Citizens voice concern

Citizens voice concern, outrage over health care

Sept 8, 2001

Yellow Jacket resident Wade Wilson voices his concerns about health care during a forum in Durango Wednesday.

By Tom Vaughan
Mancos Times Editor

"Crisis" was used frequently to describe the condition of Colorado’s rural health care during a hearing held at Fort Lewis College Wednesday.

The public meeting was one of six being held around the state by the General Assembly’s Interim Task Force to Evaluate Health Care Needs for Colorado, made up of five state representatives and five senators, including Sen. Jim Isgar (R-Hesperus).

The task force is charged with examining the "rural health-care market to address network adequacy, including the shortage of primary care physicians; cost factors driving health-insurance-premium rates for all types of consumers; and the fragility of small business in obtaining health-insurance coverage."

The legislators got an earful.

"We’ve got a crisis," declared Wade Wilson, a Yellow Jacket farmer. He said he can’t afford health insurance, nor can most of his neighbors.

"We need to find some way to keep health care affordable," Wilson went on, getting a round of applause at his observation that $85 office visits are beyond his means.

"We’re headed for a larger crisis," was Bob Peterson’s message to the legislators. The CEO of Southwest Memorial Hospital pointed out that many rural hospitals were built in the 1950s with funds from the Hill-Burton Act. Those facilities are now outdated and costly to maintain, repair and replace.

While cautioning that "very few hospitals can tell you what the cost of a specific service is," Peterson quoted an average cost of $4,727 for a hospital stay related to pneumonia in rural Colorado, compared with a $9,769 average in Colorado’s urban hospitals and $10,793 in Denver. He said health-care costs in rural areas are generally cheaper across the U.S.

Joyce Humiston-Berger, health-care director of the Valley Inn Nursing Home in Mancos, later cited Durango Health Care Coalition data showing price disparities on the Western Slope: A gall-bladder operation costs $6,000 in Durango, but only $3,000 in Grand Junction.

INSURANCE LAMBASTED

Insurance companies, though not represented among the speakers, took a drubbing, as did health maintenance organizations and the Medicare and Medicaid programs.

Peterson challenged the wisdom of insurance-company practices, using the example of a patient who needed a procedure that would have cost $9,694 at SWMH. Because the Cortez hospital does not offer discounts to insurance companies, the patient was required to go to another hospital that gives a 20-percent discount to insurers. Because the second hospital’s base rate for the same procedure was $12,618, the insurance company still paid over $10,000 — more than it would have paid at SWMH.

Sen. Andy McElhany (R-El Paso) observed that individuals often pay twice as much as insurance companies do for the same service because of the practice of discounting to insurers.

Humiston-Berger and other speakers complained about insurance networks of preferred providers that are limited by state lines. Patients who can’t find necessary services in Cortez or Durango, they said, may be forced to travel long distances and cross mountain passes when the services they need could more easily be obtained in Farmington or Albuquerque.

Brad Cochennet, Mercy Medical Center’s vice president for fiscal services, pointed out that the "usual and customary" figures used by insurance companies to cap reimbursements for services are set by the companies themselves; there are no objective, independent sources for the data.

As did others, Cochennet chastised Medicare for its low rates of reimbursement.

Rural populations tend to be older, he said, thus more likely to rely on Medicare and Medicaid. The result can be disastrous for the hospital, as evidenced by his example of three Medicare patients at Mercy in May of this year. Their total care cost more than $750,000 — but Medicare reimbursed the hospital just $50,656.

Providers at all levels decried the complexity of the present health-insurance environment. Mercy, according to Cochennet, currently deals with more than 5,000 insurance companies.

Cortez physician Leonard Cain estimated he works with 25 different payers and "the cost of doing business as a physician has been going up." He expressed the hope, echoed later by Durango physician George Maxted, that a single-payer system will be created to simplify and standardize insurance payments and procedures.

GROUP COVERAGE SCARCE

At the same time, employers said, there is a shortage of sources for group policies to cover employees.

Karen Zink, owner of Southwest Women’s Health Associates in Durango, said small businesses need help in providing health insurance to employees.

John Wolgemott owns Stoneage, Inc., in Durango. He told the panel there are only two active carriers of group policies in this area: Rocky Mountain HMO and Blue Cross/Blue Shield.

Humiston-Berger also wanted to have more options. Forced with cutting coverage to keep costs down, she would like to have the option of providing major medical policies to individuals instead of group coverage. She also suggested tax credits for employers who provide health insurance for their workers.

"The HMOs created this monster," declared task-force chair Sen. Joan Fitz-Gerald (D-Boulder), by claiming, "All your health needs will be taken care of." One result, said Linda Erickson, a La Plata County health-care consultant, is that the "insurance companies can cherry-pick," choosing where they will offer their policies.

PAPERWORK OVERWHELMING

The outlook from those on the front line wasn’t rosy, either.

"A lot of us can’t afford the health care that we’re delivering," stated Ginger Hill, interim director of nursing at Durango’s Four Corners Health Care Center.

"The nursing shortage is real!" Hill exclaimed.

Zink said it’s not only real, it’s global, adding, "An under-educated nursing pool is not an option."

"Beds are staffed by nurses and supported by dollars," explained Jean Phillips Truscott, chief nursing officer, Mercy Medical Center. In addition to the frustrations of professional isolation and limited access to continuing education in the Four Corners, she said nursing salaries are declining relative to the cost of living.

Brenda Isgar, a nurse with La Plata County’s home health-care program as well as the wife of the senator, outlined the need for more certified nursing assistants in health care. The shortage is worsened, she said, by the fact that many hospitals do not offer health insurance for CNAs.

Humiston-Berger questioned whether patient care is served when she has to assign two registered nurses each day just to do the documentation that’s now required.

Michelle Appenzeller, Mercy’s director of outpatient services, has the same doubts about the 70 questions that must be filled out by an RN on each new home health-care patient.

The task force was to meet again on Friday in Denver to consider a summary of the issues presented in the field hearings.

Though not on the task force, Rep. Mark Larson (R-Cortez) was present throughout the hearing and Rep. Kay Alexander (R-Montrose) attended the morning session.