, compared to just 4 percent of respondents in the United Kingdom. The difference? The UK has a national healthcare system which effectively controls cost—and does not exclude anyone. —Charles Idelson J A N U A R Y | F E B R U A R Y 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 7 TRENDS THE IHSP HOSPITAL CHARGE DATA SHOWS •The more hospitals charge, the more they get back in payments. •Hospitals that charge the most have the biggest profits. •Highest charges are set the highest by large corporate chains, especially the for-profit hospital systems. •Lowest charges are found at publicly run hospitals, those operated by state, county, or local governments. Not coincidentally these are the hospitals that more often have the most disclosure of their budgets, hold public meetings, and have boards that can be elected and unelected. •As a result of failure to crack down on the abuse, charges continue to skyrocket. Hospital charges in the most recent year, 2011-2012, increased by 22 percent over 2010-2011, the single largest increase since IHSP began tracking the publicly available data. WHAT SHOULD BE DONE ABOUT HIGH CHARGES •Tougher regulation on price gouging by hospitals, and on other health- care industry sectors that inflate prices, including pharmaceutical, insurance companies, medical device manufacturers, medical labs, nursing homes. •Greater public disclosure on pricing practices. •A crack down on non-profit hospitals that abuse their tax exempt status by inflating prices while providing little in return in charity care. A provision in the Affordable Care Act would allow the repeal of tax- exempt status for non-profits that engage in price gouging but it has never been enforced due in part to hospital industry lobbying. •Increased support for public hospitals, which have the lowest charges over cost and the most public oversight and accountability, yet face cut after cut in public budgets. •Transformation of our healthcare system from a profit-driven industry to one based on patient need with a uniform standard of excellent care and effective public controls of pricing practices. The best way approach, expanding and improving Medicare to cover everyone. price gouging

• Cover