The Centers for Medicare and Medicaid Services (CMS) unveiled price data today for more than 3,000 U.S. hospitals, revealing large price variations between hospitals around the nation, including in Cincinnati. For treating chest pain, charges from three Cincinnati hospitals varied by thousands of dollars: Bethesda North charged on average $17,696, Christ Hospital charged $12,000 and University Hospital charged $10,130. But the initial charge seems to have little relation to what Medicare ultimately paid out. In the three cases for chest pain, Medicare on average paid $3,242 to Bethesda North, $3,657 to Christ Hospital and $5,463 to University Hospital. In other words, University Hospital charged about 57 percent of what Bethesda North charged, but University Hospital was ultimately paid 68 percent more. The price variation wasn’t exclusive to chest pain, either. For major joint replacement or reattachment of a lower extremity without major complications, Bethesda North charged $61,947 and was paid $12,712 on average, Jewish Hospital charged $38,465 and was paid $14,069 on average and University Hospital charged $46,463 and was paid $20,116 on average. In fact, all of the 100 metrics tracked by CMS had at least some degree of variation in charges and payments. Whether it was chest pain, joint replacement, diabetes or cardiovascular complications, prices always varied between hospitals — sometimes greatly, other times by a little. The data from fiscal year 2011 shows how much hospitals initially charged Medicare for the 100 most frequently billed discharges and how much Medicare ultimately paid out. The difference between charges and payments is usually large because Medicare negotiates prices down. CMS says the price discrepancy is happening at hospitals all around the nation: “As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.” Still, some health care advocacy groups say Ohio is doing worse than other states. A study from Catalyst for Payment Reform and the Health Care Incentives Improvement Institute gave Ohio and six other states a “D” for health care price transparency, based on the states’ laws and regulations. That was actually better than 29 other states, which flat-out flunked with an “F.” Only New Hampshire and Massachusetts received an “A,” the highest grade possible. Even then, the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute cautioned in the study that their grades were given on a curve, which means all states would likely fare worse if the organizations measured them based on ideals instead of comparatively. Many health care experts and advocacy groups claim the price variation is caused by a lack of transparency in the health care system, which gives hospitals free reign to charge without typical market checks (“Healthy Discussion,” issue of April 10).

City Council will vote today on the controversial plan to lease Cincinnati’s parking assets to the Port of Greater Cincinnati Development Authority. The plan would give up some control over the city’s parking meters and garages to generate revenue to fund downtown development projects and help balance the deficit for the next two years. Before the City Council vote, City Manager Milton Dohoney Jr. will hold a presentation on solving Cincinnati’s long-term structural deficit problems, which Councilwoman Laure Quinlivan said was a remaining concern even if the parking plan passed. CityBeat previously covered the parking plan here, the city manager’s and John Cranley’s alternatives here, Councilman Chris Seelbach’s alternative here and the Budget and Finance Committee vote on the plan here. Hospital groups are telling lawmakers that the Medicaid expansion is “necessary” to preserve facilities that will face big cuts in the next year. Under the Affordable Care Act (“Obamacare”), hospitals will lose funding from the federal government, but the cuts were supposed to be made up with the prospect of more customers. If the state doesn’t expand Medicaid, the hospitals will still lose funding, and they won’t get many of their potential new customers. As part of Obamacare, the federal government is carrying the full cost of the expansion for the first three years. After that, the federal government’s share is brought down to 95 percent and ultimately phased down to 90 percent. By some estimates, the Medicaid expansion would save Ohio money by shifting costs from the state to the federal government and generate more revenue through increased economic security. Gov. John Kasich suggested the expansion in his budget proposal, which CityBeat covered here. Cincinnati and cities all around the nation are facing new federal requirements to update sewer systems to better handle stormwater runoff, which can mix with sewage and spill into rivers. Tony Parrott, executive director of the Metropolitan Sewer District (MSD), says his agency has developed software to prioritize upgrade projects and make them more efficient. CityBeat previously covered some of MSD’s efforts here. A bill sponsored by Ohio Sen. Bill Seitz, a Cincinnati Republican, would limit the window for collecting additional signatures for a state ballot initiative to 10 days if the secretary of state deems the initial petition signatures short of minimum requirements. Seitz says the bill will eliminate a loophole that allows politically motivated petitioners to extend and abuse the state’s petitioning process, and Secretary of State Jon Husted says the bill “is on the right track.” Opponents are calling the bill “punitive” and saying it will weaken Ohioans’ rights to take up ballot initiatives and referendums. Supporters of Internet sweepstakes parlors are saying that a state ban on the establishments would be unconstitutional and would potentially face litigation. Luther Liggett, an attorney representing Internet Sweepstakes Association of Ohio, said a Toledo appeals court ruling found Internet cafe games are not gambling because the outcome is predetermined. He also said a ban would violate constitutional protections against retroactively negating contracts, which internet cafes hold with employees, real estate owners and computer vendors. Greater Cincinnati Walmart stores are installing rooftop solar panels as part of the retailer’s nationwide green initiative to completely power all its stores with renewable energy. The arrays on 12 Ohio Walmart stores will generate enough electricity to power 820 homes year-round and eliminate carbon dioxide emissions equivalent to the output of 1,152 cars. The University of Cincinnati could get $30 million as a result of the reported settlement with seven schools breaking away from the Big East to form their own non-football conference. The average American severely underestimates how bad wealth inequality is, according to a YouTube video that went viral over the weekend. If the inequality trend is truly downplayed, that could have bad repercussions for Ohio: A previous report from the left-leaning Center on Budget and Policy Priorities found Ohio’s income gap — the income difference between the rich and poor — is wide and growing, and low-income and middle-income Ohioans have actually seen their incomes drop since the 1990s. How did you fare in the aftermath of the winter storm yesterday? Some southwest Ohio areas were reporting widespread power outages. Indiana lawmakers are considering changes to their state’s casinos to make them more competitive with Cincinnati’s newly opened Horseshoe Casino and other Ohio establishments. The Indiana Senate already passed a bill that would allow riverboat casinos to move on shore and racinos to replace electronic game tables with live dealers. The bill is now going to the Indiana House for approval. A gay couple was kicked out of a California mall for holding hands and kissing. Apparently, the security officer who kicked the couple out paid very close attention to the make-out session; in a recording, the officer said that he counted the couple kissing 25 times. A new study suggested Europa, Jupiter’s moon, could have salt water on its surface, which would be good for potential extraterrestrial life.