Opinion: A look at health care costs at Tahoe Forest
This is in response to the Nov 20 opinion column by Dr. Golding, “Tahoe-Truckee patients should be allowed to choose where to go,” wherein he responds to Dr. Zipkin’s opinion, “We need to save our hospital.”
For Golding to say “Dr. Zipkin does not put the patient first” is a misrepresentation of what Dr. Zipkin was trying to formulate. He was in fact placing all patients first and is concerned about the health of the entire community within Tahoe Forest Health System.
Dr. Zipkin was not discussing limitation of patient choice, which Dr. Golding chose to imply, but offering his rebuttal to the call by some hospital board candidates that the hospital must lower its patient charges in order to limit patient migration to the Reno/Sparks area.
Restricting choice was not even a topic of consideration in Dr. Zipkin’s letter. He was discussing that his opinion of what he thought would be an ill-advised attempt to compete on pricing alone with Reno Diagnostic Center and the financial impact lowering prices would have on the hospital’s financial wellbeing.
Lowering pricing on all imaging while trying to recapture a small percentage of volume lost to outside centers may have at best a revenue-neutral effect or possibly generate new losses. Unless there was a significant increase in volume, it would be hard to justify the potential decrease in revenue.
Dr. Zipkin gave examples of steps that could be considered to address the issue of cost and how to assist patients in order to keep them within Tahoe Forest. He also stated there is a perception of increased costs for screening mammography and colonoscopy, which is not true.
Tahoe Forest Hospital is a nonprofit, publicly supported hospital, open every day. Everyone who comes through the doors must be seen and taken care of, regardless of their ability to pay. Tahoe Forest provided over $5.6 million in charity care in 2013, and in 2013 wrote off $8.1 million. In 2014, it wrote off $6 million in bad debt due to non-payment.
Despite these tremendous costs that must be absorbed by our hospital, prices within Tahoe Forest are 38 percent lower than comparable California hospitals and 28 percent lower than Saint Mary’s, Renown, and Northern Nevada Hospital in Reno/Sparks.
RDC is a for-profit, privately held business. They have limited hours of operation. While they may accept some patients who do not have insurance, they can be selective and choose which patients they accept. This limits their risk and exposure to bad debt. RDC has more control over their fixed costs because they do not have the undue burden of charity care and excessive bad debt experienced by Tahoe Forest Health System.
Despite this, all exams are not less expensive at RDC as compared to Tahoe Forest. While some commonly ordered exams are indeed less expensive at RDC, other imaging exams and procedures are similar in cost.
Screening mammography was only one example of similar cost. These exams that are provided at lower cost at RDC are used to get patients in the door and capture them for future, more complex imaging if needed. When those exams are performed their cost is similar to Tahoe Forest Hospital.
As consumers of health care, patients need to be fully aware of the total cost of their exam and need to ask informed questions. If the answers to your questions are not what you expect, or you are unsure what you need to know, then ask to speak with a supervisor — whether it is at Tahoe Forest or RDC for more clarification.
I do believe that patient choice is very important. Choice, however, should be made not only on cost, but also on quality. Though patients may expect all imaging exams to be created equal and that all radiologists are equal, that is not always the case.
Thaddeus A. Laird, MD, is a member of North Tahoe Radiology Group, providing professional radiology services to Tahoe Forest Hospital since 2007. He formerly provided professional services at RDC from 1993-2003 and at Saint Mary’s Regional Medical Center from 1993-2007.
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