Hospital Consumer Assist - Questions and Answers

Look up a report about an Arkansas hospital

QUESTIONS & ANSWERS

Frequently asked questions

What is Hospital Consumer Assist?
Hospital Consumer Assist is a consumer-friendly website that provides useful quality and pricing information on Arkansas hospitals to serve as a factual starting point for more informed discussion with your hospital, physician or insurance company.

Why would I need this information? How is it useful to me?
This information is useful to provide facts about hospitals when you need healthcare services, if you are new to the area or if you are choosing a new health care plan. Hospital Consumer Assist provides:

Pricing data on the most common hospital inpatient services
Quality data on surgical infections and the most common causes of hospitalization: heart attack, congestive heart failure and pneumonia
Profile information, utilization statistics, services offered and contact numbers for hospitals

Where did this information and data come from?
All the data on this website was collected by the American Hospital Directory, an independent source, and was not modified in any way.

Where does the individual hospital data come from?
The pricing information comes from Hospital Discharge Data obtained from the Arkansas Department of Health Center for Health Statistics. The quality information comes from Hospital Quality Alliance data, which is also located on the Hospital Compare website at www.hospitalcompare.hhs.gov. Profile information is maintained by American Hospital Directory from various public and private sources including Medicare cost reports and MedPAR claims data.

What's the difference between charges and costs?
The amount a facility bills for a patient's care is known as the charge. This is not the same as the actual cost or amount paid for the care. The amount collected by a health care facility for each service is almost always less than the amount billed. There are three common examples:

Government programs such as Medicare and Medicaid typically pay health care providers much less than the billed charge. These payments are determined by government agencies. Hospitals have no ability to negotiate reimbursement rates for government-paid services.
Commercial insurers or other purchasers of health care services usually negotiate discounts with health care facilities on behalf of the patients they represent.
Hospitals typically have policies that allow low-income persons to receive reduced-charge or free care.

Negotiations between hospitals and payers generally begin with the charge amount. While each facility's charge structure may vary in important ways, charges represent a consistent, though imperfect, way to compare health care costs.

Why are charges different among hospitals?
There are many reasons that charges may differ among hospitals. These include:

Payer mix - A hospital's charges are largely a function of operating costs and the amount of services for which payments do not cover the associated costs. As a result, a hospital with a high percentage of patients covered by Medicare and Medicaid – both programs typically pay less than the cost of services – must set their charges high enough to recover a greater percentage of their operational costs from privately insured and self-pay patients through higher charges. Also, patients with inadequate or no health insurance who cannot afford to pay for the services they receive contribute dramatically to higher hospital charges. As the number of under- and uninsured patients continues to increase, a hospital is forced to continue raising its charges.
Comparability of billing - The amount included in charges may not be comparable from hospital to hospital. For example, some payers may require the hospital to combine the care for a mother and newborn on the same bill as part of a delivery charge. Other payers may want the charges to be billed separately, translating into a lower charge per discharge. Similarly, charges for hospitals where physician fees are included in the bill will be higher than for hospitals where the fees are not included.
Individual physician judgment - The manner in which a physician chooses to treat a patient, based on education, experience and patient needs, can and does influence treatment decisions and total charges.
Outlier cases - Hospital prices can vary based on patient needs, the services they receive and the resources they use. If a hospital cares for patients who develop co-morbidities and complications which cause considerably longer hospital stays than average for typical patients admitted with the same condition, overall prices will be affected. These "catastrophic" illnesses have a heavy weight on a hospital's "average" price for the DRG when compared with other hospitals.

Why do some hospitals reports contain partial or no data?
The Inpatient Pricing report details the 40 services representing the highest charges among Arkansas hospitals. Because of this, hospitals that specialize in a particular type of care, (e.g. psychiatric, long term acute care, rehabilitation, and children's hospitals) do not provide all of the most common services. Some smaller hospitals (i.e. rural and critical access hospitals) may only perform a few of the most common services.

What if I don't know the meaning of a term used on this website?
Visit the definitions page on this website.

What if I can't find my hospital?
First check to make sure you spelled the name of the facility correctly. If you did and the hospital still did not show up, try broadening your search by county.

What is the Hospital's Charge Range? Is this how much I will pay?
Because there are so many variables that factor into the cost of a particular service and every patient represents a unique case, charge ranges are displayed to provide a reasonable estimate on what it might cost for a particular service. The charge range is a summary of average charges based on actual billing information during a recent twelve-month period. Average hospital charges for a service are calculated as well as the "Higher" and "Lower" ends of the range representing about 68% of all patients. (Statistically, this is referred to as +/- one standard deviation from the mean.) These ranges are provided for comparison purposes only. Always remember that the charge for your services will be based on individual circumstances surrounding your treatment, your insurance deductibles and co-pays, and your ability to pay. For specific information on your cost estimate, please contact your healthcare provider and/or insurance company directly.

What if I have insurance?
Commercial insurers usually do not pay hospital charges, but negotiate discounts with hospitals on behalf of the patients they represent. These negotiated discounts vary among commercial insurers. Furthermore, numerous factors, such as the type of plan, the co-pay amount, the co-insurance amount, deductible, out-of-pocket maximums and other limitations will affect the individual's financial responsibility to a hospital. Therefore, it is crucial that you begin by talking to your insurance company to understand all of the factors affecting your financial responsibility.

What if I have Medicaid?
Medicaid does not pay hospital charges, but pays hospitals in accordance with a set per diem rate that represents a significant discount from hospital billed charges. Arkansas Medicaid recipients are responsible for 10 percent of the per diem for the first day of a period of hospitalization.

What if I have Medicare?
Medicare does not pay hospital charges. Medicare pays hospitals based on the patient's diagnosis at the time of admission. Similar diagnoses are grouped together under – diagnosis-related groups, or DRGs. The amount Medicare pays the hospital is predetermined, depending on the rate for a given DRG, which generally represents a discount from the hospital's billed charges. Medicare will pay for many of your healthcare expenses, but not all of them. There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse.

The best information on the Medicare Program is the Medicare Handbook. This booklet explains how the Medicare program works and what your benefits are. To order a free copy, write to: Health Care Financing Administration, Publications, N1-26-27, 7500 Security Blvd., Baltimore, MD 21244-1850. You can also contact your local Social Security office for information.

What are Diagnosis Related Groups (DRGs)?
DRGs were developed for Medicare as a means of relating injuries and illnesses a hospital treats to the costs incurred by the hospital. This system groups the thousands of existing treatments and procedures into similar categories of diseases and diagnoses. The Inpatient Pricing report is based on DRGs and the DRG number appears in parenthesis for each service reported.

What if I do not have insurance?
For patients who do not have insurance, hospitals typically have financial assistance programs for patients who qualify. Contact your hospital to determine if you qualify for any programs they may offer.

Why are only the 40 most frequent diagnoses at each facility displayed?
The Inpatient Pricing report lists the 40 services with highest total inpatient charges for all Arkansas hospitals during calendar year 2006. The 40 services reported represent half of total charges.

What is Medicaid?
Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources.

What is Medicare?
Medicare is a health insurance program for people age 65 or older or under 65 years of age with certain disabilities, or End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).