Have a heart attack in Ogdensburg, N.Y., and it’ll cost $15,087 on average. But if you are treated in Valley Regional Medical Center in Brownsville, Texas, the bill will be nearly $66,000.

The federal government, for the first time, has published the prices charged by thousands of different U.S. hospitals, and the numbers confirm what health reform advocates have been screaming about for years: The charges vary enormously, and for seemingly unclear reasons.

"These rates can vary dramatically in ways that can’t be easily explained," Health and Human Services Secretary Kathleen Sebelius told reporters in a telephone briefing. "Even within cities there can be massive variation in what consumers pay."

But the hospital industry said the prices were misleading and don't reflect what the government or insurers actually pay.

What the Obama administration hopes is that publishing these prices will help force health care providers to be more consistent in their billing. It’s called transparency, and experts say a lack of price information is one of the single biggest forces that has driven up health care costs in the United States.

“Hospital pricing is the craziest of crazy quilts. Prices are wildly different from one community to another; they are inexplicably and enormously different among hospitals in the same cities,” says Ron Pollack, executive director of the consumer health organization Families USA.

“Most perniciously, uninsured people are the ones who usually pay the highest prices for their hospital care. It is absurd – and, indeed, unconscionable – that the people least capable of paying for their hospital care bear the largest, and often unaffordable, cost burdens.”

The data uses billing information for the 100 most common hospital stays paid for by Medicare, from chronic obstructive pulmonary disease – mostly emphysema – to heart attacks, hip replacements and diabetes. The prices only cover Medicare, the federal health insurance plan for the elderly. Private insurers are often charged different prices, and people who pay cash are usually charged even more.

For treating acute myocardial infarctions -- heart attacks -- the costs ranged considerably, even within the same state. At Kingsbrook Jewish Medical Center in Brooklyn, N.Y., the average cost was $58,657, the data shows. Just across town, at Bellevue Hospital in Manhattan, the average was $38,514. Upstate at Crouse Hospital in Syracuse, N.Y., the cost was just $21,526.

Even in small states the cost varies widely. In South Carolina, Trident Regional Medical Center in North Charleston billed $59,059 on average to treat 26 heart attack cases in 2011. Aiken Regional Medical Center billed $36,895.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Sebelius said. “This data and new data centers will help fill that gap.”

The Centers for Medicare and Medicaid Services data show cost charges to treat a patient with heart failure ranged from $21,000 to $46,000 in Denver, Colo., and from $9,000 to of $51,000 in Jackson, Miss. 

"Making this available for free for the first time will save consumers money by arming them with information that can help them make better choices," Sebelius said. But the prices may not reflect what a patient's insurer pays and the database does not easily allow consumers to compare the price of a procedure from one hospital to another.

"Anybody who is insured, this is not what they ought to worry about," Chip Kahn of the Federation of American Hospitals told NBC news. "They will not find it helpful to look at that website. What they need to know is what their out of pocket will be and what their insurance premiums will be. No one is paying 10 times more at one hospital than another hospital. It is not where the rubber hits the road."

And the prices don't even reflect what Medicare actually pays. "We take out the variation that we see," said Jonathan Blum, deputy administrator at the Centers for Medicare and Medicaid Services.

Kahn puts it another way. "The government doesn't care what your price is. It sets a rate based on averages," he said. The private insurance companies negotiate rates with each hospital. Hospitals try to make up the difference in what procedures cost them and what they are reimbursed by the various payers -- who are almost never individuals, Kahn says.

The data also does not include charges made by doctors -- just the direct hospital charges.

"The prices that are listed in the CMS analysis have no direct effect on the consumer except in a few cases where a person walks through the door who is not indigent and may not have insurance," Kahn said. "And even in those cases there generally is some kind of discount offered to them. The consumer is not directly affected by this pricing system."

HHS officials said they hoped third parties would work to make the information more usable. The nonprofit Robert Wood Johnson Foundation plans to publish a map based on the data, so people can choose where to be treated.

