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MCMH addresses hospital pricing

Story Submitted: Lori Evans, Madison County Memorial Hospital

In light of the article published in the Madison County Carrier on Jan. 30, 2019, about hospital prices, Madison County Memorial Hospital (MCMH) is jumping in to help clarify information and to help simplify what is one of the most complex public service systems in the world of healthcare.

"The problem with establishing a pricing structure for hospitals and/or healthcare services is the complexity of each visit and the individual patient seeking services," said Tammy Stevens, Chief Executive Officer for the hospital. Each stay for the same patient can be different. And certainly, each patient has a different kind of stay. For example, one person may have a high tolerance for pain therefore can withstand a more intense Physical Therapy plan that does not result in many visits. Whereas, another patient may need to attend physical therapy for several months.

"When you move to diagnostic procedures it gets even more complicated," said  Stevens. "You see, the human body is very complex and unique. The same diagnostic procedure can take one hour for the first patient and 15 minutes for the next." The theory that an X-ray is an X-ray doesn't hold up. Depending on the individual patient and/or the injury, the technician might not be able to get a good enough view with one X-ray. Therefore, five separate images must be acquired to provide the doctors what they need to make a diagnosis. As far as terminology, there are decades of scientific study, research and development to be able to name the various body parts, the conditions, the medicines, the diagnosis, the procedures conducted and the materials used. "That, she says, is going to be a complicated attempt at best."

To further complicate things, small rural hospitals may pay a larger price for medication than a large urban hospital due to the quantities that are purchased-higher quantities get a lower price. Likewise, rural hospitals sometimes get a lower reimbursement from the different insurance carriers-again coming down to supply, demand and quantity of service.

Madison County Memorial Hospital uploaded the Charge Master on Dec. 14, 2018, to get ahead of the curve from Federal agency regarding the requirement to host charge masters online by Jan. 1, 2019. Like many other hospitals across the nation, in order to meet requirements, the list was assembled and made live for public access. "I don't think this is going to be enough," said Patrick McGee, Chief Financial Officer for MCMH. "We are going to have to provide additional information to patients, or they will never understand what any of this means." Therefore, additional efforts are in the works to provide more details.

For example, http://www.mcmh.us/Main/PatientFinancialServices has two links: the charge master listing and the charge master information link (details about Charge Master concepts and contact information).

When a patient has insurance or some form of medical coverage, the patient's "out of pocket" cost typically includes a deductible, co-payment, coinsurance or even non-covered services. Some services are not covered under some insurance plans. "Out of pocket cost is based on the contract terms negotiated by insurance companies with the hospital and the benefits of each patient's insurance plan," said McGee. In summary, out of pocket costs for the patient will depend on insurance contracts and insurance benefits of each plan. According to  McGee, any resident in our local community is invited to contact our hospital's Business Office at (850) 973-2271 for a price estimate of his/her out of pocket cost for a procedure offered at Madison County Memorial Hospital.

Sometimes in the healthcare system, we struggle with bringing the terminology, the concepts and the processes and systems into terms that the typical person off the street can understand. "We are not going to stop there", said Stevens. "I am going to be working with our Foundation Director over the coming months to continue to push public education regarding healthcare systems."

"The main area of misconception in the healthcare industry is insurance," said Lori Evans, Foundation Director at the hospital. Evans has over seven  years of experience in healthcare reform and over twenty years of experience in community engagement. "In rolling out a statewide engagement plan for one of the largest insurance carriers in the nation we found insurance comprehension is as big an obstacle as access to coverage," said Evans, "Therefore, this is where we want to start – helping everyone understand how to best use the insurance plan they have to cover the healthcare needs that arise. There is so much confusing terminology, without help it's nearly impossible to understand."

A series of educational opportunities will be launched in 2019 that residents can choose to participate in and will include in-person, online and print versions to help serve a large target area. If you are involved with a local organization that is interested in this industry, we invite you to partner with us by contacting Lori Evans at (850) 253-1971.

If you would like additional information about how to better understand the world of health and are not following MCMH on Facebook, consider following their page and stay up to date on trends and events regarding healthcare @MadisonCoMemorialHospital.

Madison County Memorial Hospital is a Critical Access Hospital with Emergency Room, Diagnostics, Acute Care, Swing-bed and Rehabilitation programs are available for both inpatient and outpatient services. Located near the downtown area of Madison, Fla, MCMH currently serves a sixty-mile radius of North Florida and South Georgia. With a full-service laboratory, diagnostic, nursing and rehabilitation services the goal is to provide the residents with innovative health services and to help build a collaborative network to ensure a strong and healthy community.

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