RX for Change: Confronting the health care crisis in Kansas

Dec. 6, 2005

By Rachel Davis

Garden City Telegram

The pain moving up Patty Roberts' arm was intense.

Her breathing was labored as she came to the realization that she was having a heart attack. It was a mind-numbing experience for the 53-year-old Garden City resident, who was rushed to St. Catherine Hospital and then flown to Kansas Heart Hospital in Wichita.

"I made the point of mentioning I had insurance," she said. "They told me not to worry about it."

And she didn't, until the bills started arriving. The first, for $8,000, was followed by others that eventually totaled more than $24,000.

"How was I going to pay for it?" Roberts asked.

She, like other Kansans, has health insurance but discovered her policy doesn't cover certain procedures at certain hospitals.

Hospital administrators blame rising health care costs, in part, on the uninsured, who are unable to pay for hospital stays or emergency room visits. But insurance providers say hospitals shoulder some of the blame.

Graham Bailey, vice president of corporate communications and public relations for Blue Cross Blue Shield in Topeka, said specialty medical centers, like Kansas Heart Hospital, duplicate services and cut into the profits of general care clinics and hospitals.

"Specialty centers don't have the expenses of staffing an ER for 24 hours or taking uninsured patients," Bailey said. "They pick and choose patients that will create the best income for them and give the rest to general care hospitals."

Bailey said Blue Cross isn't the only insurance provider in Kansas that refuses to contract with specialty centers. And he doesn't see that trend changing.

"If a patient goes to a specialty hospital for a procedure, then they will pay out of pocket," he said. "If they elect to go to a general care hospital, we will, more than likely, cover it."

But Kansas Heart Hospital physician and co-founder Gregory Duick said specialty centers do not cherry-pick patients nor should they be blamed for rising health care costs.

Duick said 70 percent of all patients that go to the heart hospital in Wichita are on Medicare. Insurance providers, he said, are the ones that chose where patients can go, not the specialty centers.

Roberts said she didn't have a choice.

Garden City's St. Catherine Hospital couldn't help her, and she needed a specialist. The closest one was in Wichita.

"What was I supposed to do?" she asked. "Tell the specialist not to do the life-saving surgery because my insurance refused to pay?"

In all, Roberts had three heart catheters inserted during two procedures, one in February and the other in October. Those procedures and hospital stays resulted in medical bills between $24,000 and $30,000.

Roberts now has the added stresses of paying mounting medical fees and working a job that doesn't offer paid sick leave.

"When you are the sole provider, that really hurts," she said.

Cost factors

St. Catherine Hospital, a nonprofit, also has its share of rising health care costs, said Scott Taylor, the hospital's chief executive officer.

"Virtually every payer is paying less with Medicare, Medicaid and third-party companies," he said. "The uninsured population is growing, and they can't pay to handle an extended illness."

According to the Kansas Hospital Association 2005 Stat Report, 15 percent of Kansans are uninsured.

And specialty care centers cut deeper into a hospital's share of health care dollars.

Taylor said specialty centers take away traditional services, such as outpatient care and imaging. Those services, he said, are the most profitable for hospitals and help offset the costs of an intensive care unit and emergency room.

"Taking away the revenue means jeopardizing the community because general care hospitals cannot handle the driving costs to keep up," Taylor said.

Victor Hawkins, executive director of marketing and development for St. Catherine Hospital, said 3 to 4 cents out of every dollar the hospital receives funds technology purchases. But $6.8 million - 12 percent of the hospital's top line last year - was written off to charity.

Last year, the 2005 Stat Report shows, hospital patients were billed $9.5 billion for services but hospitals received only $4.1 billion in payments

"It is becoming harder and harder to try and stay even when health care costs are increasing," Hawkins said.

Yet, developing its own specialty centers has proven helpful for St. Catherine Hospital and its patients. The hospital operates several centers, including the Cancer Center, that offer treatment for specific illnesses.

Iris Neitzel, 41, of Colby, was diagnosed with breast cancer in 2002. She had all the procedures - chemotherapy, radiation and surgery - done at St. Catherine Hospital. Medicaid covered all the costs.

Peggy Hoskinson, of Garden City, witnesses the horror stories associated with rising health care costs. Hoskinson works in home health care and said some clients - mostly elderly - debate whether to buy groceries or prescription medicines.

Duick, at the Kansas Heart Center, said the cost of prescription drugs and malpractice lawsuits drive health care costs.

"When physicians practice defensive medicine by ordering every test imaginable, just so they can say all the bases are covered, that drives up costs," Duick said. "So in turn, large settlements have really put pressure on insurance companies, who in turn put pressure on physicians."

Dick Cook, with the Kansas Insurance Department in Topeka, said Kansas has a cap system that protects physicians from outlandish settlements.

The $250,000 cap covers only non-economic loss and wrongful death, Cook said, giving insurance carriers more of a comfort zone during settlement.

The cap system is viewed as a positive step in lowering health care costs and entices physicians to locate in Kansas, said Rita Noll, chief attorney for the Kansas Healthcare Stabilization Fund in Topeka.

But others believe health care costs remain a tangled mess.

"I don't understand the rationale of the health care system," said Garden City's Hoskinson. "The elderly are taken care of when they get to a certain age. People on welfare have the taxpayers paying their way, but the middle class, all they get is screwed."