"Transformation of the health care delivery system cannot occur without greater price transparency," says the group's president, Dr. Risa Lavizzo-Mourey. "While more work lies ahead, the release of these hospital price data will allow us to shine a light on the often vast variations in hospital charges."

Hospitals said the data did not reflect their different costs. For instance, teaching hospitals said they have higher expenses. Other point out that some hospitals may bill separately for various items. But Blum said that does not explain some of the biggest variation in prices - sometimes 30-fold differences from one center to another.

"We cannot see any business reason why there is so much variation," he told reporters.

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States got a last-minute extension late Thursday of a deadline to decide whether they’ll build their own health insurance marketplaces, or let the federal government do it for them.

Republican governors had been complaining about the Nov. 16 deadline to file their formal decision with the Health and Human Services Department, mostly because HHS has not yet told them what a federal exchange would look like.

HHS secretary Kathleen Sebelius gave in at almost the last moment, extending the deadline to Dec. 14.

“While receiving a letter of intent now will help us assist states in finalizing their application, a state may submit both a letter of intent and an application to operate its own exchange by December 14,” Sebelius wrote in a letter to the Republican Governors Association.

It’s the second time in a week that Sebelius let the governors slide. Last Friday, HHS said the states could have nearly a month extra to submit plans of what their exchanges would look like, if they decided to set up their own. She gave them until Feb. 15 to detail plans if they wanted to partner with the federal government to build an exchange.

The 2010 Affordable Care Act aims to get more people covered by health insurance, so they can get medical care when they need it, and so they get care earlier, before easy-to-treat conditions like high blood pressure can cause expensive strokes or heart attacks. One way to do this is by setting up online marketplaces called exchanges to help people to buy insurance.

They’re supposed to provide a side-by-side comparison on price, what’s covered and how much you might have to pay out of pocket for a doctor’s visit. They’ll also be a route for people to get a little extra cash from the federal government to buy insurance; the health care law provides for a generous federal subsidy for many, if not most, buyers.

However, many governors have balked at doing this and most states were procrastinating. Some were gambling that the Supreme Court would strike down the health reform law in June and when it didn’t, they waited to see if Republicans took the White House and Senate in the Nov. 6 election.

Now they will have to decide, but HHS has also taken some time in publishing rules many governors say they need to see before they decide whether to take on the job of running an exchange.

Virginia Gov. Bob McDonnell and Louisiana Gov. Bobby Jindal wrote to President Barack Obama, asking him to extend the Nov. 16 deadline. 

Jindal and McDonnell are among the governors who have said they won’t set up exchanges. Nebraska Gov. Dave Heineman joined the group on Thursday.

"The reality is that the federal health care law is being totally dictated and totally controlled by the federal government," Heineman told a news conference.

South Carolina’s Nikki Haley repeated her decision to opt out of running an exchange Thursday. Other Republicans who have said no include Texas Gov. Rick Perry, Alaska Gov. Sean Parnell and Kansas Gov. Sam Brownback.

But Mississippi has said it will set up an exchange and Florida Gov. Rick Scott, who led one of the major lawsuits trying to overturn the Affordable Care Act, now says he’ll try to do so in his state, also. New Mexico’s Republican Gov. Susana Martinez had been working already to set one up. Heavily Democratic states such as California and Connecticut have already begun work on their exchanges and Colorado says it will, too.

Sebelius said in her letter she would provide more information soon.

“Additional guidance will be released in the coming days and weeks,” she wrote. “We are confident governors will have enough time to decide whether they want to establish an exchange, work in partnership with the federal government or have a federally facilitated exchange in their state.”

The exchanges must, under law, be up and running by January 2014. Open enrollment -- when people get to have a peek at what is on offer and start signing up -- is supposed to start by October of next year.

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A Medicare payment policy designed to push hospitals to cut their infection rates has had no effect in reducing two types of preventable infections among patients in intensive care units, researchers say in the latest issue of the New England Journal of Medicine.

In 2008, the Centers for Medicare and Medicaid Services began denying additional payments to hospitals whose patients became sicker as a result of bloodstream infections and urinary tract infections associated with the use of central lines or catheters.

