RX for Change: Confronting the health care crisis in Kansas

Patients' demands for latest technology drive medical costs

Editor's note: In a series of stories this week, Harris News Service and the Harris Group newspapers in Kansas examine the growing cost of health care and its effects on the state's residents.

Dec. 5, 2005

By Phyllis J. Zorn

Hays Daily News

When it comes to medical technology, keeping up with the Joneses and staying out of the red is like having the devil on the left shoulder and an angel on the right.

If a hospital doesn't boast equipment the patients think they need, they'll go elsewhere. But high-dollar equipment drives up the cost of health care.

Few can argue that advancing medical technology hasn't benefited patients and made a difference in effective treatment.

"We've been able to identify diseases earlier and more accurately," said Dr. John Jeter, president and CEO of Hays Medical Center. "The cure rates for cancer have gone up significantly."

The average length of life today in comparison to that of 15 or 20 years ago is a testament to advances in medical treatment. But access to medical technology triggers supply-induced demand, Jeter said.

"Baby boomers have this insatiable need for more tests, and physicians order them," he said.

Hays cardiologist Dr. Jeffrey Curtis agrees.

"In this country, the culture is that everyone deserves the best treatment," he said.

Curtis admits that if a patient makes a particular request, he tends to comply. But if that's not the best treatment, or the patient has to travel for that treatment, he discusses other options with the patient.

Curtis said that if patients took more direct financial responsibility for their treatment decisions, they would make different decisions, both when a physician is seeing them and before they need to be seen.

One factor in physicians' willingness to order tests is that they fear the patient will go elsewhere if the test is withheld, Jeter said. That same fear contributes to hospitals and clinics purchasing expensive equipment so they can stay competitive.

"You have this arms race," Jeter said. "It increases the cost of care."

Hays Medical Center annually budgets $6.5 million for capital projects - or 5.4 percent of its $120 million operating budget.

Having access to technology in their home area is important to northwest Kansas residents, Jeter said.

Margie Hammerschmidt, administrative director for imaging, radiation and biomed services for the Hays hospital, said the hospital makes arrangements for occasionally needed equipment to be brought here by a contractor.

An example Hammerschmidt pointed to is a PET-CT scanner, a machine that combines nuclear medicine with a Computed Tomography scanner. About 10 patients each week need it, and the hospital didn't want those patients to have to drive to Wichita, Hammerschmidt said.

Besides patients requesting expensive tests, sometimes physicians order the tests for their own benefit.

"If physicians order a lot of tests simply so they can say on the witness stand, ÔI ordered every test,' that's a piece of the cost of medicine," Jeter said. "I think it's a big piece."

Jeter said the Hays hospital's standards and equipment compare similarly with Salina Regional Medical Center. But the eyes are cast in a different direction in the DeBakey Heart Institute section of Hays Medical Center.

"Our primary competitor is Wichita," said HMC Chief of Operations Bryce Young.

The DeBakey Heart Institute over the past year has sought to expand its reach and draw in patients from southwest Kansas.

"I think our objective has always been to provide the best care," Curtis said. "If you do, you expand the market share."

In cardiology, finding a less-invasive way to solve old problems drives new technology, Curtis said. Patients have fewer open-heart surgeries because newer treatment options can solve the problem.

"Coronary angioplasty and stenting have become nearly gold standard for treatment of patients with coronary blockage," the physician said. "With most patients, we see that stenting with drug-coated stents is as effective as open heart surgery."

Dale Montgomery, HMC vice president for support services, said when it comes to the purchase of major medical equipment, he believes in matching new technology with the needs of patients.

Recently the hospital decided to invest in digital mammography, but it sees no need for an expensive upgrade to the latest CT scanner when the one the hospital already owns does the job to everyone's satisfaction, Montgomery said.

"All of our technology, including our CT, is giving our people what they need to treat the patients right now," Montgomery said.

HMC is the supporting hospital in the Northwest Kansas Health Alliance, the nation's largest alliance of hospitals. HMC serves as a referral center for smaller hospitals in the region that are designated Critical Access Hospitals.

The Critical Access Hospitals provide medical services geared for simpler, more ordinary health needs.

The equipment game

One of the hospitals in that network is Norton County Hospital. Administrator and CEO Richard Miller said that not having to provide the more complex services puts technology decisions into a different context.

His concerns center on equipment costs.

"I think you have to make the equipment pay for itself," Miller said.

Norton has to consider if the equipment is available nearby, such as in Hays or Kearney, Neb.

"There are times we just can't provide it," he said.

But it's not always about the cost of the equipment.

"A lot of times ... it takes credentialed staff members - and you just don't find those kind of people in the smaller communities," Miller said.

Smaller hospitals must find a more carefully balanced equation, he said.

"There's certain things we can do, and there's other things you just have to go to the secondary or tertiary hospitals," Miller said.

"When you're a larger facility, you do specialize in more complicated cases. I do think those things may provide a revenue source that gives you some leeway."

Sometimes, a high-dollar piece of equipment is purchased regardless of how soon it will pay for itself.

"The most expensive piece of equipment that we have at our hospital is a CT scanner," Miller said.

The hospital invested about $420,000 in the machine and a room that houses it. The machine is used only when needed, Miller said, and hospital officials refrain from urging physicians to make it pay for itself.

" ... It's become something that nearly every small hospital has now," Miller said. "But to tell the doctors we have that equipment and now you have to order it so we can pay for it, we just don't do that."

At Neosho Memorial Regional Medical Center in Chanute, the philosophy about expensive equipment purchases is much the same as at Norton. The small hospital is not part of a hospital alliance, but still considers whether patients reasonably have access to specific medical equipment.

Patricia Morris, communications and planning director, said the most expensive piece of medical equipment the hospital owns is a CT scanner.

The hospital relies heavily on contractors to lease mobile equipment, Morris said.

"The mobile services are nice to be able to gauge your volumes," she said. "You can use mobile technology to determine whether enough demand is there to buy the equipment."