Transparency is creeping into health care in Western Pennsylvania, and that's a good thing.

A report by the Pennsylvania Health Care Cost Containment Council reveals vast disparities in insurance reimbursements to hospitals for the same medical procedure.

Though known to hospital chief executive officers and a handful of other top health care officials, the cost comparison information provided by the cost containment group will help the general public see what has frustrated most hospital administrators at smaller hospitals for years.

The council's analysis factored in the severity of each patient's condition as well as the surgical outcomes or results, in terms of mortality and readmission. The comparison report reveals that for coronary artery bypass graft surgery (without a valve procedure), the UPMC Shadyside and Presbyterian hospitals were paid $34,803 by Highmark. The same procedure done at Butler Memorial Hospital produced a Highmark reimbursement of just $18,613.

Other hospitals and their reimbursements were: Washington Hospital, $31,113; Mercy Hospital, $25,315; West Penn, $25,184; UPMC Passavant, $24,834; Medical Center Beaver, $21,903.

The questions raised by the council's report are obvious and important. What can explain such a wide disparity in reimbursements? How can this imbalance be justified, by either UPMCor Highmark?

Tom Chakurda, spokesman for West Penn Allegheny Hospital, noted that "in any other market, quality and efficiency are rewarded. That does not appear to be the case in health care."

Quality of care appears to not be a primary factor in the reimbursement rates. Consider that Allegheny General, a crosstown rival to UPMC in Pittsburgh, had better outcomes in terms of lower readmission rates following heart bypass surgeries, yet it received about $11,000 less for the same heart operation.

One possible conclusion to the report is that inefficiency or higher expenses are being rewarded in the case of UPMC. Another explanation might be that UPMC, the Western Pennsylvania health care giant, exerts more clout and therefore can negotiate higher reimbursements from Highmark.

The health care cost report raises questions that deserve answers. The report's findings should put pressure on Highmark and UPMC to explain the lopsided reimbursements.

Because Highmark reimbursements are related to what hospitals charge, the much-higher UPMC charges should have many employers in Western Pennsylvania questioning why they are paying so much more for their employees to receive care at UPMC hospitals, when other hospitals in the region provide similar services with similar results — but at lower costs.

A Highmark official noted that UPMC also serves as a teaching hospital and conducts research, and these also are factored into reimbursements. That might be true, but it cannot explain why the discrepancy is so large.

It appears the region's biggest nonprofit hospital, which made $512 million in profits last year, has an arrangement with the region's dominant nonprofit health insurer, which has about $3 billion in reserves (excess profits), that is mutually beneficial — but detrimental to other area hospitals and UPMC's insured patients.

The cost containment council's objective is to arm consumers with facts that will allow them to shop for health care competitively, just like they shop for other goods and services. But since most people's health care is provided by employers, the employees can at least ask why the employers don't shop around for better prices.

At a time when more and more employers are asking employees to pay a larger share of their health care expenses, employees should expect the employer to spend health care dollars wisely. The cost council's report will provide valuable information to encourage that process and possibly bring change to the market.

If change does occur as a result of this report, it probably is unlikely that smaller hospitals will get more money for their heart procedures. But pressure from consumers and employers could (and should) reduce the outsized reimbursements paid to UPMC, and several hospitals in Philadelphia.

UPMC and Highmark are complicit partners in this hard-to-justify reimbursement arrangement. More competition would have made it less likely to occur, but public and corporate pressure from across Western Pennsylvania and possibly from Harrisburg could make the next wave of negotiations for reimbursements very interesting.