Discrepancy in local medical costs can cause sticker shock

Procedures at St. Mary's can be twice as high 
as Community Hospital, but context is key

Anesthesia technician Fran Duke, right, puts clean sheets on the bed as surgical staff member Kristin Bentley works at the new anesthesia machine as they prepare one of the operating rooms for surgery at Community Hospital.



062213_gdd_hospital_costs

Anesthesia technician Fran Duke, right, puts clean sheets on the bed as surgical staff member Kristin Bentley works at the new anesthesia machine as they prepare one of the operating rooms for surgery at Community Hospital.

St. Mary’s Hospital and Community Hospital in Grand Junction are barely a three-minute drive from each other, but the two are far apart when it comes to what they charge patients.

Medical costs at St. Mary’s are almost always more expensive than those over at Community, and in some cases twice as high, according to a federal database on hospital costs.

While the two hospitals, and others in the region, are still cheaper than most parts of the state, St. Mary’s costs were higher in 18 of 19 diagnoses in what hospitals charge Medicaid and Medicare patients, according to a federal database maintained by the Centers for Medicare and Medicaid Services.

Dan Prinster, St. Mary’s vice president of business development, acknowledged those numbers as accurate, but said a true comparison of the two hospitals isn’t that simple.

“If you have a patient who has additional complications, they’re going to come here before they go there (to Community),” he said. “We’re at a different level as a facility. We offer many more services that they don’t.”

While patients may get comparable care at both facilities for certain procedures and treatments, the two hospitals really can’t be compared because there is a limited list of conditions the two facilities have in common that they treat, Prinster said.

St. Mary’s has services and staff that Community doesn’t, so its expenses are naturally higher, he said.

Furthermore, Community has made a conscious effort to keep its charges low, a philosophy that eventually will hurt them, Prinster said.

“I know from having looked at charge data that Community has made the decision over several years that they’re not going to raise rates in certain areas,” he said. “Our board has made the decision over the years that given cost increases for medical equipment, for pharmaceuticals, for staff and other things, is that we have to — from a fiduciary standpoint — ... adjust our rates on an annual basis. That accounts for some of the price differences.”

Chris Thomas, president and chief executive officer at Community, agreed that the two hospitals are different when it comes to the services they offer, but he said Prinster doesn’t have a clue what drives his charges.

He said St. Mary’s costs are higher simply because it can get away with charging more.

“A big part of this is, when little Community Hospital sits down with the insurance companies and says, ‘Boy, I’d like to get paid more,’ the insurance companies say, ‘Yeah, Chris. No thanks,’ and I say, ‘Okay,’” Thomas said. “But when St. Mary’s, who has 85 percent of the market share, goes in and says, ‘I’d like to get paid this,’ they get it. I’m limited in most of my (insurance) contracts to not be able to increase my charges more than 6 percent a year. St. Mary’s doesn’t have those kind of restrictions.”

As a result, the difference in costs continues to widen, he said.

According to the Medicare cost database, St. Mary’s charges more than $46,000, for example, to treat a blood infection such as septicemia, but Community Hospital charges only about $21,000 to treat that same illness.

Dr. Donald Nicolay, chief medical officer at Community, said the only thing that is different in the treatment of that infection between the two hospitals is what patients would be charged.

Prinster, however, said cost considerations don’t stop there. When complications develop while treating such life-threatening conditions as septicemia, patients prefer to be at a hospital that has more services, and can more quickly deal with unexpected situations.

Oftentimes, Community Hospital patients end up being transferred to St. Mary’s because it doesn’t have the wherewithal to treat those who develop complications, he said.

Prinster points out that when there are no complications, the cost between St. Mary’s and Community is nearly identical.

Indeed, the database bears that out, showing St. Mary’s cost to be $27,158, and Community’s charge at $27,058. Charges for that condition, without complications, at Delta and Montrose are even cheaper, at $17,303 and $14,954, respectively.

Still, the Colorado Center on Law & Policy, a left-leaning group that advocates for affordable health care and responsible government spending that has studied hospital charges, says there seems to be no rhyme or reason as to why costs for the same procedures vary so widely across the state.

In a recent study of those charges, the center found that hospital costs can range from 43 percent higher than the statewide median to 57 percent lower.

Community Hospital, Delta County Memorial Hospital and Montrose Memorial Hospital were among the bottom five charging the least of all major hospitals in the state, with Montrose and Delta coming in second and third to last, respectively.

St. Mary’s, however, ranked closer to the middle, at about 19 percent below the state average.

With the exception of Denver Health, which charges about as much as St. Mary’s, all other Denver-area hospitals listed charges that were, on average, 25 percent higher than the state median, with some as high as 43 percent over that baseline.

Prinster said that’s why it’s better to compare St. Mary’s with hospitals located elsewhere in the state, such as Fort Collins, Boulder or Pueblo.

When compared to those facilities, St. Mary’s costs are more often than not much lower, and that’s by design.

“What we don’t want to do is force people to go to Denver to get cheaper care,” he said. “Every year when we do that (cost) analysis, we look at how our rates compare to similar hospitals, and on average we’re 10 to 15 percent below them. So, with our rate increases, we’re still below them. What’s fascinating is, we raise our rates, and they do, too, and some of them raise them even more.”

Both St. Mary’s and Community are in the midst of major construction projects to expand their facilities.

St. Mary’s, which opened its new $276 million 12-story building in 2010, is spending another $40 million to complete construction on the four top floors, two of which will become the new home to its rehab and surgical units.

Meanwhile, Community is building a whole new hospital and medical office building for about $73 million.

# # #

HOSPITAL COSTS

Here’s a list of 41 charges of common ailments treated at regional hospitals, according to data from the Centers for Medicare and Medicaid Services.

Blood infection with a major complication:
• Community Hospital: $20,910.46
• St. Mary’s Hospital: $46,268.97
• Montrose Memorial Hospital: $24,270.38

Fluid accumulation in the lungs and respiratory failure:
• Community Hospital: $18,812.58
• St. Mary’s Hospital: $39,572.48

Chronic obstructive pulmonary disease with a major complication:
• Delta County Memorial Hospital: $20,283.08
• Community Hospital: $17,501.39
• St. Mary’s Hospital: $28,461.46
• Montrose Memorial Hospital: $14,539.19

Pneumonia and lung inflammation with a major complication:
• Delta County Memorial Hospital: $24,681.69
• Community Hospital: $24,361.82
• St. Mary’s Hospital: $34,133.83
• Montrose Memorial Hospital: $17,892.29

Heart failure and shock with a major complication:
• Community Hospital: $14,361.91
• St. Mary’s Hospital: $28,228.12

Major small and large bowel procedures with complication:
• Community Hospital: $36,950.88
• St. Mary’s Hospital: $49,988.05

Chronic obstructive pulmonary disease with a complication:
• Delta County Memorial Hospital: $16,416.65
• Community Hospital: $16,959.93
• St. Mary’s Hospital: $23,603.48
• Montrose Memorial Hospital: $14,115.83

Chronic obstructive pulmonary disease without complications:
• Delta County Memorial Hospital: $11,723.56
• Community Hospital: $15,416.09
• St. Mary’s Hospital: $16,533.21
• Montrose Memorial Hospital:$9,141.40

Pneumonia and lung inflammation with a complication:
• Delta County Memorial Hospital: $17,302.14
• Community Hospital: $17,223.78
• St. Mary’s Hospital: $23,314
• Montrose Memorial Hospital: $11,244.70

Pneumonia and lung inflammation without a complication:
• Delta County Memorial Hospital: $9,809.72
• Community Hospital: $12,720.14
• St. Mary’s Hospital: $18,100.51
• Montrose Memorial Hospital: $9,680.86

Heart failure and shock with a complication:
• Delta County Memorial Hospital: $10,830.43
• Community Hospital: $16,268
• St. Mary’s Hospital: $22,092.77
• Montrose Memorial Hospital: $12,705.17

Stroke or bleeding within the skull with a complication:
• Community Hospital: $19,931.47
• St. Mary’s Hospital: $24,025.42
• Montrose Memorial Hospital: $12,592

Blood infection without  a major complication:
• Delta County Memorial Hospital: $17,303.91
• Community Hospital: $27,058
• St. Mary’s Hospital: $27,158.90
• Montrose Memorial Hospital: $14,954.40

Inflammation of the esophagus, gastrointestinal tract or other major digestive disorders without major complications:
• Delta County Memorial Hospital: $10,339.65
• Community Hospital: $13,953.12
• St. Mary’s Hospital: $16,699.77
• Montrose Memorial Hospital: $8,590.93

Skin or connective tissue inflammation:
• Delta County Memorial Hospital: $8,544.95
• Community Hospital: $11,641.08
• St. Mary’s Hospital: $21,005.58
• Montrose Memorial Hospital: $11,164.12

Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without major complications:
• Delta County Memorial Hospital: $8,597.86
• Community Hospital: $11,695.88
• St. Mary’s Hospital: $13,354.75
• Montrose Memorial Hospital: $11,812.36

Hip and femur procedures not including major joint replacement with complications:
• Community Hospital: $28,152.73
• St. Mary’s Hospital: $36,832.12
• Montrose Memorial Hospital: $27,593.74

Major joint replacement or reattachment of lower limb without major complications:
• Delta County Memorial Hospital: $31,814.80
• Community Hospital: $37,524.77
• St. Mary’s Hospital: $34,378.06
• Montrose Memorial Hospital: $31,441.26

Kidney and urinary tract infections without major complications:
• Delta County Memorial Hospital: $10,958.25
• Community Hospital: $10,073.53
• St. Mary’s Hospital: $14,433.41
• Montrose Memorial Hospital: $11,141.69

Heart pacemaker with a complication:
• Montrose Memorial Hospital: $34,939
• St. Mary’s Hospital: $64,094.60

Stroke or bleeding within the skull without a complication:
• Delta County Memorial Hospital: $12,147.29
• St. Mary’s Hospital: $22,598.36
• Montrose Memorial Hospital: $9,385.70

Short term loss of blood flow to the nervous system:
• Delta County Memorial Hospital: $8,854.87
• St. Mary’s Hospital: $16,546.46

Seizures without a major complication:
• St. Mary’s Hospital: $19,283.85
• Montrose Memorial Hospital: $7,573

Blockage of an artery of the lung without a major complication:
• Delta County Memorial Hospital: $14,768.68
• St. Mary’s Hospital: $23,736.04
• Montrose Memorial Hospital: $13,054.44

Permanent heart pacemaker:
• St. Mary’s Hospital: $64,094.60
• Montrose Memorial Hospital: $34,939

Perc cardiovascular procedure with a drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,519.17
• Montrose Memorial Hospital: $34,859.20

Perc cardiovascular procedure with a non-drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,493.55
• Montrose Memorial Hospital:$34,072.92

Heart failure and shock without a complication:
• Delta County Memorial Hospital: $7,911.91
• St. Mary’s Hospital: $15,955.39
• Montrose Memorial Hospital: $7,594.50

Heart arrhythmia and conduction disorders with a complication:
• Delta County Memorial Hospital: $13,749.77
• St. Mary’s Hospital: $23,247.50
• Montrose Memorial Hospital:$13,753.24

Heart arrhythmia and conduction disorders without a complication:
• Delta County Memorial Hospital: $6,109.94
• St. Mary’s Hospital: $11,970.62
• Montrose Memorial Hospital: $8,613.79

Fainting and collapse:
• Delta County Memorial Hospital: $7,344
• St. Mary’s Hospital: $16,640.82

Chest pain:
• Delta County Memorial Hospital: $5,345.43
• St. Mary’s Hospital: $12,033.37
• Montrose Memorial Hospital: $7,877.40

Major small and large bowel procedures with major complication:
• Delta County Memorial Hospital: $69,319.75
• St. Mary’s Hospital: $105,751.25

Gastrointestinal hemorrhage with complication:
• St. Mary’s Hospital: $20,359.18
• Montrose Memorial Hospital: $13,632.23

Gastrointestinal hemorrhage without complication:
• Delta County Memorial Hospital: $13,628.12
• St. Mary’s Hospital: $14,011.36

Gastrointestinal obstruction with complication:
• Delta County Memorial Hospital: $16,624.83
• St. Mary’s Hospital: $21,347.64

Gastrointestinal obstruction without complication:
• Delta County Memorial Hospital: $9,029.35
• St. Mary’s Hospital: $12,163.70

Minimally invasive removal of the gall bladder without complications:
• St. Mary’s Hospital: $25,684.89
• Montrose Memorial Hospital: $19,444.82

Fractures of the hip and pelvis without complications:
\• Delta County Memorial Hospital: $13,324.25
• St. Mary’s Hospital: $14,299.92

Medical back problems without major complication:
• Delta County Memorial Hospital: $10,025.12
• St. Mary’s Hospital: $18,586.62

Signs and symptoms without complications without major complication:
• St. Mary’s Hospital: $19,006.70
• Montrose Memorial Hospital: $7,925.31



COMMENTS

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As a Parachute subscriber I would be more interested in comparison costs for Grand River Hospital and Valley View Hospital both of which, I believe, would be more convenient to Grand Junction residents than Montrose Hospital.

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