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East Oregonian
COVID:
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Living with long
COVID-19
In the weeks after she
tested negative for COVID-
19, Rodriguez knew some-
thing was wrong. She wasn’t
getting better.
She had developed high
blood pressure and began to
lose her eyesight. Migraines
settled in. A searing pain
had developed in her legs
when she would walk. She
was growing much sicker,
but it was difficult to find
a doctor who could tell her
what was going on.
For he r m ig r ai nes,
doctors initially prescribed
hydrocodone, which she
took three times a day. She
hated the opiate. It left her
in a haze for more than a
month. She would take up to
five naps a day, and her chil-
dren had difficulty waking
her up.
Her
pharmacist
prescribed Narcan in case
of an emergency where she
didn’t wake up. She didn’t
want her children to use it,
so she put the note above her
bed for her kids to call 911.
The Narcan still sits on the
nightstand beside her bed,
just in case.
“There were times I
didn’t think I would live,”
she said. “I told my husband,
‘I know it’s COVID-19, but
if I die, I don’t want you to
wait to have a funeral. I want
my family to be there. I want
everybody to be there.’”
Eventually, a doctor at
CHI St. Anthony in Pendle-
ton diagnosed her with long
COVID-19. In the months to
come, doctors would diag-
nose her with a variety of
other illnesses, including
Meniere’s disease, a rare
disorder of the inner ear
known to cause vertigo and
tinnitus.
Initially, Rodriguez only
struggled to hear with her
right ear. During the past
month, she’s begun losing
hearing in her left ear,
too. It sounds like being
submerged under water,
she says. When the tinnitus
is at its worst, that sound
becomes an electric screech.
The vertigo became a
day-to-day struggle for
Rodriguez. Standing to talk
or get a glass of water, the
room would spin and she
would collapse or walk into
doorways.
“Those were dark days,”
she said. “For me and my
kids.”
Amid the brain fog,
she began to forget things,
including the names of her
own family members. One
night she left her garden
hose on and turned the lawn
into a swamp. Another night
she told her children to wash
their feet for dinner. On
Thanksgiving, she put half
a cup of salt in the pumpkin
pie. She said it tasted terri-
ble, but her kids still ate it.
“I’m grateful now if I can
make my kids brownies or
cook them dinner without it
tasting horrible,” she said.
One step at a time
Since starting physical
therapy in April, things
have slowly gotten better
for Rodriguez. She does
exercises at home with her
daughter, Adriana. Her
family supports her, with
her mother taking her to
doctor’s appointments and
her husband sometimes
taking days off work.
Before she fell ill, power
walking the Pendleton
River Parkway along the
Umatilla River through
Pendleton was one of Rodri-
guez’s favorite things to do.
She could easily walk the
2.5-mile path every day. In
April, she set out with the
simple goal to walk that
distance again.
At first she couldn’t walk
further than a single block.
Her legs would burn. She
would feel pressure in her
ears and a sensation pull-
ing her to the ground. But
she listened to her body,
and each day she set out to
move a bit further. After
five months of effort, she
can finally walk more than
a mile.
“When I started to get
active, I realized that I
could take control of my life
again,” she said.
Her daughters trade off
joining her on the walks
along the river. They were
recently vaccinated against
COVID-19, the oldest at
Wild horse Resor t and
Casino and her two young-
est at the Pendleton Farmers
Market.
“I actually cried watch-
ing my kids get the vaccine,”
she said. “It actually is hope
for me. Like this is going
to end and that they won’t
end up catching it and have
horrible things like this
happen.”
The moment was a prom-
ise of a future Rodriguez
was once unsure she would
have. She’s come to accept
her life with the illness, and
appreciates her walks by the
river more than ever before.
“I know I’m not going to
die now,” she said. “I know
that. I have bad days where
I hurt more than I’ve ever
hurt in my entire life. But
I know I’m going to keep
going, and I’m going to get
up and keep going through
the day.”
Ben Lonergan/East Oregonian, File
Elementary students wear masks and sit in alternating desks on Feb. 2, 2021, during in-person instruction at the Echo
School. The state of Oregon will require students and staff to wear masks indoors when school returns in the fall, Gov. Kate
Brown announced Thursday, July 29.
