Monday, April 21, 2014
By Michael Shepherd email@example.com
State House Bureau
AUGUSTA - Jessica Falconer of Belfast told a legislative committee Wednesday that she was "staggered" when she saw the hospital bill for her Caesarean section.
It was nearly $30,000, several thousand dollars of which her family had to pay even though insurance covered most of the costs.
"I have to wonder where this money is going," Falconer said. "It makes me feel like I had a birth based on commission."
Falconer was testifying on a financial transparency bill aimed at Maine's hospitals, prompted by a recent national dialogue on the widely varying costs of health care nationwide. The bill had a public hearing before the Legislature's Insurance and Financial Services Committee.
Sponsored by Sen. Geoffrey Gratwick, a Democrat from Bangor who is a physician, L.D. 1453 would direct the Maine Health Data Organization, an independent state agency that collects clinical and financial health care information, to publish an annual study of hospitals' financial data. The study would enable consumers to compare pricing among hospitals.
Gratwick's bill also would establish an 11-member Commission to Study Transparency, Costs and Accountability of Health Care System Financing, appointed by House and Senate leaders.
The commission would review hospitals' financial data, including revenue and charges, with an eye toward standardizing data reporting to the state. It would also evaluate ways to reduce health care costs and address rates of increase in spending.
Gratwick, who's a co-chair of the committee, a rheumatologist and a freshman lawmaker, said the bill is a key reason why his constituents elected him.
"This bill, I have to say, comes from deep within me. It comes from 40 years of medical practice," he said. "This comes from my guts."
He called it "a small step along the path to reforming our broken health system."
The Maine Hospital Association, which testified neither for nor against the bill, said much data is already available to the public -- for example, hospitals' tax returns are public because they're nonprofits.
Jeffrey Austin, the association's lobbyist, said hospitals and insurance companies fund the Maine Health Data Organization. He said the organization now provides a lot of information to the public, including the costs of some procedures.
"I don't know what you want or why, so I can't support it," he said. "We are frustrated that we are providing resources -- both to provide the data and the cash -- to help build websites that have exactly what you need."
The nonpartisan Kaiser Family Foundation, using 2009 data, found that the United States spends substantially more per capita on health care than other developed nations -- about 48 percent more than Switzerland, the next-highest spender.
Uneven hospital charges have become a popular topic in the national health care dialogue. Gratwick said an article in February in Time magazine, which set out to find why America spends so much on health care, contributed to his decision to introduce the bill.
Among other things, Time found that many American hospitals charge exorbitant amounts for certain mundane items. For example, one hospital charged $77 each for four boxes of gauze pads in a $348,000 bill following a patient's diagnosis of lung cancer.
"When a patient goes to a hospital, they should know what they are paying for," Gratwick said in a prepared statement Tuesday. "Mainers can only make informed decisions about their health care if they have accurate information. Hospitals must make their charges transparent."
On Wednesday, the federal Centers for Medicare and Medicaid Services released data showing hospital charges to Medicare for the 100 most common treatments and procedures. The data reveal wide cost ranges for similar procedures nationwide and even locally.
According to a press release, inpatient charges for a joint replacement range from $5,300, at a hospital in Oklahoma, to $223,000, at one in California.
One hospital in Jackson, Miss., charged an average of $9,000 for heart-failure treatment. Another charged $51,000.
In Maine, the lowest and highest amounts billed to Medicare for joint replacements were at two hospitals about 15 miles apart in Aroostook County: Cary Medical Center in Caribou charged $22,870, while The Aroostook Medical Center in Presque Isle charged $55,425, an amount just above the national average.
Maine Medical Center in Portland charged $28,216 for a similar procedure, while MaineGeneral Medical Center in Augusta charged $33,212.
Austin, the hospital association's spokesman, said Maine hospitals are generally reimbursed at a lower rate for Medicare services than those in many states.
Still, Maine is known as a state with relatively high costs. For 2009, Kaiser found that Mainers were spending $8,521 per capita on health care fourth-highest in the nation behind Massachusetts, Alaska and Connecticut.
The foundation attributed that to high enrollment in Medicaid, which serves the poor.
Michael Shepherd can be reached at 370-7652 or at: