RICHMOND, Va. - If you're going to break a leg, be careful where you do it. You might end up at a hospital that charges the uninsured as much as a 1,000 percent markup.

A list of the 50 hospitals with the highest price markups over actual costs is included in a new study published in Health Affairs. Ge Bai, the report's co-author and a certified public accountant, said some hospitals are marking up prices by an extraordinary amount for the same medical services.

"The hospitals are playing a price-gouging game," she said, "and this price gouging will trickle down to all consumers, whether you have insurance or not."

One of the hospitals named is the Southside Regional Medical Center in Petersburg, part of the Community Health Systems chain. The hospital pointed out that the study does not account for uncompensated care or reflect the price people actually pay.

The study found that hospitals are charging the uninsured, workers'-compensation and out-of-network patients more than 10 times the costs allowed by Medicare. Those are the patients with the least power to negotiate, said Bai, an assistant professor at Washington and Lee University, adding that people can't bargain when they're sick.

"So there's a big loophole in our hospital pricing system," she said, "and our policy makers need to understand that and step in, using their policy tools to help regulate hospital pricing and control overall health-care spending."

Since there is no regulation of hospital fees in most states and no market forces to compel hospitals to lower costs, Bai said, they charge higher prices because they can. The report also found that while for-profit hospitals represent only 30 percent of all hospitals in the United States, they account for 98 percent of hospitals with the highest markups.

The report abstract is online at content.healthaffairs.org.


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May is Lyme Disease Awareness Month and the latest state data show Wisconsin recently recorded the highest number of Lyme disease cases in state history.

Experts are urging residents to be mindful of the ticks carrying it as they become more active across the state. There are 16 confirmed tick species in Wisconsin and experts are focused on the "black-legged tick," or "deer tick," in the transmission of Lyme disease. Experts recommended taking preventive measures when spending time outdoors like wearing protective clothing and using insect repellent. They added you should perform tick checks and shower after any outdoor activity.

Dr. Xia Lee, public health entomologist at the Wisconsin Department of Health Services, said some ticks, especially younger ones, may be harder to spot.

"Those are usually the ones that we associate with a lot of the cases of Lyme disease or tick-borne diseases, most active in June and July," Lee explained. "This is also reflected in the number of people who go into the emergency department or go into the physician for tick bite-related illness."

The number of reported Lyme disease cases has tripled over the past 15 years, according to state data. Lee noted the Wisconsin Department of Health Services conducts surveillance and tracking of ticks for the public, including a tick identification service and a dashboard reporting ER visits for tick bites.

Deer ticks have spread from northwestern Wisconsin to every county in the state over the past 30 years. Experts said changes in land use, wildlife management and the environment have helped spread the disease.

PJ Liesch, entomologist at the University of Wisconsin-Madison, said the deer tick is a generalist feeder and can be found on many small mammals, in addition to deer. He added the increasing prevalence of the species has led to an emerging health threat.

"They are still spreading outwards," Liesch pointed out. "They seem to be moving into newer areas, in some cases that can be more like suburban backyards, areas where we haven't seen them historically. And they're still potentially expanding and we don't know when they are going to stop."

Liesch stressed if you are bitten by a tick in Wisconsin, there's about a 50-50 chance it is carrying Lyme disease. He emphasized the risk of Lyme disease transmission increases with the duration of tick attachment, which is why prevention and detection are so important.

"That's a pretty high rate of infectivity, kind of a scary number," Liesch acknowledged. "Even if you have a deer tick that is Lyme-positive, if you are checking yourself and making sure they are not attached to you for very long, that's going to greatly reduce the chances of transmission."

Some early symptoms of Lyme disease include fever, headache, fatigue, swollen lymph nodes, joint and muscle pain and a rash. If left untreated, more complicated conditions can develop.


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A new study showed in 2022, more than 240,000 hospitalizations in California could have been prevented with proper outpatient care.

Researchers said most of the patients had poorly-controlled chronic conditions like diabetes, heart disease or COPD.

Rhonda Smith, executive director of the California Black Health Network, which cosponsored the report, said her organization helps patients learn to advocate for themselves.

"I can tell you countless stories that we hear about patients who just are not listened to and then end up being hospitalized or misdiagnosed," Smith explained.

The report showed patients who rely on Medi-Cal or are Black, Native American, or English-language learners are affected the most. The report found the state could save $400 million a year if Medi-Cal members had the same rate of preventable hospitalizations as people with private insurance.

Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network, also a co-sponsor of the report, said the savings would help the state's taxpayers.

"Each preventable hospitalization has a significant cost to the system, and that's the cost that's ultimately borne by all of us, by all health care consumers," Savage-Sangwan emphasized. "We pay for our insurance right? Those rates are determined by how much money is being spent in hospitals, etc., and so it comes at a cost."

The report authors suggested policymakers resist calls to cut Medicaid nationally and to eliminate coverage for undocumented people in California. They also recommended hiring more culturally and linguistically responsive primary care physicians.

A new report from the Commonwealth Fund showed between 8,000 and 12,000 Kentuckians could lose their jobs as a result of the state implementing Medicaid work requirements, which would cause more people to lose health coverage.

Leighton Ku, professor of health policy and management at George Washington University and co-author of the report, said around half of job losses would occur in health care and the other half downstream, in other industries connected to hospitals and doctor's offices. He added many rural health care providers rely heavily on patients with Medicaid to operate, noting without the funds, they will have to make tough choices.

"Health care providers, they have to compensate for that by doing things like laying off staff and by buying less from people who they purchase things from," Ku pointed out. "Whether it's medical equipment or whether that's how they pay the rent for their space."

Rep. Brett Guthrie, R-Ky., heads the committee spearheading the effort to slash $880 billion in federal funding for Medicaid over the next decade. In a recent op-ed, Guthrie argued, "Washington can't afford to undermine the program further by subsidizing capable adults who choose not to work."

The Commonwealth ranks sixth-highest among states in its share of its population covered by Medicaid, according to the Kentucky Center for Economic Policy. Of the 435 congressional districts across the nation, four of Kentucky's rank within the top 100 for the largest share covered by Medicaid.

Ku stressed Kentucky should brace for a billion dollars in economic losses, if health care workers are laid off.

"Relatively speaking, the state of Kentucky gets hurt more than almost any other state in the country," Ku added.

This week, the American Association of American Medical Colleges expressed concern the cuts would limit coverage and access to care for many of the 70 million Americans, including those of its member hospitals, who account for 29% of all Medicaid inpatient days.


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