What hospitals charge vs. what's actually paid.
A hospital's charge and the amount it actually gets paid are almost two different currencies. The public records hold both, side by side, for each kind of hospital stay, what was charged, and what Medicare really paid. They're large enough that the gap usually stays a vague complaint. Asked properly, that gap becomes a precise number you can rank, by kind of stay and by hospital.
The charge and the payment are not the same number.
The records carry, for each hospital and each kind of stay, how many patients were treated, the average charge the hospital billed, the average total payment it received, and the average Medicare payment in particular. The gap between the charge and the payment is sitting right there, in columns next to each other. What's missing is a way to ask it at scale, across thousands of hospitals and hundreds of kinds of stay, rather than one line at a time.
Made easy to ask, the question is direct. You can work out how far the charge runs above the payment for the same kind of stay across hospitals, hold the kind of stay steady so the comparison is fair, and rank both the kinds of stay where the markup is steepest and the hospitals that charge furthest above what's paid, instead of treating the gap as a generic grievance.
Questions you can finally ask.
Each is a question you simply ask and get an answer to, not a three-week analysis project.
Which kinds of stay have the biggest charge-to-payment gap?
Rank kinds of stay by how far the average charge runs above the actual payment to find where billed and paid diverge most.
Which hospitals charge the most above what's paid?
Hold a kind of stay steady and rank hospitals by how far their charges run above the payment they actually receive.
How much does the payment vary for the same stay?
Compare the actual payments for one kind of stay across hospitals to see the spread in what's paid for identical work.
Where do high charges not change the payment?
Show that for a given kind of stay, wildly different charges still map to similar payments, the clearest evidence charges aren't real prices.
Which kinds of stay drive the most spending?
Rank kinds of stay by how many patients and total dollars they involve, to see where the hospital spending concentrates.
How does the gap vary by region?
Compare the charge-to-payment gap for the same kind of stay across regions to see where charging practices diverge most.
What the answer pulls together.
Each hospital and kind of stay
A line for each hospital and kind of stay, so charges and payments are comparable hospital to hospital for the same kind of admission.
How many patients
How many patients each hospital treated for each kind of stay, the volume that turns an average gap into a real dollar total.
What was charged and paid
The average charge, the average total payment, and the average Medicare payment, the three figures that define the gap.
A hospital's charge and what's actually paid sit in columns next to each other, and they barely relate. The gap was always there, nobody just put a number on it at scale. So I did.
What people ask about this.
Does a big gap mean a hospital is gouging?
Not on its own, hospital charges are list figures that few payers ever pay in full, and Medicare's payment is set by rule, so a wide gap is partly just how the system works. What you get is which kinds of stay and which hospitals run furthest from the payment, which is where the question of why becomes worth asking. It's a way to find the outliers, not to convict them.
Why compare by kind of stay instead of overall?
Because the mix of cases would otherwise make the comparison meaningless, a hospital that handles more complex stays will look more expensive on raw totals for reasons that have nothing to do with its charging. Holding the kind of stay steady lets charge and payment vary on a like-for-like basis. That's what makes the spread across hospitals meaningful rather than an artifact of who treats whom.
How current is the answer?
It stays current on its own. When new information is published, it's already in there, so you're asking against today's picture, not a year-old extract.
Want this measured
for your hospitals?
Whether you're a payer, an employer, or a hospital sizing yourself up, I can get you the exact charge-versus-payment answer you care about.