A local woman wants to alert those on Medicare, and their physicians, to be aware the amount they will be expected to pay could be double what it should be if they have outpatient procedures performed at any Critical Access Hospital. Eureka Springs Hospital (ESH) and Mercy Hospital-Berryville are both CAHs.
CAHs are rural hospitals designated by the Centers for Medicare and Medicaid Services (CMS) to receive supplemental financial assistance. The idea is for CAH status to help preserve healthcare access in rural areas. Medicare pays an additional “adjustment” to CAHs, which may be equal to or greater than the Medicare payment for the procedure itself. That means patients on Medicare who are required to provide a co-pay of up to 20 percent can end up with a co-pay twice as high as expected.
“Last year, I was referred to the Eureka hospital by a local physician for a CT scan,” said the Medicare patient who chose to remain anonymous for health privacy reasons. “Neither the Eureka hospital nor the physician told me that the hospital is a Critical Access Hospital. I learned about the impact the hospital’s Critical Access Hospital status had on me and others on Medicare after the hospital sent me a bill that was twice the amount the hospital staff had given as the cost of the CT scan before it was carried out.”
The woman, who provided copies of records to back up her statements, researched costs for CT scans in the region prior to having her procedure. The regional average was $1,000. She said the staff at ESH told her it would be $2,000, but she decided it would be easier to pay a $400 co-pay than to screen, arrange for, and travel to an out-of-county medical facility.
“When I got the bill, my co-pay was not $400, as I had expected,” she said. “It was almost $800. In other words, my co-pay was close to the average regional cost of the procedure itself. Eureka hospital had already received about $4,000 from Medicare for the CT scan – four times more than the scan would have cost at a non-CAH facility – and the hospital’s total intake would rise to nearly $5,000 when my $800 was included.”
In doing research to file a complaint with Medicare, she found a 2014 study by the Office of the Inspector-General: “Medicare beneficiaries paid nearly half the cost for outpatient services at Critical Access Hospitals.” The study found that Medicare outpatients are paying up to six times more at CAHs and recommended charging a co-pay based on Medicare’s payment to CAHs for the procedure itself, rather than basing the co-pay on the sum of the payment for the procedure, plus the additional adjustment Medicare pays to CAHs.
She said that retirees, many of whom can’t afford high medical bills, are being gouged by CAH hospitals under the method currently used to calculate co-pays. She noted that this economic burden is compounded by the practice of most hospitals, including ESH, of demanding the maximum co-pay allowed by law.
“I was not adequately informed,” she said. “If I had known then what I know now, I would have gone somewhere other than the Eureka Springs Hospital for that CT scan. In the future, I will not go to any CAH for an outpatient procedure. The Department of Health and Human Services needs to make the changes that were recommended by their own Office of Inspector General several years ago.”
In an effort to resolve the issue of her co-pay, she asked to meet with the hospital’s billing manager, but met with no success.
“Rather than agreeing to my request for a meeting with management to discuss my bill, Eureka hospital decided to turn the bill over to a collection agency,” she said. “I wrote the collection agency a letter saying, ‘Please provide documentation that you are licensed to operate in Arkansas and also notify anyone you have communication with in this case that it is in dispute.’”
She has heard nothing more from the debt collection agency or the hospital, and doesn’t know if the hospital sold her debt to the collection agency or requested reimbursement by Medicare. The charge remains on the Medicare statement she receives quarterly.
Peter Savoy, CEO of EHS, said all ESH patients are charged the same price for the same type of service rendered. Savoy said this is true regardless of their status as an inpatient or outpatient, and regardless of their payer classification, be it Medicare, Medicaid, private pay, commercial insurance or any other payer type.
“Also, Medicare requires that delinquent accounts go through a collection process, which at some point may include the use of an outside collection service, in order for a claim to be written off,” Savoy said. “This mandated process is followed for all payer classifications. In addition, the hospital works diligently with patients/guarantors in an effort to set up payment arrangements when a balance cannot be paid in full.”
“The key thing here is that every Medicare patient in this region needs to know that their costs will be two to six times greater if they are referred to a CAH or go to a CAH for emergency care,” the woman said. “People need to know. I am not sure physicians are aware of this, either.”
She said while doing research, she found something of even greater concern.
“Hospital staff not only didn’t tell me the hospital was a CAH, they didn’t tell me that the CT scanner they had at that time did not comply with the XR-29 standard established by the National Electrical Manufacturers Association with the aim of protecting patients from radiation overdoses,” she said.
The woman provided billing and codes showing that the ESH scanner was non-compliant, as well as notices warning that Medicare payments to hospitals with non-compliant scanners would be reduced if the scanners were not upgraded or replaced by 2016. She found that in some areas of the country, non-compliant scanners had delivered high doses of radiation.
“Cases of patients receiving high radiation overdoses during CT scans started making the news almost ten years ago,” she said. “My CT scan was in March of 2016, and in December of 2016, the Eureka hospital bought a new scanner. The point is they had to get that new scanner and they should have gotten it years earlier.”
Regarding safety concerns for the hospital’s CT scanning procedures, Savoy said it is the mission of Eureka Springs Hospital to provide safe and first class services for the Eureka Springs community.
“Costing approximately $500,000, Eureka Springs Hospital has the most up to date radiologic equipment, with a Siemens SOMATOM Scope 32-Slice CT Scanner and Quantum Digital Radiographic System,” Savoy said. “Preceding and concurrent with the recent NEMA XR-29 standard, Eureka Springs Hospital, as required by law, continues to follow in-house safety procedures, complete routine training and in-services, and attains its state inspections in order to comply with regulatory issues. In addition, it is hospital policy to practice ALARA [As Low As Reasonably Achievable] for all services provided. The hospital is also in line with the NEMA XR-29 standard.”
Mercy Hospital-Berryville is also a CAH. Eric Pianalto, CEO of Mercy Hospital Northwest, said as a not-for-profit ministry, they are going to take care of people regardless of their ability to pay.
“We will work with them on payment arrangements,” he said. “If it was non emergent, I would recommend patients proactively discuss the bill and ask about a payment arrangement. I would highly encourage that.”