SATURDAY, AUGUST 7, 2021
BAKER CITY HERALD — A3
LOCAL & STATE
Counting the costs of care
Patient variables, markets play key roles in health care prices
By Alex Wittwer
The (La Grande) Observer
LA GRANDE — The long-await-
ed hospital price transparency laws
have taken effect on the national
level, following a landmark bill by
the Trump administration requiring
hospitals to post their negotiated
rates that insurers pay for typical
procedures.
For Oregon, it’s too little too late.
In 2015, the Oregon Senate passed
a law requiring hospitals to post the
prices they paid for procedures to the
All Payers, All Claims Reporting Pro-
gram. Analysts at the Oregon Health
Authority used the data to make
reports about the prices of common
procedures.
The prices were all over the map.
Arthrocentesis — removal of fluid
from a socket or joint — can range
from $370 to $4,921 at Good Shep-
herd Medical Center in Hermiston
and costs between $947 to $1,091 at
Grande Ronde Hospital, La Grande.
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 indicative of the unique challenges
diagnosing and treating patients.
Ben Lonergan/East Oregonian, File
An MRI for the head and spine
costs $217 at Good Shepherd
Medical Center, Hermiston,
according to the All Payers, All
Claims data.
SCHOOLS
Continued from Page A1
The Oregon Health
Authority (OHA) and Oregon
Department of Education are
requiring the mask mandate
for this fall to be reviewed
monthly.
The Baker School District,
which had relaxed its mask
rules for the Summer Acad-
emy classes, returned to a
mask requirement on Aug. 2.
Potential consequences
for failing to comply with the
new state mandate include
OSHA fines, civil penalties,
personal liability and educa-
tors putting their licenses at
risk, Witty said, as well as
the increased potential for
spreading the virus.
Witty said during Thurs-
day’s meeting that he has
talked with OHA officials
and elected officials to try to
get more local control and
flexibility in complying with
health protocols.
Witty said he supports a
letter that Baker County’s
two state legislators, Sen.
Lynn Findley, R-Vale and
Rep. Mark Owens, R-Crane,
sent on Tuesday, Aug. 3 to
Brown. The lawmakers ask
the governor to provide, im-
mediately and to the public,
“scientific data specific to
Oregon necessitating the
statewide, schools-wide,
grade-wide mask mandate.”
Findley and Owens also
ask the governor’s office and
Department of Education
to “hold a series of public,
in-person town halls and
listening sessions throughout
our counties immediately
over the course of the next
several weeks” to discuss the
rules and the “very serious
implications” of them.
Finally, the two lawmak-
ers request from Brown “clear
and precise metrics for when
the statewide mask policy
transparency doesn’t have the ability
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
physician to make choices for them
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 consequences 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 advantage.
“There is a lot of chatter about,
‘Oh, if I knew about the price I
would actually price-shop,’” said
Atul Gupta, an assistant profes-
sor of health care management at
University of Pennsylvania during
a university podcast on health care
transparency. “The evidence suggests
Market power
The intended effect of price trans- that a very small fraction of people
who have that tool available to them
parency was to introduce healthy
actually use it.”
competition to a marketplace that
“Price transparency is a great
had long been shrouded in secrecy.
concept in principle,” Sharma said,
But Rajiv Sharma, a health eco-
“but is incredibly hard to implement
nomics professor at Portland State
University, said market power plays in practice.”
a big role in pricing.
“If insurance companies are faced Following the laws
with one or two big hospital chains,
Most hospitals in Eastern
then they don’t have very much
Oregon follow the laws regarding
negotiating power,” she said. “That’s price transparency — all hospitals
true in rural areas where there is
in the region have price comparison
only one hospital.”
tools readily available to patients
And without that market power, on their web portals allowing them
hospitals have no incentive or need
to compare prices between typical
to lower their costs. But if price
procedures. Compliance with the
“You might go in thinking that
it’s a $20,000 inpatient 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
president and chief revenue officer
at Trinity Health, which owns the
St. Alphonsus chain of hospitals in
Eastern Oregon and Idaho.
But even procedures that offer
little variation in execution can have
dramatic variations in price.
An MRI for the head and spine
costs $217 at Good Shepherd in
Hermiston, according to the All Pay-
ers, All Claims data. That same pro-
cedure would cost $2,306 at Grande
Ronde Hospital.
“There appears to be no rhyme or
reason behind how hospitals price
their procedures,” said Jeremy Van-
dehey, director of Health Policy and
Analytics at OHA. “A normal birth
with no complications can vary a lot;
so one hospital may charge $5,000
while another charges $15,000.”
That remains true for several
other procedures as 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
residents.
“When you have several payers
competing for one hospital, they
become price takers,” Vandehey said.
may be lifted.”
As for the start of classes
Aug. 30, Witty said students
can expect a similar system to
what was in place last spring,
with morning health checks,
students divided into cohorts,
frequent handwashing, three
feet of social distancing, and
for students who have symp-
toms of COVID-19, rapid
tests for those whose parents
give permission.
As has been the case
throughout the pandemic,
though, the district encour-
ages students to stay home if
they feel ill at all, and online
classes will be available for
affected students.
Barry Nemec, the dis-
trict’s special education and
counseling director, said there
will be increased counseling
for students due to the added
stress and anxiety of the
pandemic.
Fall athletic schedules are
set, with practices starting
Monday, Aug. 16, but changes
are to be expected.
