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The Cost of a 3-Day Hospital Stay (a reader, January 7, 2008) Some holidays are better than others. This last Thanksgiving, I spent the holiday in the hospital. Medicare recently sent me the summary of the bills, and I thought you would be interested. I had gone to the Emergency Room about my left leg, which was swollen below the knee, red, and very warm to the touch. It was 4:00 am, and I thought I would just get a quick reassurance that it was nothing serious, and then go home and go back to bed. It didn’t work out that way. I was told that the most likely diagnosis was Deep Vein Thrombosis, the famous complication of tight airline seating. In other words, a blood clot in my leg. Of course, they couldn’t verify this without a test. The simplest would be an ultrasound, but that couldn’t be done until the next shift started at 9:00 am. After hours of staring at the walls in the ER, they finally did the test. It did show a blockage, and so they admitted me to the hospital. I was given two shots a day of blood thinner, a couple of pills, and no other treatment. I had a private room and the usual hospital meals. Nurses did blood pressure monitoring every few hours, and one blood test was done each day to see how the blood thinners were doing. After three days of this, they repeated the ultrasound, found the clot gone, and I was released. Guess how much all of this cost? Here are the items on Medicare bill. This does not include the three separate doctors who saw me, both in the hospital, and in the ER. We all know that many patients in the ER never pay (I think the percentage is about 50%.) I assume many inpatients never pay as well. The costs for this are added to the bills of paying patients, including Medicare patients. Fine. Someone has to pay. The thing I wonder is if hospitals even really know their own costs. You may scoff at the idea that they don’t, but think about it. If there were some secret internal accounting system that had the true cost, with another huge line item saying “charity care”, no insurance company or Medicare would pay that inflated cost. They’d want to pay the real cost as shown on that other set of books. This would bankrupt the hospital. Since this real number is so dangerous to have around, I wonder if the hospital even keeps it. I expect they push as much cost as possible into an “overhead” category, then distribute this as widely as possible over all their charges. The problem with this of course is that not knowing their own costs in detail makes it very hard for them to be cost efficient. It also removes a lot of the motivation to work on improvements, if none of it helps the bottom line of the hospital. Staff will resist any nickel and diming of their day to day activity, so perhaps they just shrug and overbill their paying customers and leave it at that. I can't wait to see what happens to this system when the boomers all start to pile onto it in four years or so! For more on a wide array of other topics, please visit the oftwominds.com weblog. 
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