Taking a Turn for the Worse

              (The dinus Sun., Jan. 23,1983
UPDATE
This couple moved
and took home too
— Page 3
Scott and Popcorn:
they're winners
Page 15 E
Taking a
turn
for the worse
Cutbacks, inflation may force
raising the cost of being ill
By Jane Miller
YOU just got over a bout with pneumonia that confined
you to the hospital bed for six days. The hospital bill ar-rives
in the mail. This time it's your financial health that is
stricken when you see the $300-a-day charges.
Local hospital administrators say
charges may soar for patients who pay
for their hospital stays through in-surance.
These patients are caught in
the whirlwind of government cut-backs
to hospitals providing care for
Medicaid and Medicare patients, ex-pensive
new technology and inflation.
According to hospital figures, pa-tients
in Shreveport and Bossier City
may pay an average $134 a day for
rooms.
Room rates long have been the
benchmark for comparing hospital
charges. Based on local figures, the
average daily hospital tab here is
pushed up to $300 to take care of X-rays,
lab tests and anesthesia. Phys-ician's
fees are usually billed separ-ately.
The eight hospitals in Shreveport
and Bossier City show a spread of $30
between daily private room rates —
from $120 at LSU Medical Center to
$150 at Schumpert Medical Center.
Shreveport-Bossier's daily room
charges are the seventh highest in the
state, according to hospital cost com-parisons
compiled by Equitable in-surance
company. Shreveport-Bossier
is behind New Orleans ($163), Metairie
($155), Marrero ($148), Lake Charles
($142.50) and Covington ($136.50).
Nationally, Louisiana's daily rates
are ranked 47th. National average dai-ly
hospital room rates climbed 12 per-cent
from $150 in 1981 to $167.50 in
1982. Only Arkansas ($124), Missis-sippi
($99) and South Carolina
($126.50) have lower averages than
Louisiana. The average daily room
rate in Texas is $141.50.
Cost-shifting culprit?
Most hospital administrators blame
skyrocketing hospital bills on "cost-shifting."
Hospital administrators and
insurance companies use that term to
mean putting the burden of hospital-izing
the poor and the elderly on the
patient who pays for his room with in-surance.
Beginning this year, the Medicare
program, which provides health care
for the aged sick, was cut $2.5 billion
nationwide. Also, cuts into the Medi-caid
program, which assists the poor,
prompted Health and Human Re-sources
to trim $7.5 million from the
$120 million reimbursed Louisiana
hospitals that participate in the pro-gram.
Health and Human Resources post-poned
the cuts until April 1, after the
Louisiana Hospital Association filed a
lawsuit contending the cuts would
produce a financial hardship for hospi-tals
and force them to up rates.
Spokesmen in Health and Human
Resources and local hospitals, how-ever,
still say future cuts will shift the
health care cost load even more heavi-ly
onto the lap of the insurance-carry-ing
patients.
"That leaves three alternatives for
hospitals," said James Hughes,
comptroller at Physicians & Surgeon's
Hospital in Shreveport. "They can ac-cept
the cutbacks and let their
financial condition suffer, raise more
outside funds or shift the costs to the
private-paying patient."
A spokesman for the Health In-surance
Association of America said
the private-paying patient or his in-surance
carrier paid $50 a day to make
up for what the federal government
underpaid for Medicaid and Medicare
patients in 1980, the latest figures
available.
That compares with a $12 cost shift
in 1975, said Neil Swan of HIAA, an as-sociation
of 340 private insurance
companies in the United States. Be-cause
of the growing spread between
what the government pays for Medi-caid
and Medicare patients and what
other patients pay, insurance
premiums have increased 20 to 50 per-cent
in the past two years, Swan said.
The effect locally
The federal cutbacks in Medicaid
and Medicare payments are likely to
hit hardest metropolitan hospitals and
rural hospitals. In New Orleans, for
example, the labor market is ex-pensive.
In rural hospitals, there are
more elderly patients, said John
Matessino, director of planning for the
Louisiana Hospital Association.
For example, between 57 and 60
percent of the patients at the 33-bed
North Caddo Medical Center in Vivian
are Medicare patients, said adminis-trator
Kenneth Gray. That compares
with an average of 30 percent at
Shreveport-Bossier hospitals.
LSU Medical Center will be af-fected
by changes in payments for
Medicaid and Medicare, which ac-counted
for 39 percent of the patient
load last year, said administrator
Robert Hall. Also, 48 percent of the pa-tients
at LSU were considered charity
cases last year.
State budget cuts, hospital reno-vation
work and a shortage of regis-tered
nurses already have forced LSU
to reduce its bed count from 507 to 365,
Hall said.
"What's been happening in the last
six to seven years is that a larger por-tion
of the operating budget has come
from Medicaid and Medicare," Hall
said. "The slack is going to have to be
made up by the state Legislature."
At Highland Hospital, Medicare pa-tients
accounted for 43 percent of the
hospital's census last year. Richard
Ketcham, administrator, said hospi-tals
have been receiving Medicare re-imbursements
at about 80 percent of
what a private patient pays.
Meanwhile, hospitals are faced with
stricter Medicare payment guidelines.
Hospitals will no longer be reim-bursed
for a variety of costs such as
housing Medicare patients in private
rooms and supplementing nursing
salaries for extra care to be provided
the elderly.
Coming up short
What that means is many hospitals
will come up short during fiscal 1983,
said John Adams, financial director at
Bossier Medical Center.
Preliminary estimates show Boss-ier
Medical Center may receive
$200,000 less in Medicare reimburse-ments
in fiscal 1983 than in 1982, he
said. Only 18 percent of Bossier Medi-cal
Center's patient load receive Medi-care,
but elderly patients' hospital
stays are usually longer, Adams said.
The trend in Medicare, hospital ad-ministrators
said, is toward reimburs-ing
hospitals at a maximum,
predetermined rate. Currently, hospi-tals
are retrospectively reimbursed,
meaning that hospitals are paid ac-cording
to cost reports submitted to
the state agency.
Reimbursing at a maximum rate
provokes cost shifting even more, the
administrators said. However, HIAA's
PITAL
Hospital
BOSSIER MED.
Semi- Priv.
priv.
$126 1131
ICU Avg.
care days
stayed
DOCTORS1 HOSPITAL $139.50 $141
HIGHLAND HOSPITAL
LSU MED. CENTER
P&S HOSPITAL
$120 $130
$115 $120
$125 $130
RIVERSIDE HOSPITAL $121 $131
SCHUMPERT
WILLIS-KNIGHTON
$146 $150
$292
$237
$275
$270
$300
$262
$310
$136 $138 $300
5.04
5.80
5.00
7.00
6.00
5.40
6.80
5.20
Apply shopping skills to medical care
By ROBERT KIECKHEFER
CHICAGO (UPI) - People could
save a lot of money if they applied
their usual shopping skills when
they need medical care, says the
head of a national organization of
medical assistants.
"Most people, especially women,
are great comparative shoppers,"
said Janet Hensinger, president-elect
of the American Association
of Medical Assistants. "When it
comes to medical needs, however,
they hesitate to shop around for sec-ond
opinions and lower-priced
drugs.
"In truth, most families could
save as much as several hundred
dollars annually, depending on
their health care requirements."
Ms. Hensinger said one of the
basic ideas for saving money is to
find a good family-oriented doctor
who can perform basic diagnostic
work on a variety of illnesses. That
will prevent unnecessary visits to
higher-priced specialists, she said.
She said patients should shop
around to see how much doctors
charge for an initial visit and for
subsequent visits. Differences in
fees can save many dollars over a
long period of time. The same is
true of drugs; in some cases it may
be possible to buy generic drugs
that cost much less than name
brands, she said.
She cautioned people against
stopping medicine unless told to do
so by their doctors.
"We find patients often will use
the medication a few times, start
feeling better and quit taking the
drug when, in fact, they should have
completed the prescription," Ms
Hensinger said. "Then they wonder
why they have a flare-up and have
to order — and pay for — another
prescription."
Tests also can be a significant
factor in the cost of medical treat-ment,
and should not be taken
without consideration, she said.
"Tests are so expensive today, es-pecially
the CAT scans which have
become so popular," Ms. Hensinger
said. "It's a good idea to get at least
two opinions on whether the test is
necessary."
Patients also should determine
ahead of time what kind of payment
the doctor prefers. Some accept
credit cards for small amounts and
others give a 5 percent to 10 percent
discount for immediate payment,
she said.
"Sometimes, a doctor's approach
to bill collection may seem harsh,"
she said. "But bill collection is a
major problem for physicians."
Ms. Hensinger said 60 percent of
the nation's 210,000 office-based
doctors have "excessive" outstand-ing
accounts.
Swan said it will give hospitals incen-tive
to economize.
Cost-cutting measures
There is room for hospitals to cut
back on operating expenses without
shifting the cost of hospitalizing the
poor and elderly from the federal gov-ernment
to the private-paying patient,
officials of Louisiana's Department of
Health and Human Resources said.
Dr. Jonathan Roberts heads the
state agency's division for charity hos-pitals.
He suggested ways to cut labor
costs, which eat up 75 percent of most
hospital budgets: Employ licensed
practical nurses where registered
nurses are often hired, but not re-quired;
replace, in some cases, LPNs
with nursing assistants.
Other moves include pooling
purchasing, sharing equipment and
consolidation, Roberts said.
However, most local hospital ad-ministrators
said going up on bills paid
by private-paying patients and their
insurance companies is the easiest
may to make up for declining reim-bursements.
The hardest pill for hospitals to
swallow may be cutting back on ser-vices.
Jon Sherwin, administrator of
Riverside Community Hospital, ad-dressed
that aspect.
"There probably is (room for more
economical hospital operation) if
people are going to take less than the
existing level of care, but I'm not go-ing
to make that decision as a health
care provider," he said. "That's some-thing
society as a whole has to make."
Hospital administrators say they
have undertaken cost-cutting
measures by reducing the average
length of the patient's stay. In
Shreveport, that figure ranged from
five days at Highland Hospital to
seven days at LSU Medical Center.
The national average is 6.39.
Surgical patients at Bossier Medi-cal
Center stay on the average 4.88
days, but for Medicare patients over
65, that average climbs to 8.49 days,
Adams said.
LSU Medical Center's average
seven-day stay and approximate
$2,100 cost per stay may be above av-erage
because of the demographics
and the economic status of the patients
it serves, said Hall.
"They're usually the ones who have
gone without care more often," Hall
said. "We treat a lot of premature
babies and more elderly, who usually
stay longer."
Administrators insist their hospi-tals
are operating as efficiently as
possible, given doctors' orders and
hospitals' responsibility to provide the
best care, even if that means ex-pensive.
"The people who don't need health
may complain about high medical
costs," said David Beach, director of
the Bossier Medical Center. "But
when they get to the hospital they
thank God for all the technology and
innovations and demand the finest for
themselves, their mothers and
fathers."
Jerry Cronin, vice president of actu-ary
and underwriting services for
Blue Cross/Blue Shield of Louisiana,
said "There's been a lot of finger point-ing
among doctors, hospitals, Blue
Cross and other insurance companies.
We all share in the cause, including the
general public who don't take care of
themselves."
Insurance companies involved
Blue Cross/Blue Shield, which ac-counts
for about 25 percent of Louisi-ana's
health insurance, and other in-surance
companies are beginning to
take a stand against rising hospital
costs.
The companies are lobbying the fed-eral
government to pay its share of
Medicaid and Medicare costs. The
companies also encourage patients to
take advantage of less expensive out-patient
services.
Employers, which supply most of
the nation's insurance through group
policies, also are cracking down after
finding themselves paying sky-rocketing
insurance premiums.
They're asking employees to foot
more of the bill. That may mean much
higher deductibles in the future, in
some cases $1,000, said Donald
Boudreaux, chief of the life and health
insurance division in the Louisiana In-surance
Commissioner's office.
As Cronin said, health care con-sumers
want an eternal contract on
life without paying the regular dues.
"We smoke our cigarettes, drink our
whiskey, drive our cars 90 miles an
hour and demand immortality."