My 20-month old son was recently hospitalized with accute anemia. It was eventualy diagnosed as Transient Erythroblastopenia of Childhood, but at the time all we knew was his hemoglobin level was 2.3 grams / deciliter, which I’ve been told is extremely low. He recieved 4 transfusion of packed red blood cells, totaling 240 cc of blood, or just over 8 ounces. He has thankfully recovered fully. The hospital thoughtfully sent us a copy of the invoice they submitted to the insurance company which contained the following charges:
WTF? Four thousand dollars for 8 ounces of blood? 500 simoleons per fluid ounce? Why is the stuff so damned pricy? I understand its not available on tap, and it requires screening and storage and whatnot, but that seems very expensive. Is there just one hell of a markup on the stuff?
Hospitals charge you for every damn ting they can, with (I have heard) a mark up of up to ten times what it cost the hospital. Sometimes it might jsut cost close to what they paid, but not always. I’ve seen people get charged a hundred or two hundred dollar fee for taking a blood pressure. The hell? You know how nurses take a blood pressure? Strap a cuff (usually a RE-USEABLE one, at that) on you and hit the ‘NIBP’ buttom on the monitor. Takes fifteen seconds of their time.
I can not answer this, but I am with you on it. I do want to put my two cents worth in, though, on another related question.
Why is it when I DONATE blood, at no friggin’ cost, do people have to PAY for it on the other end? OK, I can accept such things as storage/processing costs, but I just think these should be waived as well, since I am NOT selling it. And, also, how is it determined that what is going into your son’s veins was purchased blood, versus donated blood?
I’m not really totally pissed about this, because if it might save a life, I then am not concerned about the cost…but then, I’m not (yet) the one paying for it.
Ah, hell, never mind. Maybe my blood’ll make a difference anyway. Go on, there’s nothing to see here, move along, I’m tired.
I don’t know how much hospitals markup the blood, but I worked at a blood bank a few years ago and we would charge the hospitals about $250 for one unit of red blood cells (minus the plasma). And we added another $150 if they wanted the white blood cells removed as well.
Even though we were receiving more than 400 blood donations per day, the blood bank made no profit (it was a non-profit orginization after all). Most of the money just went into buying additional equipment which was ridiculously expensive-$25,000 for one centrifuge, $500,000 for a machine that tested the blood for one specific disease.
Others have asked this question. Basically, it’s very expensive to screen out all possible or potential blood-borne diseases. And that’s above and beyond a rather expensive collection, classification, purification and storage system of a product which has a limited shelf life.
I suspect we can have a blood system which is pretty safe, or one which is less expensive. But not both. Which do you want for yourself and your loved ones?
I would imagine that the administration part of that bill would have something to do with the RN getting the order to hang blood, getting Informed Consent signed and in the chart, educating the family, sending the order to type and cross match, drawing a sample from the patient, labeling, sending to lab and then getting the match confirmed. No one wants mistakes here. Most fatal reactions to blood transfusions are acute hemolytic due to incompatibility, but other reactions can be a simple febrile reaction, cutaneous uritcarial allergics, anaphylactics, hypervolemia, mechanical, temperature extreme hemoysis, bacterial sepsis, transfusion-related acute lung injuries and air embolisms. So before the bag of blood is spiked, the RN goes down to the blood bank and gets one bag at a time, checking it against the bb’s computer and the pick-up order form. The RN has a set amount of time to give the blood in, usually 4 hours to give an adult a unit of PRBCs. Because of the time limits, I start a line of normal saline with an 18g needle in a vein that I hope won’t blow, midway up the forearm if I can get it. I have Y tubing with a filter and pump tubing and a Gemini pump in the patient’s room. I take a baseline set of vitals.
How much care has this patient already received and not a bag of blood in sight.
I spike the bag, set the pump and stand there. I record start time. I stand there. Most serious reactions are evident pretty quickly. After 15 minutes, I take another set of vitals. 15 minutes later, I take another set. It’s a perfect world, no reaction, not clots, I set the pump to drip a little faster and I’m free to check on the patient every 30 minutes and record vitals every hour until the infusion is done. I run down to the bb and get the 2nd bag for infusion. The tubing is only good for 2 bags, so if there’s more blood, I have to get new filtered Y tubing and prime it. With every new bag, there’s the careful monitoring the first 30 minutes or so.
