Leader erred in article on Jefferson Healthcare

Posted

I read with interest your article entitled “Privately insured continue to augment Medicare/Medicaid” (Leader, June 5) about the dynamics of private health insurance vs. Medicare and Medicaid. While I appreciate The Leader’s interest in healthcare finance, the article contained many errors and misquotes, offered inaccurate explanations for very complicated issues and sent a mistaken and distorted message to the community we both serve. For the sake of clarity, I will correct and clarify in a question and answer format:

Are some patients charged more for services than other patients at Jefferson Healthcare?

No. All patients are charged the same for all services, regardless of insurer or lack of insurance.

Are the charges posted on the Jefferson Healthcare website the same as the charges used to calculate the patient bill?

Yes. We have one set of charges for all patients. As of January 1, 2019, these charges are posted on our website.

If, “On average, the cost to the hospital to provide services increases by about 3-6% a year” is “this cost generally absorbed by those covered with commercial insurance”?

No. Medicare and Medicaid also pay for the cost increases. Jefferson Healthcare is a Critical Access Hospital, which are reimbursed through a model that considers the costs of providing care. Therefore, Medicare and Medicaid increase their payments as Jefferson Healthcare costs increase.

Are those with private (or commercial) insurance placed “on the hook for a larger bill to support lower rates paid by government insurance?”

No, to reiterate all patients are charged the same. Patient “out of pocket” responsibility varies widely and is determined by the plan requirements of all insurance policies, including both private (or commercial) and Medicare or Medicaid insurance coverage.

Do private (or commercially) insured patients pay more for services like emergency room and after-hours MRI to keep the services available in the community?

No, all patients are charged the same for these and all services. Services like the emergency room and MRI are provided because they are necessary to care for our community. We have set our prices to be competitive with other hospitals in the region.

Does the hospital focus on specialty care services because there is better reimbursement from Medicare and Medicaid?

No. All hospital services (including specialty) are paid by Medicare and Medicaid the same way (based on the cost of providing the service). We are focused on expanding specialty services because our community needs services like orthopedics, oncology, cardiology and dermatology and appreciates them being provided close to where they live.

With respect to reimbursement, does “Medicare provide(s) the hospital 59% of total charges for a hip replacement while Medicaid provides 16% of total charges?”

No. Medicaid and Medicare reimburse Jefferson Healthcare based on a model that considers the cost of the care provided.

The reporter asked our CFO “What is the percentage of patients served by the hospital that are insured by Medicare and Medicaid?” The response given to the reporter by our CFO was “Medicare: 59% of total gross revenue (charges) Medicaid: 16% of total gross revenue (charges).” The article states Medicare provides the hospital 59% of total charges for a hip replacement while Medicaid provides 16% of total charges. The percentages our CFO provided were about the percentage of our total business (as asked) and have nothing to do with how much these payers pay.

Healthcare finance is complicated and we applaud The Leader’s interest in helping to demystify some of the complexity. However, it is important that The Leader understand the issues and complexity behind them, place in a local context and partner with either Jefferson Healthcare staff or outside industry experts to fact check and vet their work.

Mike Glenn has been Chief Executive Officer of Jefferson Healthcare since 2010. Prior to that, he was CEO of Olympic Medical Center in Port Angeles and has worked for University of Washington Medicine and Providence St. Peter Hospital in Olympia.