At small rural hospitals, paying more for worse treatment: WSJ

Summary: “Small rural hospitals called critical-access hospitals have in recent years been performing more and more inpatient orthopedic surgeries, even as their overall stays decline, a Journal analysis of Medicare billing records shows,” Christopher Weaver, Anna Wilde Mathews and Tom McGinty write in The Wall Street Journal. “Inpatient joint-replacement surgeries covered by Medicare rose 42.6% at the hospitals from 2008 to 2013, far outpacing the growth of those services at general hospitals. The trend reflects financial incentives built into the way Medicare pays the nation’s roughly 1,300 critical-access hospitals—generally isolated facilities with 25 or fewer beds—experts say, but it has troubling implications for patient safety. Many studies suggest that patients generally get better results when their procedures are done at hospitals that perform them frequently.” Christopher Weaver, Anna Wilde Mathews and Tom McGinty “New Risks at Rural Hospitals,” The Wall Street Journal.

In the same issue of The Journal:

“Due to an obscure bit of regulatory wording, Medicare patients pay far more out of pocket for outpatient care at … critical-access hospitals than they would for the same care elsewhere, according a Wall Street Journal analysis of Medicare billing records,” Melinda Beck and Christopher Weaver write. “For example, Medicare patients who had colonoscopies at critical-access hospitals had copays of $840.22 on average in 2013, more than three times the $270.53 average copay at general hospitals, according to the Journal’s analysis. Copays for outpatient hernia surgery averaged $1,926.60 at critical-access hospitals, compared with $562.52 at other hospitals. For bunion surgery, Medicare patients paid copays of $2,272.56 on average at the small rural hospitals, compared with $780.79 at other hospitals. The reason is buried in a 1997 law that created the critical-access designation to help small, struggling hospitals. Under the program, Medicare pays such hospitals more than it pays general hospitals, using a different formula. The law also set the Medicare copay for outpatient care at qualifying hospitals at 20% of hospital ‘charges,’ as the facilities call their list prices. At most hospitals, patients only pay 20% of the rates Medicare sets for outpatient services, which are generally much lower than list prices.” Melinda Beck and Christopher Weaver, “Comparing Costs for Outpatient Care,” The Wall Street Journal.