Hospital Procedure Costs

oregon health authority

The Oregon Health Authority released its annual Oregon Hospital Payment report as an online dashboard, which was updated with 2019 data. The report details the median amounts paid by commercial insurers for the most common inpatient and outpatient procedures performed in Oregon hospitals in 2019. The report details median prices on 115 procedures that account for over $1.2 billion in payments to hospitals. Among these procedures, 79 of the 115 saw increases in median prices, while 32 procedures saw prices fall and four stayed the same.

"While this is just one look at the ways that our health care system provides services and gets paid, it has deep relevance to patients, who may owe a significant portion of these amounts in the form of co-pays or deductibles," said Jeremy Vandehey, director of health policy and analytics. "Hospitals have many levers to reduce costs to meet our statewide cost growth target. But in the end, the cost growth target creates an imperative and call to action for the health system to reduce price increases and flatten the cost of health care to consumers."

The report shows that insurance companies pay hospitals widely varying amounts for the same procedures at individual hospitals, among different hospitals, and across the state as the dashboard's comparative features illustrate. For instance, the wide range is notable in these common procedures:

  • For inpatient hip replacement, 90% of the procedures ranged from $2,875 to $50,993, (with half falling between $24,744 and $37,508).
  • For normal delivery without complicating conditions, 90% of the procedures ranged from $4,768 to $15,267, (with half falling between $5,664 and $11,151).
  • For inpatient spinal fusion, 90% of the procedures ranged in price from $22,213 to $118,515, (with half falling between $41,605 and $75,752).

In 2019 the largest growth in median paid amount was for inpatient heart catheterization which rose $3,806 (20.7%) from 2018. Meanwhile the most expensive procedure was heart value replacement, with a median paid amount of $94,945, which is up 4.1% ($3,764) from 2018.

Other highlights of the report include:

  • Most procedures again show significant variation in paid amounts, both at individual hospitals and among hospitals.
  • Laboratory disease panels were the most frequently performed procedure, with 931,176 lab orders reported. This accounts for nearly half of all the procedures in this analysis.
  • The largest decrease was for inpatient shoulder replacements, which fell $4,933 (-12.9%) from 2018.
  • The largest percent decrease was in the newborn care with complications which fell 28.3% (-$1,157) from 2018.

The goal of the report is to provide transparency about hospital reimbursement and make information available to consumers. Users can click on interactive charts and graphs to see payment details by hospital for common hospital procedures. The dashboard also shows whether the amounts paid increased or decreased from 2018. New for the 2019 update is the inclusion of a sixth large category, Laboratory and Pathology, which includes median amounts paid for common laboratory tests and examinations of blood and tissue samples.

For more details on the 2019 Oregon Hospital Payment Report, visit the visit the visit the OHA Health Policy and Analytics website.

Source: Oregon Health Authority

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