By Laurie D. Morstad
Members of the community and past patients have spoken to interim CEO of the South Big Horn Hospital District, Vince DiFranco, with concerns that the cost of emergency room and physician care in the district appeared to be higher than others in the area. DiFranco and the hospital board listened to these concerns and DiFranco was able to complete a cost comparison with five neighboring emergency rooms and found out that this was indeed accurate.
The prices for services had been increased significantly in 2017 and had not been reevaluated until recently.
Another impetus for evaluating prices comes from the enactment of the Hospital Price Transparency Rule that went into effect nationwide on Jan. 1, 2019. This rule requires hospitals to make the prices of services and tests available on the Internet for the prospective patients to view. DiFranco discovered that a significant increase in the cost of services occurred in 2017, resulting in SBHCHD being the highest in cost of all five hospitals he reviewed for emergency room services.
There are five levels of care in the ER for both base rates and physician costs. The first level involves the lowest amount of care necessary to meet patient needs. That amount was $1,069 as opposed to a range of $202-$280 for the other five health care facilities reviewed by DiFranco.
A Level 5 ER visit would be the most extensive in terms of both services and physician expense. The cost allowed in the 2017 recalibration of rates for a Level 5 emergency room visit was $4,286 for SBHCHD; the cost for the five comparison facilities ranged from $1,431 to $1,658.
DiFranco was not in place as interim CEO at the time of the 2017 rate increase. During his review of costs, he found that ER physician charges were only slightly higher at the south BHC facility. The cost of physician care at Level 1 was $147 while the range for the other four evaluated for physician cost was between $83 and $229; for Level 5, the range was between $685 and $1,347. SBHCH’s cost was $1,007 for Level 5 physician care.
Based on the feedback from the community over the last 10 months, the rates from area emergency rooms, and Medicare and Medicaid reimbursement limits, the board has lowered the price for both ER and ER physician costs significantly for all five levels of care. Level 1 care in the ER now is $243 as compared to the $1,069 it was previously. Level 5 care, which involves extensive patient services, is now $1,547 instead of the 2017 rate of $4,286. A trauma activation fee of $2,924 will remain the same. This compares to a range of $2,667 to $8,656 at four of the facilities reviewed. This fee is activated in situations where there may be significant trauma requiring an increase in both provider and staff services.
“There are four main components to an emergency department visit. The facility fee is based on the intensity of services needed and amount of time spent with the patient. The physician fee has similar criteria. Level 1 is the most basic care to Level 5 being the most complex,” DiFranco said. He also wants patients to know that this is the ER charge only for facility usage. Equipment, lab work, radiology or other ancillary services would be added to the patient’s bill as separate items from the ER facility charges. These changes make the charges for the use of the ER much closer to the Medicare reimbursement rate.
“The board and I feel strongly that this is a positive change for the community and demonstrates our interest in listening to community feedback and making changes to better serve the community,” DiFranco stated.
The board and DiFranco “are now confident that these are fair rates for residents of the community.” He is grateful for the feedback from the community and is hopeful that patients who are either private pay or self pay will be able to access medical services at the new rate.
The new rates were implemented on Feb. 1, 2019.