Local hospital needs to tighten its beltArticle from The Piscataquis Observer, Vol. 165, No. 16, April 16, 2003To the editor:I have read with interest Mr. Ralph Gabarro's letter in the March 26 edition of The Observer, headlined, "Medicaid Loss Hurts Mayo". In my view I find his acceptance of "cost shifting" both unjust and discriminatory to those patients with health care insurances that do not pay beyond "reasonable and customary charges" or who have other policy limitations. It appears from reading his article that the blame and justification for cost shifting rests with Medicaid payments and a proposed budget cut in state funding.His comment, "This proposed budget cut is a classic case of state government transferring their problem to the local level," appears to also be a classic example of finding somebody else to blame when problems begin to mount.It seems oxymoronic that in aregion invariably referred to as one of the lowest income level areas in the state, and a region with declining population, to have a hospital think they need, or believe that they could support, two multi-million dollar expansions. It now appears there may be a looming problem of expenditures exceeding revenues, thus the blame to Medicaid and a need to support a cost shifting policy. I do not understand the need for a small hospital to spend sums of money for expensive TV advertising, sponsorships of radio broadcasts and to spend money for other public relations missions. Does a TV ad really entice enough "full-paying" (cost shifting) patients to MRH to justify the expenses? Let's face it; those are the only patients that MRH wants.I cannot understand how a hospital administration, and a board of directors that is elected by its fellow citizens, can in good conscience, openly endorse a policy that allows some patients to be billed at higher rates for the same procedure than they bill other patients. If MRH agrees to contractual fees with some insurance providers then those 'fees should be uniformly applied to all other patients, including those who have different health care coverage and to those who are paying cash for their services.As a publicly supported institution MRH has an obligation to fairness to all, but with their open policy of cost shifting they resort to the age-old practice of caveat emptor - let the buyer beware!A personal experience in May 2002 (as reported in the October 21, 2002 edition in the Bangor Daily News) opened my eyes as to how cost shifting works at MRH. A procedure performed at MRH in 1999 and again in 2000 for $430 suddenly went to $1102.50 in March 2002. Why should there be an increase of 256 percent for the same procedure in a short period of time? In correspondence with MRH there was no understanding of my complaint or any willingness by MRH's administration to alter the charges. Until that point in time I had not given any thought to being treated unjustly or discriminated against by a local public institution.In January 2003 my wife's doctor recommended that she have an outpatient procedure. Remembering my experience in 2002 we decided that we should become "informed consumers" before agreeing to use MRH. A call to MRH quoted an unequivocal $2,700 fee. A call to EMMC in Bangor revealed a minimum fee of $900, with an average range of $1200 to $1300, and in complicated cases up to $2100.Needless to say the procedure was performed at EMMC, and for $1300.Again I ask, "Is the MRH administration, and the elected board of directors, treating the residents of HAD 4 fairly"? I firmly believe they are not. I further believe that sooner, rather than later, people will become more and more aware of their health care choices and choose to use other area hospitals that charge lower fees.Those patients who are presently fortunate enough to have full coverage insurance should be mindful that insurance companies paying high hospital fees will recoup their outlays through future increased premiums. If MRH continues to follow their present practices I believe that they will be losing many more patients. Who will they blame next for those losses?In conclusion I would like to be clear that my comments are related to policymakers and administrative issues only and are not intended to cast any disparagement towards MRH's very capable staff.Paul BradeenMiloNOTE - This article reflects the views of the author and not necessarily those of the TRC Alliance Team.