Masks:
Continued from Page A1
Tricia Mooney, the super-
intendent of the Hermiston
School District, sounded
slightly more optimistic, but
said the community would
need to come together to
support students. Mooney
said young students needed
to be able to view mouths to
build language skills and it
was her hope that case rates
would fall enough that the
district would be able to
make masks optional again.
Given the contentious-
ness surrounding masks,
Pendleton Superintendent
Chris Fritsch anticipated
facing some sort of public
pressure even if Pendle-
ton maintained its optional
mask policy.
“We are in a difficult
situation either way,” he
said.
With COVID-19 case
rates continuing to rise,
both Fritsch and Mulvihill
were concerned about the
impacts large local events
could have on schools.
After moving most of its
activities virtually last
year, the youth-friendly
Umatilla County Fair is
returning on Aug. 11, only
a few weeks before many
schools will be reopening
for the year. The Pendleton
Round-Up also is schedul-
ing its return for the second
full week of September, a
week the Pendleton School
District traditionally takes
off to give students a chance
to volunteer at the rodeo or
enjoy the festivities.
well, and it’s especially true
in Eastern Oregon, where
Type A hospitals — hospitals
that are more than 30 miles
away from each other — are
typically the only source of
health care for rural resi-
dents.
“When you have several
payers competing for one
hospital, they become price
takers,” Vandehey said.
Market power
St. Alphonsus Medical Center-Baker City/Contributed Photo
Medical procedures can vary in price by hundreds or thou-
sands of dollars between hospitals. David Bittner, vice pres-
ident and chief revenue officer at Trinity Health, which own
St. Alphonsus Medical Center-Baker City, pictured here, says
patient variables contribute in big ways to price differences.
Prices:
Continued from Page A1
Tonsil removal, another
common procedure, costs
between $8,018 and $10,281
at Grande Ronde, while
an hour drive northwest to
CHI St. Anthony Hospital in
Pendleton the procedure runs
from $6,740 to $7,295.
Hospitals argue that each
patient is different, and the
care they receive is indica-
tive of the unique challenges
diagnosing and treating
patients.
“You might go in think-
ing that it’s a $20,000 inpa-
tient surgical procedure and
then you might get a bill for
$40,000 because you have
implantables, pharmacy,
ultrasounds and the like,”
said David Bittner, vice pres-
ident and chief revenue offi-
cer at Trinity Health, which
Saturday, July 31, 2021
owns the St. Alphonsus
chain of hospitals in Eastern
Oregon and Idaho.
But even procedures that
offer little variation in execu-
tion can have dramatic varia-
tions in price.
An MRI for the head and
spine costs $217 at Good
Shepherd in Hermiston,
according to the All Payers,
All Claims data. That same
procedure would cost $2,306
at Grande Ronde Hospital.
“There appears to be no
rhyme or reason behind how
hospitals price their proce-
dures,” said Jeremy Vande-
hey, director of Health Policy
and Analytics at OHA.
“A normal birth with no
complications,” Vandehey
continued, “can vary a lot;
so one hospital may charge
$5,000 while another charges
$15,000.”
That remains true for
several other procedures as
The intended effect of
price transparency was to
introduce healthy compe-
tition to a marketplace that
had long been shrouded in
secrecy. But Rajiv Sharma, a
health economics professor
at Portland State University,
said market power plays a big
role in pricing.
“If insurance companies
are faced with one or two
big hospital chains, then
they don’t have very much
negotiating power,” she
said. “That’s true in rural
areas where there is only one
hospital.”
And without that market
power, hospitals have no
incentive or need to lower
their costs. But if price trans-
parency doesn’t have the abil-
ity to lower prices, then what
entity or law could?
“The way that health
insurance has been lowered
has been through negotiation
with powerful entities, such
as Medicare or Medicaid,”
Sharma said.
For the average consumer,
Sharma admitted, the ability
to influence prices of health
care is low, and the patients
mostly rely on their physi-
cian to make choices for them
Thanks to extra funding
from federal COVID-19
relief stimulus, many local
school districts bolstered
t hei r su m mer school
programs. According to the
Oregon Health Authority,
Pendleton and Hermiston
reported only one student
case each. Mooney said
Hermiston did see an uptick
in new cases toward the end
of summer school, but she
attributed it to community
spread rather than summer
school itself.