Researchers looked to see whether denying additional payments would spur hospitals to cut their infection rates, comparing those infections with a type of pneumonia not targeted by the payment policy.

“The financial penalty did not further reduce infection rates, which were already going down because of multitude of (infection control) campaigns and interventions that were already ongoing,” said the study’s lead author Grace Lee, associate professor, Harvard Pilgrim Health Care Institute and Harvard Medical School.

Infections picked up by hospitalized patients are an area of growing concern. It is estimated that about one in 20 hospitalized patients get an infection, resulting in up to $33 billion in additional costs each year. Efforts to reduce the rate of infections include public reporting requirements and the payment policy in Medicare, which is now being expanded into state Medicaid programs.

Other studies have found the payment policy resulted in increased attention by hospital leaders, sometimes at the expense of other infections not targeted by the policy.

As policy efforts expand, the researchers say “careful evaluation is needed to determine when these programs work … and when they have unintended consequences.” They did give did give some caveats about their findings: The study looked only at patients in the ICU, for example, so it can’t say if infection rates in other parts of hospitals changed. Researchers tracked data reported to the National Healthcare Safety Network by 398 hospitals from January 2006 to March 2011.

Many of those 398 hospitals were voluntarily reporting that data even before the payment policy was implemented, which means they may have been further ahead in their infection control efforts than others, thus resulting in no additional slowdown after the penalties, says Lisa McGiffert of Consumers Union, publisher of Consumer Reports.

She and others say efforts to affect hospital payments and to publish infection rates do work.

“When you start affecting payments and publishing results, it does get the attention of leadership in a hospital,” said McGiffert. “This study shows it’s enormously difficult to connect a singular policy with progress.”

The study is consistent with data from other studies, including one recently completed by the American Hospital Association, said Nancy Foster, vice president for quality and patient safety policy at the association. Those studies have shown an ongoing decline in infections that pre-dated the payment policy.

Still, Foster said a key piece of any effort to reduce hospital infections is not just to count the number of patients who have problems, but to have a specific, detailed prevention strategy. Preliminary results from the association study found a 40 percent reduction in central line-associated bloodstream infections in intensive care units when they used a team-based approach.

“With infections, you need a series of things you’re doing right each and every time. Not just washing hands, although that is important. Not just the right antiseptic, not just the right antibiotic. But all of those things together,” said Foster. “That’s the shift in perspective hospitals have gained.”

CMS spokesman Brian Cook did not address the study results directly, but said the 2010 federal health care law strengthens policies to reduce infections in hospitals.  ”We’re confident that these polices will improve health care quality and reduce costs,” Cook said.

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© 2012 This information was reprinted with permission from KHN. Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

A new nationwide strategy to prevent suicides, especially among U.S. military veterans and younger Americans, will tap Facebook Inc as part of a community-driven push to report concerns before someone takes their own life.

The new Facebook service will allow users to report suicidal comments they see online from friends. The website will then send the potential victims an email urging them to call the hotline as well as chat confidentially online with a counselor.

"All too often, people in crisis do not know how - or who - to ask for help," Facebook Global Vice President for Public Policy Marne Levine said in a statement. "We have a unique opportunity to provide the right resources to our users in distress, when and where they need them most."

The effort, announced on Monday, is the first new plan in more than a decade to address what officials say is a growing public health issue and aims to curb deaths over the next 10 years.

"It takes the entire community to prevent suicides. It's not just one individual," says U.S. Surgeon General Dr. Regina Benjamin. "We call can play a role."

The plan, which also includes $55.6 million in grant funding for suicide prevention programs, will be released in Washington on Monday by Benjamin, U.S. Health and Human Services Secretary Kathleen Sebelius and Army Secretary John McHugh.

Suicide is a growing concern, taking the lives of twice as many people on average as homicide, officials said. They said on average, about 100 Americans take their own lives each day. More than 8 million U.S. adults seriously thought about suicide in the last year, according to the Substance Abuse and Mental Health Services Administration.

U.S. officials are also seeking to increase awareness in other media outlets with several new public service announcements to promote the national suicide prevention line, which is 1-800-273-TALK (8255).