I’m just a floor nurse. I’m not a baby ICU goddess. I don’t watch tiny veins or for a reaction from a person who can’t say “What’s that funny taste in my mouth?” So I don’t make the big bucks that they earn. My job is a lot less specialized, so I only make 30-40 an hour.
But do you know what to do with the information? Why take a blood pressure? Why take a temp? These get charted and if they are not what the nurse expects, something has to be done. I call the doc and s/he aks me about what I found and a treatment decision is made.
Just because the hospital charges $1500 to store blood, that doesn’t mean they’ll GET $1500 for it.
Depending upon the contract with the insurance company, the hospital may get paid a per diem (which includes ALL charges) or they get paid by the DRG (a flat rate regardless of total charges).
If the hospital does not have a contract with the insurance company, they may get a percentage of the cost depending on the patient’s policy.
**Cyn **- good post. It’s amazing how something that seems simple to the outside observer can actually be a ridiculously complicated procedure.
If I may add to the lab side of the story: I’ve been interning in the hospital blood bank for a month, and I can tell you that it’s not a totally simple process to get the blood out to the patient.
We have to check the patient’s blood type.
We do an antibody screen to make sure he doesn’t have antibodies against proteins that may be on the donor cells, because if he does, they will destroy the cells and cause a transfusion reaction.
If we find an antibody, we have to identify which it is, so we can be very sure that the donor unit we’re giving him is negative for whatever the antibody is against.
Then we have to crossmatch the blood against donor units and find one that works.
And that’s just for your average patient. Pre- and postnatal mothers have different tests that need to be done, as do newborns. Sometimes it’s very hard to properly identify antibodies because patients are on medication which causes errors in the testing, or have antibodies against their own cells. People like this need different tests done, to make sure we’re doing it right and giving them blood which will be safe for them.
The reagents we use are mainly antibodies, which are ridiculously expensive (a vial of one type of antibody we use is $600 for 10mL), and commercial red blood cells, which are also expensive because they’ve been analyzed to see which proteins are on them. Then there are the temperature-monitored freezers and refrigerators, the centrifuges, the plasma warmers, the incubators, and the platelet agitator.
And none of this takes into account the other half of the blood system - the Red Cross or equivalent organization has to get the blood, separate the components, test for dozens of diseases, determine blood types and do some special typing, irradiate some products, and then store all the products properly.
Not that I think it’s right to be charged so much for a few ounces of blood, but just because it was donated doesn’t mean it’s not costing anyone anything to process it.
What a timely thread! When I stepped out of the bloodmobile yesterday morning, I was wondering how they can turn a profit at all selling the stuff.
You see, at my employer of 600, only 12 people had signed up. They still came up in their fancy vehicle, equipped with 4 or 5 workers. They stayed until just after lunch and then drove off.
Perhaps they went elsewhere to tap some late-afternoon blood, but I figure that they called it a day.
I was thinking about that. Those 12 pints of unprocessed raw blood had to pay for the bloodmobile, all materials used, and a day’s pay for 5 workers. That’s before anyone starts doing the extra work needed to get the blood ready for customers.
In the end, they actually got 17 donations, thanks in part to 5 walk-ins.
The price of blood doesn’t surprise me, especially when it is provided in a hospital, as others have already covered in detail here.
…Also, keep in mind that the hospital must pay employees for 3 8 hour shifts/day or 2 12 hour shifts/day…Blood typing and matching cannot be mickeymoused…one bad cross match can cause death.
How about drug costs? a 2.00/pill you purchase at the pharmacy outside of the hospital may be billed at 20.00/pill in the hospital.
The costs are humungus but I’m sure glad what we need is there and ready to give.
only tangentially related, but I was wondering this: are hospitals coroprations? that is, for profit? I was always under the impression that they are either non-profit or government run, but its easily possible that i completely made that up.
