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Taking the temperature of health care part 2: Decisions, decisions

Editor’s note: This is the second article in a five-part series on the cost of health care in western Wisconsin. Get caught up on the series here.

Whether you are purchasing health insurance for your employees, buying your own insurance privately or on the government marketplace, participating in a healthcare sharing ministry, or opting not to purchase health insurance, it has become a frustrating, stress-inducing experience. The blatant politicization of the health care system holds consumers hostage leading to anxiety and uncertainty.

Even with insurance, practically every health care decision today has also become a financial decision and that makes people more than a little uncomfortable. Patients can pay thousands of dollars for care and barely benefit from their insurance.

Are we approaching a point where the cure is becoming worse than the disease? To find out, RiverTown Multimedia asked the CEO's of four local hospitals to answer five questions about the state of health care in our backyard. Here is Part Two of the discussion.

  • Steve Massey, President and Chief Executive Officer, Westfields Hospital & Clinic
  • Alison Page, Chief Executive Officer, Western Wisconsin Health
  • David Miller, President River Falls Area Hospital, Allina Health
  • Thomas Borowski, President Hudson Hospital & Clinic 

Question #2

There is a fair amount of anxiety well before you even make a health care decision these days because of the financial implications of those decisions. People who were just settling into the Affordable Care Act (ACA) and understanding that the basics of healthcare, important preventative procedures like physicals, mammograms, colonoscopies, were going to be covered, question that assumption now. Politics have introduced uncertainty into the equation and it is no longer clear that the basics will be covered, or for how long they will be covered, or whether subsidies will continue to help people afford Insurance. How does that uncertainty impact the provider side of the equation?

Alison PageAP: I think the ACA has moved things forward to try to get people coverage for those basic preventive things, get your mammogram, get your colonoscopy, do the preventive screening stuff. If you get sick, only then will you be into your deductible. The idea was to get people to do the preventive stuff. Most of the people in the state of WI are insured right now. In the area that we live in, almost 100% of people have insurance. However, they have insurance where they are going to have to pay the first $5,000 or more out-of-pocket. Who makes $15 hr. and can afford the first $5,000 cash out of pocket? People don't go to the doctor because they have to pay a lot of money.

Steven MasseySM: In St. Croix County, over the last two decades, we've had a very low pure uninsured (population). But what you'll find is families have pretty high deductibles, and so they are paying the first dollar of whatever that negotiated price is. They want to know, is there a price outside of insurance that they can pay. There really isn't. By law, we've got to run things through insurance claims because that's part of our agreement with insurance companies.

AP: The ACA covered a list of mandatory procedures that could be received by people before their insurance kicked into their deductible as a way to try to convince people to get primary care. Research shows that even people who should be able to afford to pay that money don't, because they would rather just not spend cash out of pocket (on healthcare). They would rather spend it on something else.

Thomas BorowskiTB: At Health Partners, we believe that it's really important that everybody have good, affordable health care coverage. We know for a fact, that when people have good coverage they are more likely to do preventative type of care. They are more likely to do diagnostic testing and typical screenings for things like blood pressure and cholesterol before it becomes major. With that health care coverage combined with the care delivery model, we're really trying to address all the aspects of the care continuum. In today's environment, that preventative care can make a big difference preventing larger costs from happening down the line. Don't believe everything you hear. Take charge of your own health, become an informed consumer. Partner with the healthcare organization that you trust.

David MillerDM: Yes, there is more churn today for a variety of factors, such as people changing insurance more often. At River Falls Area Hospital and Allina Health in general, we work very hard to create and support lasting physician and patient relationships. However we know the most important connection is between a patient and their primary care doctor; so much so that we spend a lot of time and resources in the hospital trying to connect patients to a primary care physician if they don't already have one. It is that important to maintaining health and wellness. Allina Health is committed to disease awareness and prevention, not just treating the illness after the fact.

SM: The better price is to make sure you are going to get care where it makes sense, the right care, at the right time, by the right type of clinician, in the right setting. Whether its a clinic, an urgent care clinic at Walmart, on line, or and ER visit, it's really about making sure you are going to the right setting, because they are all priced at different levels because of the complexity and resource utilization.

AP: What happens is, people go, whether its on the government website or an insurance broker, shopping for insurance and they look at price first. But they also need to look at where can I get my care. My mom is 92 yrs old and she lives in River Falls. She wants to get her care at the RF Vibrant Health Clinic and she wants to go to the RF Hospital. That's her hometown hospital. She needs to make sure she gets insurance that will let her go there. People need to be a little bit more discriminate maybe than they've been and not just look at price. In the old world, your insurance would cover you anywhere. Now that's called Medicare and Medicaid. That way of thinking is changing. For your basic care, you need to select insurance that will let you go where you want to go.

SM: At the end of the day, all of the hospitals in western WI, whether you are part of a system or not, they've got financial counselors in place. We're all nonprofit, we all give hundreds of thousands of dollars away in charity care based on financial hardship. It's all based on financial metrics. A lot of times, by providing us with their information, we can get patients approved for BadgerCare they didn't even realize they could get. Other times, because of financial hardship, we can get people approved for a cash price at a discounted rate, even with their deductible. Maybe they've had something happen where they've had to meet their deductible of $10,000, we've got payment plans, zero percent interest, plans that go out 4-5 years. There's not too many people that could walk in and just write a check for $10,000. The key is just to be upfront, if you're having issues, come in and work with a financial counselor. The hard part is, when patients aren't wanting to work to understand their options, they just throw up their hands and say I'm just not going to do anything. It's hard to help someone who prefers not to be involved, not to be a partner.

AP: Hospitals are generally 501(c)(3) not-for-profit organizations and are required to provide some amount of charity care. It is hard to say how much a hospital can provide. I would say it depends on how profitable that particular hospital is. The uninsured rate in Western Wisconsin is very low, and so, the charity care level is also fairly low.