Of particular concern are the nation's 23 million veterans.

President Barack Obama has made caring for those who have served in the military a top concern, including tackling mental illness, but it has been a struggle.

Despite his administration's efforts to expand prevention efforts for veterans, including beefing up a special hotline, the number of suicides appear to be growing. There were 17,754 suicide attempts among veterans last year - about 48 a day - up from 10,888 in 2009, data from the Department of Veterans Affairs showed.

"Suicide is one of the most challenging issues we face," McHugh said in a statement. "In the Army, suicide prevention requires soldiers to look out for fellow soldiers. We must foster an environment that encourages people in need to seek help and be supported."

The last major U.S. plan tackling suicide was in 2001. Since then, there has been more research and data about suicide and who is most at risk, as well as the best strategies to reach those people, Benjamin said.

"We now know what we didn't know 15 years ago - or we didn't understand - which is that suicide is preventable. So prevention is where we're focusing now," she said.

"We didn't really talk about suicide much," Benjamin added. "We didn't bring up the idea of suicide. We were afraid it might give someone a new idea. Now we know that it's important to ask 'Have you have suicidal thoughts?' or 'Are you thinking about suicide?' and say if you are, there are ways to get help."

Overall, any new effort that might encourage people to talk about how they are feeling would help, especially if trained experts can quickly reach those at risk, said Cheryl Sharp, who tried to commit suicide nine times between the ages of 13 and 24.

"If you're putting that out on Facebook, you're saying 'I am desperate, and I need help,' but you may not be able to make the phone call," said Sharp, now 55 and a special adviser on trauma-informed services at the National Council for Community Behavioral Healthcare, which represents state and local mental health organizations.

"You don't wait until someone says 'I want to die'. There are things that lead up to that," she said. "There is some way to make some kind of connection, and it's an online connection. I think it's good."

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Starting Wednesday, millions of American women will no longer pay for birth control pills, Pap smears or mammograms -- not even a co-pay. Women also have the right to free breast-feeding support, supplies for pregnancy-related diabetes, also known as gestational diabetes, and even screening for domestic violence.

It's not clear how many women will take advantage of the new policy, but the US Health and Human Services Department estimates that 47 million women, ages 15 to 64, have private health insurance plans that will be affected. The 2010 health reform law requires that policies provided by private health insurance companies pay for a list of women’s health preventive services, starting August 1.

However, there may be a delay in services for many women. The law applies to new policies -- women with existing coverage may have to wait for their policies to renew for the requirements to kick in, which could take months. Many health insurers already provide this coverage.

The new rules are based on guidelines from the independent, non-partisan Institute of Medicine, which said paying for these services will save money and lives down the road.

“We want healthy women to have healthy babies,” said Dr. Jennifer Howse, president of the March of Dimes Foundation, a charity that works to prevent birth defects. “Receiving regular medical care greatly increases the likelihood that important messages can be delivered to pregnant women around issues such as nutrition and tobacco cessation, and provides opportunities to detect potentially dangerous conditions like gestational diabetes or high blood pressure.”

There are a few exceptions. Purely religious employers don’t have to provide the services to employees if they object. Related groups, such as Catholic-affiliated universities, have objected so the Obama administration offered what it called an accommodation, forcing the insurance companies themselves to pay for the coverage. But the religious associations still object, as do Republicans in Congress. They have promised to repeal the whole law if they win enough seats in the November election.

On Friday, a federal judge in Colorado ruled that a Catholic-owned heating and air conditioning company in Denver did not have to provide contraception coverage for its workers.

Americans also get refunds starting today from health insurance companies that spent too much on administrative expenses. The law requires health insurance companies to spend at least 80 percent of premiums on actual medical care and not on salaries, office rental and other overheads.

While opponents continue efforts to repeal the health care law, HHS secretary Kathleen Sebelius cheered the the promise of free screening for women's health services. 

"For too long insurance companies have stacked the deck against women, forcing us to pay more for coverage that didn't meet our needs,” Sebelius said Tuesday.

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