PARKERSBURG - Costs at Camden Clark Medical Center have remained low due to state regulations keeping costs under control while a number of factors play into costs charged at Marietta Memorial Hospital, which officials have said have been kept below projected growth.
In recent weeks a number of media reports have shown a wide range of costs for the same procedure at different hospitals in the same geographic area across the country.
Allen Butcher, chief financial officer at Camden Clark Medical Center, said the West Virginia Health Care Authority has been in place for more than 20 years and set rates for medical procedures throughout the state.
"That is its primary mission and they have been trying to keep the cost of health care down through rate-setting," Butcher said. "West Virginia has some of the lowest medical costs in the nation."
Like most businesses, the Memorial Health System, which owns Marietta Memorial Hospital, sets its prices based on a variety of factors, including cost of supplies, labor, facility costs, population need and reimbursement from insurance companies and the government, said Jennifer Offenberger, director of marketing and public relations for the Memorial Health System.
"As a not-for-profit community-based hospital we seek to provide the best value for the care we deliver," she said. "Even though the CPI Index for health care has grown to 7-8 percent, we've been able to keep our pricing lower than that growth."
An example of how Marietta Memorial keeps pricing low is its partnership with other hospitals in a network that can do group purchasing and negotiate with vendors as a larger entity, Offenberger said.
"The Memorial Health System fully supports the move toward improving transparency in the health care system and educating consumers about how to make the best choices for themselves and their families," she said. "A list of prices for some of our most common procedures such as a typical visit to the emergency room, can be found on our website. Not all hospitals are that transparent."
Costs matter for patients, Butcher said.
For those covered by Medicare and Medicaid, the programs have the authority and the ability to set the rate they are going to pay, he said
"Camden Clark is the receiver of the reimbursement," Butcher said. "We can't really sit across the the table and negotiate like we would with a Highmark, Cigna or an Aetna."
When it comes to the commercial carriers, in many instances, insurance companies pay a percentage of the charges, he said.
"That becomes what is the allowed amount," he said. If a hospital has high charges, it trickles down to the patients.
Butcher said it helps to have a number of procedures to be offered locally.
"That keeps tax dollars in the state and helps keep our costs down," he said. "At Camden Clark, we think it is important to let people know we have low charges. We are the low-cost provider in the market. We are really transparent about that."
Information available through the West Virginia Health Care Authority can show the cost of different procedures at hospitals throughout the state. "West Virginia and its leadership has been focused on making this information available to folks," Butcher said.
The Centers for Medicare and Medicaid Services has a website, data.cms.gov, that shows and compares costs of procedures for Medicare and Medicaid patients at hospitals across the country through its Inpatient Prospective Payment System.
According to the Inpatient Prospective Payment System, an acute myocardial infraction (heart attack) with major complications/comorbidities where the patient was discharged alive, Camden Clark had 63 total discharges last year with $27,480.78 in average covered charges and $9,581.86 in average total payments.
An acute myocardial infraction with just complications/comorbidities where the patient was discharged alive, Camden Clark had 50 total discharges last year with $17,981.78 in average covered charges and $6,485.54 in average payments. An acute myocardial infraction without any complications/comorbidities where the patient was discharged alive, Camden Clark had 37 discharges last year with $19,468.00 in average covered charges and $4,621 in average total payments.
According to the Inpatient Prospective Payment System, an acute myocardial infraction with major complications/comorbidities where the patient was discharged alive, Marietta Memorial Hospital had 38 discharges last year with $25,321.95 in average covered charges and $8,028.87 in average total payments. An acute myocardial infraction with complications/comorbidities where the patient was discharged alive, Marietta Memorial had 22 total discharges last year with $22,502.68 in average covered charges and $5,955.50 in average total payments. An acute myocardial infraction without complications/comorbidities where the patient was discharged alive, MMH had 15 total discharges last year with $20,532.27 in average covered charges and $4,408.13 in average total payments.
Offenberger said the health care payment system in the United States is incredibly complex, and officials with Marietta Memorial agree improvements can be made.
"While a hospital bills all patients and insurers the same charge for a particular service, government and private insurers are able to negotiate and pay lower rates," she said. "For government insurers, like Medicare and Medicaid, hospitals must accept payment rates that are often lower than what it costs a hospital to provide care.
"It's difficult to understand CMS' concern over costs when they pay a fixed price, regardless of the cost to deliver the care. For our health system, we receive approximately 25 to 30 cents of each dollar of cost from Medicare and Medicaid alone. This causes challenges when prices are set."
Butcher said people can compare Camden Clark's prices to anyone in the region and there will be times when another hospital may have a lower price on a certain procedure, but he said people have the option to look around and see what works best for them.
For people with different types of coverage, the center offers discounts and payment options.
"We have sliding fee discount scales," Butcher said. "It offers a discount from 25 percent up to 100 percent if you qualify for charity care.
"A family of four with a household income of $80,000 could be eligible for a 25 percent discount. We try to give a lot of options."
Offenberger said they also have a discount policy based on a patient's insurance and on their income.
"For those who don't have insurance, for example, we automatically offer 40 percent off the cost of their care," she said. "We review our policies frequently and work to provide financial counseling support to help people understand their bill, their opportunities for payment plans, free care and discounts as well as their options for receiving free or low-cost health insurance through government-funded programs. We train our staff to work with patients every step of the way."
Tim Brunicardi, director of marketing and public affairs for Camden Clark, said the perception is that hospitals are charging whatever they want.
"The bottom line is media reports are making it look like hospitals are arbitrarily charging large amounts and consumers are put at a disadvantage," he said. "Here locally, that is not the case. It is regulated here and that should give confidence to the people here in the Mid-Ohio Valley that we are not in that situation.
"Our prices are the lowest in the market and they are fair."
Offenberger said hospitals are there to care for patients.
"We believe hospitals have the responsibility to safely and efficiently provide care to everyone who walks through our doors and we need to be properly compensated for the services so we can continue our mission of caring for the community," she said.