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N.J. hospitals among highest billing, data show

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N.J. hospitals among highest billing, data show

JUNE 1, 2015, 11:09 PM    LAST UPDATED: MONDAY, JUNE 1, 2015, 11:12 PM
BY LINDY WASHBURN AND DAVE SHEINGOLD
STAFF WRITERS |
THE RECORD

Two for-profit Hudson County hospitals charge more than any other medical centers in the nation to treat patients for some of the most common diagnoses, according to Medicare data released Monday. One — CarePoint-Bayonne Medical Center — ranked as among the nation’s most expensive for the third year in a row.

The hospitals are owned by CarePoint Health, a group of three private investors that bought them at bankruptcy, stabilized their finances and invested in physical improvements. About 7 percent of the 300,000 patients treated at the chain — which also includes Christ Hospital in Jersey City and Hoboken University Medical Center — actually is billed those charges, according to CarePoint’s CEO, Dennis Kelly.

But that number is expected to climb as Christ Hospital on Monday ended its contract with Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurance plan, and will no longer accept Horizon’s in-network rates as payment in full.

The federal government’s release of the data was timely, as a New Jersey Assembly committee on Monday considered a proposed law to rein in so-called out-of-network fees charged to patients and insurers by hospitals and doctors who do not accept the contracted rates of some insurance plans.

Monday’s data release showed how much 3,000 hospitals nationwide charge Medicare — the government insurance program for those over 65 — for the 100 most common diagnoses. While Medicare pays only a fraction of those charges, the hospitals use those numbers as the basis for their out-of-network charges to insurers and patients.

The data show that Bayonne charged more than any other hospital in the country for 29 of the 100 most common diagnoses, and ranked in the top three for 45 of those diagnoses. Christ Hospital was in the top three for 15 of the 20 most common diagnoses.

Bayonne’s charges for treating heart failure, for example, averaged more than $197,000 — the highest in the country and more than 19 times Medicare’s average payment to the hospital of $10,350. Christ Hospital ranked fourth in the country for the same diagnosis, at $177,620.

In another example, Christ Hospital’s charge for treating a stroke averaged $173,000 — the highest in the country and nearly 17 times Medicare’s payment of $10,241. Bayonne’s charge was second-highest in the country, at $153,740. The data were based on Medicare patients treated in 2013.

Kelly, the CarePoint CEO, defended those bills. Without the ability to charge such rates, or to receive higher reimbursements from insurance networks, he said, “Our safety net hospitals risk closure. Being out-of-network is not a business strategy, it’s a survival strategy.”

The data also revealed the huge range of Medicare charges among New Jersey hospitals for various procedures, including hip or knee replacement surgery, the most common procedure analyzed.

At The Valley Hospital in Ridgewood and St. Joseph’s Regional Medical Center in Paterson for example, hospital charges for major joint-replacement surgery and related costs were just under $54,000 — only four times what Medicare paid those hospitals. At Hackensack University Medical Center, the charges were $70,387; at Englewood Hospital Medical Center, $82,864; and at CarePoint Bayonne Medical Center, $192,657. Meadowlands Hospital Medical Center in Secaucus did not have enough cases for the government to release its average.

https://www.northjersey.com/news/n-j-hospitals-among-highest-billing-data-show-1.1346911

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