An inaugural report by the New York Metropolis Well being Division aimed toward cracking down on sky-high costs hospitals cost sufferers has gaping holes in it as a result of the Huge Apple’s largest public-employee insurer refuses to show over information, officers mentioned.
The 263-page report quietly launched Friday by way of the company’s new Workplace of Healthcare Accountability says hospital costs are wildly inconsistent. The examine targeted on funds made by way of town’s well being care supplier, Anthem Blue Cross, and never private-sector insurance coverage.
Town’s GHI-Complete Advantages Plan by way of Anthem paid on common $45,150 for inpatient providers final fiscal yr at New York’s high 10 hospital techniques, the report mentioned.
at $92,727. Stephen Yang
The very best costs for full in-patient remedy have been at New York-Presbyterian ($92,727) and Montefiore Medical Middle ($83,573), whereas Stony Brook College Hospital was the bottom ($36,876).
The report famous town spent $3.3 billion paying for worker hospital care throughout the fiscal yr ending June 30, and half went to a few hospital techniques: Northwell Well being ($759 million), New York-Presbyterian ($485 million) and NYU Langone Well being ($443 million).
New York-Presbyterian had the best costs for 11 of 12 inpatient procedures analyzed and 14 of 27 outpatient procedures, the report mentioned.
Costs at hospital techniques ranged extensively, from $940 to $12,000 for a colonoscopy, and $7,000 to $58,000 for a cesarean-section supply.
And town is now spending extra on hospital outpatient care than inpatient.
The report cited Anthem — which town pays a whopping $3 billion yearly to supply insurance coverage to roughly 900,000 staff — for refusing to supply the OFA the total prices of well being care at hospitals and different knowledge it wants to find out whether or not these costs are warranted.
Anthem claimed releasing a few of the pricing knowledge would violate confidentiality agreements it has with hospitals that predate a 2021 federal rule requiring hospitals to reveal their costs to the general public.
Nevertheless, Councilwoman Julie Menin (D-Manhattan), who sponsored laws creating the first-of-its-kind well being care watchdog workplace in 2023, isn’t shopping for it.
“It’s a slap in the face to the City of New York when federal rules require hospital pricing be made public, but Anthem won’t comply with city law due to so-called ‘preexisting agreements,’” she mentioned. “This health care industry cat-and-mouse game is costing the city billions, and we need full transparency now.”
“It’s so distressing to see these prices,” added Menin. “It’s extremely high and is why we need price transparency. Why should New York City be paying so much for health care? It’s sickening and unsustainable.”
Town’s well being care insurance coverage contract is up later this yr, and town “must require full disclosure of pricing” to whoever will get it,” mentioned Menin. Anthem is among the many bidders for the brand new deal.
The Publish two years in the past reported on analyses by 32BJ SEIU, town’s building-services worker union, exhibiting the Huge Apple may save taxpayers as a lot as $2 billion yearly by auditing precisely how a lot municipal staff pay for care at varied hospitals and making suggestions on methods to decrease the costs.
Manny Pastreich, president of 32BJ, mentioned his union pushed exhausting to create the OFA however added it’s unlucky the “inaugural report is more noteworthy for what is missing.”
“It’s clear that hospitals and insurers are still exerting their influence to block sharing certain data the city needs to reverse the trend of exorbitant health care costs,” he mentioned.
The OFA was created largely to supply larger transparency to sufferers on prices of medical procedures at a non-public hospital vs. city-run medical services because it has the authority to publicly launch hospital pricing citywide. It operates with a $2 million price range and 15 staffers.
“Health insurance companies and New York City hospitals must remove arbitrary barriers to data access that would otherwise support transparent and equitable pricing of medical services,” mentioned Henry Garrido, government director of District Council 37, town’s largest municipal worker union.
“We must utilize every tool at our disposal to fight these unfair practices, including ensuring the Office of Healthcare Accountability is adequately staffed to fulfill its primary purpose of tackling disparity pricing that exploits the vulnerabilities of New Yorkers in need of care.”
Anthem reps didn’t instantly return messages.
