PENDLETON -- One of the things that St. Anthony Hospital is most proud of is its policy of treating everyone, regardless of their insurance coverage or financial situation.
"The finance situation is not spoken of when a person presents themselves to the facility," said Avril Nicholson, Medicare coordinator. "It's what can we do for you? What are you here for? And we go from there. The financial is afterwards. I think that's what makes St. Anthony very viable for the community."
The hospital sees that philosophy as part of its commitment to the community, while recognizing that some in the community view hospital care as one of their given rights.
"We have to treat our fellow people and we have to be here 24 hours a day," St. Anthony President Jeffrey Drop said. "When you're sick, I guarantee you whether you have insurance or not, you're going to come to this emergency room ... That's what we have to go into. We fix everyone that has to be fixed and we take care of them."
While St. Anthony will continue with that policy, it does put a bit of a strain on the hospital's balance sheet. That strain on the hospital's bottom line affects every person seeking medical treatment, Drop said, because low government reimbursement, particularly in the form of Medicare payments, means others must pay more.
"We are financially self-sufficient here, but it's an uphill struggle all the time," Drop said. "When people look at their bills and ask why in God's name does it cost us so much to do this, it's because I'm not getting everything on the government side. We have so much less than cost reimbursement on the government side that we have to make it up on the private side. That is why hospital bills are so drastically high."
Few people are more familiar with the Medicare system and its changes over the years than Nicholson, who started at St. Anthony in 1966, the same year Medicare began.
What was started as a benefit to those of retirement age was later expanded to include the disabled, those who had received disability Social Security for 24 months, and now mentally ill clients as well, which sometimes includes children. But the inclusions didn't come without a price tag.
"By opening up the area for those, Medicare itself decided to cut down on the amount of money they were going to reimburse facilities for their services," Nicholson said. "In 1982, they began the realm of what they call a DRG, a diagnostic related group. There's like 475 of those groups. Based on your diagnosis they put you into a group number and they give you 'X' number of dollars."
Rural hospitals particularly often are left covering much of the cost of treating Medicare patients, St. Anthony officials said. The government uses a payment formula that can vary greatly depending upon location. Medicare pays $1,880 for a total knee replacement in Manhattan, while an Arkansas physician would receive $1,310 for the exact same procedure.
"All too often, America's rural hospitals are overlooked when it comes to federal funding," Rep. Jim Turner, D-Texas, said when introducing legislation to increase funding for rural hospitals. "By improving Medicare reimbursements to rural hospitals, we can ensure that health care professionals and their patients are not left behind."
Last month Congress passed a bill co-sponsored by Rep. Greg Walden, R-Ore., that would increase Medicare payments across the board by 2 percent annually for the next three years and allocate $21.3 billion over the next five years to prevent further reductions in Medicare conversions.
The existing law is projecting a 14-percent cut in reimbursements over the same three-year period.
The bill has gone through two readings in the Senate and has been placed on the calendar.