Charges from Maine hospitals for the same procedures – from treating pneumonia to bringing you back after heart failure – vary by thousands of dollars depending on where you go.

People hospitalized for pneumonia without complications were charged anywhere from $11,000 to a low of around $4,400, based on average charges from the state’s 36 hospitals for 2002 – the latest comparable data available. Out-patient procedures also varied. One of the most common – mammography – ranged from $52 to a high of $186. For a full list of charges by hospital go to the Maine Health Data Organization’s Web site, www.healthweb.state.me.us.

Average hospital charges have become an issue as the state tries to find ways to reduce hospital costs. The idea is if patients see that charges vary among facilities, they will shop around, or at least ask more questions.

“People have to check their bills, ask questions and get involved about why the prices are what they are. Why are they so different?” said Trish Riley, head of the governor’s Office of Health Policy and Finance.

Under the Dirigo Health legislation passed in 2003, hospitals are supposed to have public price lists for the most common procedures and a rule change will make them more uniform and easier to read in 2006.

Patients also have the right to ask what they will likely end up paying for treatment, which on average is 14 percent lower than the listed charge.

“The only people that pay the highest price are the uninsured,” said Alan Prysunka, executive director of the Maine Health Data Organization, which tracks hospital charges and costs for the state.

Insurance companies negotiate lower prices for the rest of us, and those too vary, since separate deals are made with each hospital. Hospitals and insurance companies do not have to reveal the specifics of those deals because the state has agreed they are proprietary information.

Starting this fall, Prysunka said, Maine will become the first state in the nation to actually post average amounts paid by patients versus the charges, which at least will show people the aggregate discounts that have been negotiated.

Hospitals agree the public has a right to know what they’re in for before they go in for a procedure.

“Given the increase in high deductible policies, it’s a necessity that we make available information around average procedure charges,” said Mary Mayhew of the Maine Hospital Association.

What is being debated are why the charges differ so much and what drives the costs.

Mayhew says it’s because the government doesn’t pay enough through Medicaid and Medicare to cover hospital costs, and, in Maine’s case, the state is behind on promised payments by millions of dollars.

“Because the government payers fail to cover the costs of caring for their beneficiaries, the cost shifting that occurs creates all these disparities from one facility to another,” she said, particularly for hospitals that run nursing homes and pediatric care facilities. Both attract a high number of Medicaid patients.

The cost shift is often on out-patient procedures, where the majority of patients are privately insured. Medicaid and Medicare patients account for 70 percent or more of days of inpatient care, ranging from a low of 59 percent for Maine Medical Center in Portland to 84 percent at Redington-Fairview General Hospital in Skowhegan.

Riley said there isn’t a direct correlation between a high-volume of Medicaid patients and higher costs, and other things like the number of procedures a hospital does come into play.

“We have our suspicions. I don’t think we have a lot of facts,” around everything that drives costs, Riley said. Part of it, she said, is pure efficiency. “Volume matters,” so you would expect a hospital that does a lot of the same procedure to have a lower cost. “Arguably there are things some of the hospitals shouldn’t be doing,” she said.

Prysunka of Maine Health Data doubts that people will choose hospitals based on cost.

For the insured, price often gives way to perceived quality of care, at least for serious problems.

“If you develop cancer…in a way price goes out the window,” Prysunka said.

And, for the uninsured, the option often taken is to do without.

“If you don’t have any insurance, you’re not going to be shopping around for heart surgery,” he said.