I’m not saying it’s not useful information, I’m objecting to a seperate charge for it. I mean, let’s say I got to the ER. Odds are, there will be a flat “ER fee” that they charge every one who walks in there, probably in the range of $200-$600. I would like to think that simple, non-invasive procedures that use no supplies wouldn’t have a seperate charge. What was that intial $200-$600 for if not cover things like that? I don’t object to getting charged if they use a band-aid (though I suspect it will cost more than one would cost if I were to buy it myself…despite the fact that they buy them in bulk and get them for cheaper than retail) but I do object to things like that, which I feel I am already paying for.
And for the record, I do work in the healthcare industry. I’m a biomed tech (I imagine you have these were you work as well?) It’s my job to make sure EVERY piece of medical equipment in my hospital is in perfect working order (except for radiology equipment, which is all vevdor contracts.) So obviously some of the money has to go for paying my salary and parts I need to order, but it isn’t that much per machine. On average, each piece of small equipment like NIBPs, pulse oximeters, and thermometers cost the hospital $20-$100 a year for PM and repair parts, if that. Some things go years never needing any kind of repair. So if it costs $100 a year to keep it running, why does each patient get charged $20 when it’s used?
(Of course, not all healthcare facilities do charge for things like this. But some do, and I don’t like it. Healthcare reform is something this country really needs to reform, but that’s a topic for GD so I’ll end my hijack now.)
Some are non-profit (or is it not-for-profit?) and others are not. Private hospitals are out to make money, for the most part. A good satire of this is the hospital on Scrubs. The Chief of Medicine is portrayed as “evil” because he only cares about getting the hospital money, not saving people. Although we do ifnd out in some eps that the only reason he is trying to get money, is because with more money, they can treat more people. (In a recent ep, he had to let one patient die beacuse another patient with lots of money ready to donate needed to be in the same drug testing study. However, putting the rich guy in it allowed them to get a big donation and save their mobile “baby-mobile” that traveled around and provided free pre-natal care to pregnant women.
Don’t be fooled by the term non-profit…the Red Cross is non-profit…the Director makes about 650,000/year…the Salvation Army is nonprofit…the head man makes less than 15,000/year.
Many non-profit hospitals charge plenty to “cover costs” liability ins for the Board of Directors…salaries: can be quite high for certain people and many other “perks” too numerous to mention.
It’s pretty much the same for a child. Under ideal conditions, anyone recieving blood or blood products should have 1:1 care at least for the first hour.
I will add one anecdote, or cautionary tale, however, true.
When I was was very new nurse, I got pulled to an unfamiliar floor for my 3-11 shift. I got a scanty report on 10 patients from a GN (graduate nurse, one who has taken, but not gotten State Board scores yet) like myself. She was rather scattered, flustered, and overwhelmed. One patient was receiving blood. She had taken one set of vital signs, and told me she had been “too busy” to take more. The blood had been going for 45 minutes.
I started my rounds with that patient. As I walked in, the first thing I noticed was that the urine in the bag hanging on the side of the bed was black, not red, not brown… black. The patient was shaking so hard with chills, the bed had moved away from the wall.
I looked at my notes and his wrist band for his name and blood type, then at the blood bag…THEY DIDN’T MATCH! Different person, different blood type.
The first thing I did was pull his whole IV. Then I called the code team, even though he was breathing, it was obvious he wouldn’t be for long.
Then I started a new IV in his other arm. By then the room was full of people much smarter than I, so I went shakily to the periphery. I was asked a few questions, but really wasn’t needed, so I moved on to quickly look at the rest of my patients, hoping I wouldn’t find the person whose name had been on that bag in the same condition. I didn’t, and everyone else was ok.
I then had to write the incident up, and talk to the supervisor. They called the other nurse back from home, and she lost her job that night. I felt bad for her. She made one mistake, that cost a life, and cost her, her long sought career.
Cyn BTW, no Goddess here. Your job is, in many ways, harder than mine. You deal with more patients & families, and you keep them all straight, you chart what seems like a million words a day all on the correct charts. you feed, bathe, medicate and treat the equivalent of a basketball team on a good day, and a football team on a bad one. You rock.
I know floor nurses don’t always get the credit due you, so, for all the times you’ve been overlooked and not thanked, or have watched the Critical Care nurses get the credit. I thank you
In the UK there’s no reimbursement for donating blood, or blood platelets, bone marrow or sperm (although I’ve only donated the first) There may be some sort of cost cover for donating sperm involved.
