Behind the bill: Beaufort Memorial, Lowcountry Medical explain price increases

emoody@beaufortgazette.comApril 5, 2014 

Billy Powell says he has a "bug they just haven't figured out yet," and he's not sure he can afford to keep searching for a diagnosis.

He has been going to the Lowcountry Medical Group for blood tests and X-rays. He likes the practice because he knows the doctors, who have long tried to keep costs low for uninsured, cash-paying patients such as himself.

But following a visit in March, after the practice was purchased by Beaufort Memorial Hospital, Powell says he has a new ailment: a bad case of sticker shock.

"I was told in February that they had been bought by the hospital, and there was probably going to be a rate increase in the future," Powell said. "I in no way expected $75 worth of blood work to turn into $360-plus."

Beaufort Memorial Hospital, a nonprofit, public hospital, acquired Lowcountry Medical Group on March 1. While officials say employees, patient services and the list of accepted insurance providers remain unchanged, some of the prices have increased.

Powell said he paid his bill, but he decided not to get a recommended chest X-ray because the cost had increased from $45 in February to $274 in March.

After some negotiating, Lowcountry Medical Group dropped the price to $174 and then to $164, to reflect discounts for the uninsured and for those who pay cash in full. However, the final price was still more than Powell said he was willing to pay.

Hospital spokeswoman Courtney McDermott said the Health Insurance Portability and Accountability Act, or HIPAA, does not allow officials to discuss specific patients without the permission of the patient and their physician.

NEW COST STRUCTURE

Beaufort Memorial needed to restructure charges to Lowcountry Medical Group patients in part because the hospital purchased the group's clinical equipment and kept most of its employees, according to hospital chief financial officer Jeff White. Both factors increased the hospital's costs, he said.

The hospital tried to keep changes modest and to a minimum, working with a consultant to leave as many prices unchanged as possible, White said.

Some increases were unavoidable, he said, because by becoming part of a public hospital, the practice is now subject to some regulations it had previously escaped.

Though some prices rose -- specifically those paid for imaging and diagnostic services -- they are still lower than those paid by patients who deal directly with the hospital.

For example, a brain MRI through the Lowcountry Medical Group now costs about $2,914, up from about $2,240 before the sale. The hospital's charge, which has not changed, is $4,415 for the same procedure.

BEARING THE BRUNT

Such increases to Lowcountry Medical Group patients are likely to be sharpest among the uninsured because they don't have an insurance company negotiating lower rates on their behalf or paying part of the bill, said Jim Ritchie, executive director of the S.C. Alliance of Health Plans.

"The problem we have with health care in the United States is the person who receives the health care is rarely the person who pays the tab," he said.

However, Lowcountry Medical Group senior regional practice administrator Turner Wortham said the number of non-insured patients is only "a small percentage" at private practices, as many tend to go to the emergency room for primary care.

He expects the number of uninsured patients to continue to decline because of the federal Affordable Care Act.

In 2013, 1.9 percent of Lowcountry Medical Group's charges were for self-pay patients, Wortham said. The group had 62,959 patient visits.

Last year, 12 percent of Beaufort Memorial's patients overall and 30 percent of emergency room patients were uninsured, according to the hospital. The hospital does not specifically track numbers of patients or visits, McDermott said. However, it had 10,245 patient admissions, 43,475 ER visits and 153,503 outpatient registrations in 2013, according to a fact sheet.

In theory, the Affordable Care Act is supposed to mean no one has to be uninsured. However, a recent study by the Henry J. Kaiser Family Foundation estimated that at least 194,000 South Carolinians will go without health coverage because they earn too much to qualify for Medicaid and too little to qualify for health insurance subsidies and tax credits, which the ACA uses to offset costs for low-income individuals and families.

Powell, for example, says he owns a small business, Complete Car Care of Beaufort, and can't afford coverage.

"Any plan I get, the deductible is so far out, I can't afford it," he said. "Short of a major catastrophic illness, you're never going to clear the deductible."

Wortham said the group had offered discounts to uninsured patients as an incentive for them to pay early and in full. The group also accepted Medicare and Medicaid before it was purchased by the hospital.

"When you do have a self-pay situation, there's potentially a high exposure to not getting paid," he said. "... Often, health care providers do provide discounts at time of service to settle the account, and move on to the next patient."

Uninsured patients at Beaufort Memorial, and now Lowcountry Medical Group, also get 30 percent off automatically, and upfront payment means an additional discount, he said.

"It saves the organization costs of handling and processing, and we're more than happy to share that with the patient," he said.

But for Powell, those discounts aren't enough. He said that if a serious emergency comes up, he'll swallow his pride and beg for free indigent care at the hospital.

"I'm trying to do the right thing by paying my bills as I go," he said. "I try to stay healthy. I don't drink, I don't smoke, I try to work out. ... I would rather pay, but if they make it so I can't afford it, I have to join the dark side."

Follow reporter Erin Moody at twitter.com/IPBG_Erin.

Related content:

Beaufort Memorial adds OB-GYN, multi-specialty practice, Feb. 13, 2014

Beaufort Memorial Hospital expands care for emergency cardiac interventions, June 10, 2013

Beaufort County ranked healthiest in state, March 27, 2014

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