Apparently the good old days of public shaming are gone forever.

Related: Trump has problems in Florida

One of the results of America’s new consciousness about health care costs, and the variances by geography and care providers, has been the effort to rate health care institutions by the degree to which they mark up patient bills.

In 2015, Johns Hopkins Bloomberg School of Public Health released a much-ballyhooed study that listed the U.S. hospitals that marked up fees by more than 1,000 percent. The results, published in such media outlets as the Atlantic Monthly, showed that Florida was home to 20 of them — or 40 percent of those on the list.

Now, a year later, researchers from the University of Miami decided to find out if those Florida fee-raisers had reined in their markups at all. What they found was that, to the contrary, the cost escalation continued unabated despite the bad publicity.

“In fact,” the study authors report, “those hospitals continued to increase their charges after they were named.” This latest study was published in the Journal of Health Care Finance.

The original study revealed the 50 U.S. hospitals with the highest markup of charges raised their charges an average of more than 10 times their cost. The University of Miami study looked specifically at the 20 Florida hospitals on the list, comparing their charges in the quarter one year before the media publicity to the charges in the same quarter following the publicity.

“The analysis found no evidence that the hospitals responded to the negative publicity with a reduction in charges. Rather, the study found, charges were significantly higher after the publicity than in previous quarters,” the authors report.

The study analyzes other aspects of Florida's highest cost-to-charge hospitals:

- All but one of the hospitals are for-profits and belong to one of two for-profit health systems: HCA health system (70 percent) and Community Health Systems (30 percent).
- All 20 hospitals are located in urban areas in the state.
- All but one of the 20 received low-quality ratings from consumers, while 52 percent of the other hospitals in the state got three or more quality stars.
- Overall the 20 hospitals charge high fees for services in addition to their high charge-to-cost status.

The authors concluded that, in order to effect change among such super chargers, the public and government agencies need to step up the pressure on all health care organizations to be more transparent about costs and to set stronger regulatory guidelines so that unbridled increases can be better controlled.

“As hospital charges continue to rise and the best answer to price transparency eludes policy makers and stakeholders, it is important to recognize that hospitals may not respond quickly to public exposure and these initiatives,” says Karoline Mortensen, associate professor of health sector management and policy at the University of Miami School of Business Administration. “Perhaps the way to move the needle on this issue must include regular, public, transparent hospital check-ups over longer periods of time.”

Instant Insights /

Florida hospitals run up costs despite negative press

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