For now, athletes will
not have to wear masks for
outdoors sports, including
football, soccer and cheer-
leading. The exception is
volleyball, the only indoor
sport during the fall season,
and as of now masks will be
required for players, coaches
and spectators.
Buell Gonzales Jr., the
district’s athletic director, said
he is exploring the possibility
of using COVID-19 testing
in place of masks in indoor
settings.
Witty expressed concern
for the limited number of
substitute teachers in the
area if and when teachers call
out sick. Limited substitute
teachers and transportation,
as well as the varying risk
levels in students for the
virus, are all reasons as to
why masks must be worn in
schools this coming academ-
ic year.
COVID numbers
Nancy Staten, director
of the Baker County Health
Department, said the county’s
total of 68 cases from July
25-31 was the county’s highest
during the pandemic.
The county reported
another 49 cases from Aug.
1 through noon on Thursday,
Aug. 5, Staten said.
Dr. Eric Lamb, the county’s
public health officer, expressed
frustration at the county’s
vaccination rate, which ranks
eighth-lowest among Oregon’s
36 counties, with 46.9% of resi-
dents 18 and older vaccinated.
The statewide vaccination
rate is 69.3%.
“Had our vaccination rates
been up to 80% three months
ago, we’d be done with this,”
Lamb said. “The pandemic
would be over. The only long-
term solution to this problem
is going to be vaccinations.”
Lamb cited a study that
some people who oppose mask
mandates for children have
mentioned, claiming that
requiring students to wear
masks is dangerous.
That’s not the case, Lamb
said.
He said children younger
than 12 are likely to be eligible
for COVID-19 vaccinations
in late September or early
October.
Among Baker County
residents ages 12-17, who
are eligible for COVID-19
vaccinations, the vaccination
rate is 18.8%, compared with a
statewide average for that age
group of 50.1%.
Dr. Lily Wittich talked
about staffing shortages in
hospitals in Boise, Portland
and Bend. She said patients
from Baker County are being
sent back because they can’t
be accommodated due to an
influx of COVID-19 patients at
larger hospitals.
“We’re hearing the same
stories from all over the
Pacific Northwest,” Wittich
Baker City Herald, File
Hospitals in the Trinity Health system, such as Saint Alphonsus
Medical Center, Baker City, are working toward increasing price
transparency across the board.
full extent of the law, however, is
less than ideal.
Out of the seven hospitals that
serve most of Eastern Oregon, only
four follow the second requirement
of the transparency laws, and com-
pletely forgo a machine-readable
file.
And the consequences for ignor-
ing the law are minor; the Centers
for Medicare and Medicaid Services,
which oversees the price transpar-
ency laws, is allowed to fine hospi-
tals 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 proposing 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 maximum
penalty for noncompliance to just
above $2 million. But even with a
heavy fine, some hospitals are un-
sure about what that machine-read-
able file would entail, and whether
or not that information would be of
particular usefulness to analysts
and app developers.
said. “Vaccinations, masks and
social distancing are still our
greatest tools to manage the
situation.”
Opposition to mask
mandate
Following Witty’s presen-
tation and those by health
officials, some parents, and
board members, questioned
both the mask mandate and
the severity of the current
surge.
Board
chair Chris
Hawkins
asked about
how many
of the recent
cases in the
Hawkins
county have
led to severe illness.
Board member Travis
Cook was curious to hear if
the increased positive cases
were specific to the school
district, or if they were reflec-
tive of the general public.
That information was not
available.
Three parents addressed
the board, including Karen
Shaw, a spokesperson for the
Facebook group Baker City
Parents Against School Mask
Mandates, which was started
the same day Brown an-
nounced the mask mandate
and has since added 1,200
members.
“Masking our children, we
believe, is child abuse,” Shaw
said. She urged the district
to “fight this mandate at the
state level.”
The group publicly dis-
agreed with studies conduct-
ed by local, state and federal
health organizations, instead
stating they had “substantial
evidence” that masks harm
children physically, psycho-
logically and medically.
Nathan Hogeland, who
has three children in the
Baker School District, said
he has watched the deterio-
ration of his child’s character
“The challenge with the machine-
readable files is that the definitions
of those are different depending
on the hospital,” Bittner of Trin-
ity Health said. “Without common
definitions, then the comparability
of that information is significantly
lacking.”
Information overload
Further, Sharma contended that
for the average health care consum-
er, price transparency is rendered
nearly ineffective due to the volume
of information required to make
informed choices regarding care.
“The informational requirements
on patients is enormous,” Sharma
said. “Even if you had perfect price
transparency, and even if that trans-
parent price was incredibly well
customized, there is still so much
uncertainty regarding exactly what
would be required, that it would be
difficult to sort through these possi-
bly hundreds of price combinations
for the five or six hospitals that are
reasonably available.”
Bittner said hospitals in the
Trinity Health system, such as St.
Alphonsus Medical Center 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 transpar-
ency will help lower costs, however,
remains the question.
due to having to wear a
mask, and he believes the
number of positive cases has
been taken out of context.
“You guys are elected
officials to represent us,”
Hogeland said. “We feel that
you guys have not and you
have taken a more conserva-
tive approach. I believe that
you guys need to push back,
and you need to listen to the
community as a whole.”
Megan Spriet, who has
10 children in the school
district, said her children
have come home with mouth
sores from their masks. She
believes that the health
implications of wearing a
mask are more negative
than positive.