While schools were
closed for a significant
portion of the 2020-21
school year, cases did start
creep up once in-person
instruction resumed in the
spring. Hermiston reported
39 student cases while
Pendleton documented 26.
W hile the gover nor
issued orders reinstating
the mask rules in schools, it
will be the Oregon Depart-
ment of Education that will
be charged with writing the
actual rules. Local admin-
istrators are still looking
for clarification on whether
staff will be required to
wear masks and if there
are any other additional
requirements that will
be reintroduced.
Ben Lonergan/East Oregonian, File
Masked students walk to their classes on Feb. 22, 2021, the first day of in-person instruc-
tion at Washington Elementary School in Pendleton. When Oregon K-12 students and staff
return to school in the fall they will be required to wear masks indoors, Gov. Kate Brown
announced Thursday, July 29.
regarding their health care.
“(Health care prices are)
very inelastic because your
life and your health is at
stake,” Sharma said, “and
because consumers rely on
professionals rather than
their own judgement to make
choices.”
Succinctly, a patient who
needs an appendectomy isn’t
likely to spend their precious
time deliberating over prices
when their life is in danger
— they’ll go to the nearest
hospital and face the conse-
quences of payment later.
But for other procedures,
such as diagnostic testing, the
outcome isn’t as clear; even
less clear is the notion that
consumers would use price
transparency to their advan-
tage.
“There is a lot of chat-
ter about, ‘Oh, if I knew
about the price I would actu-
ally price-shop,’” said Atul
Gupta, an assistant professor
of health care management at
University of Pennsylvania
during a university podcast
on health care transparency.
“The evidence suggests that a
very small fraction of people
who have that tool available
to them actually use it.”
“Price transparency is a
great concept in principle,”
Sharma said, “but is incred-
ibly hard to implement in
practice.”
Following the laws
Most hospitals in East-
ern Oregon follow the laws
regarding price transpar-
ency — all hospitals in the
region have price compari-
son tools readily available to
patients on their web portals
allowing them to compare
prices between typical
procedures. Compliance
with the full extent of the
law, however, is less than
ideal.
Out of the seven hospi-
tals that serve most of
Eastern Oregon, only four
follow the second require-
ment of the transparency
laws, and completely forgo
a machine-readable file.
And the consequences
for ignoring the law are
minor; the Centers for Medi-
care and Medicaid Services,
which oversees the price
t ra nspa rency laws, is
allowed to fine hospitals up
to $300 per day for noncom-
pliance. For a full year, this
works out to just more than
$100,000. CHI St. Anthony
Hospital in Pendleton, in
comparison, on its 2020
tax form reported revenue
exceeding $18.7 million.
CMS officials are propos-
ing to stiffen those fines to
a minimum civil monetary
penalty of $300 per day
that would apply to smaller
hospitals with a bed count
of 30 or fewer, according
to the center, and apply a
penalty of $10 per bed per
day for hospitals with a bed
count greater than 30, not to
exceed $5,500 per day.
That would raise the
maxi mu m penalt y for
noncompliance to just above
$2 million. But even with a
heavy fine, some hospitals
are unsure about what that
machine-readable file would
entail, and whether or not
that information would be
of particular usefulness to
analysts and app developers.
“The challenge with the
machine-readable files is
that the definitions of those
are different depending on
the hospital,” Bittner of
Trinity Health said. “With-
out common definitions,
then the comparability of
that information is signifi-
cantly lacking.”
Information overload
Fu r t he r,
Shar ma
contended that for the aver-
age health care consumer,
pr ice t r a nspa rency is
rendered nearly ineffective
due to the volume of infor-
mation required to make
informed choices regarding
care.
“ T he i n for m at ion al
requirements on patients is
enormous,” Sharma said.
“Even if you had perfect
price transparency, and even
if that transparent price was
incredibly well customized,
there is still so much uncer-
tainty regarding exactly
what would be required,
that it would be difficult to
sort through these possibly
hundreds of price combi-
nations for the five or six
hospitals that are reasonably
available.”
Bittner said hospitals in
the Trinity Health system,
such as St. Alphonsus in
Baker City, are working
toward increasing price
transparency across the
board to help its members
become better informed
about the prices they pay
for services.
Whether or not price
transparency will help lower
costs, however, remains
the question.