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Who is footing the bill for COVID-19 patient care?

Andy Atkinson / Mail Tribune Heather Rowenhorst, Asante director of finance, works through a stack of bills in her Medford office.
Taxpayers, hospitals, insurers taking the hit — for now

A COVID-19 patient who suffered a 141-day stay at a local Asante hospital generated a $3 million bill.

The almost five-month stay in the hospital included time spent on a ventilator, according to Asante Finance Director Heather Rowenhorst.

She said the patient’s insurance covered $500,000 of the bill, and Asante absorbed the rest. Asante hopes to get at least partial reimbursement from the federal government.

To protect patient privacy, Asante won’t disclose whether the patient survived the ordeal.

The $3 million COVID-19 bill is the highest yet that Asante has seen, Rowenhorst said.

But five-day stays in a hospital can typically generate $50,000 bills, she said.

For now, COVID-19 patients in the Rogue Valley aren’t being charged by Asante or Providence hospitals for the cost of their medical care.

Instead, hospitals, insurance companies and federal taxpayers are footing the bill.

Policies to waive the patient portion of COVID-19 testing and treatment bills were widely adopted by hospitals and insurers when the virus first struck.

"We really wanted to encourage patients to do the right thing and to come and seek care,“ Rowenhorst said. ”We felt like if they were going to face a large bill, they wouldn't come in to seek care. It was more about making sure that patients knew that coming into the hospital and seeking care was the right thing to do if they were experiencing symptoms.“

But waiving charges for COVID-19 patients has come under question with the widespread availability of free, effective vaccines.

The four hospitals in Jackson and Josephine counties are being overrun with COVID-19 patients as the Rogue Valley experiences its worst surge of the pandemic. More than 94% of those needing hospitalization aren’t vaccinated, according to Asante.

The surge is impacting COVID-19 patients plus victims of heart attacks, strokes, cancer and other serious medical problems as hospitals cancel surgeries, delay care and house the overflow of patients in hallways, emergency rooms and idled operating rooms.

Last week, Jackson and Josephine counties sent an urgent request to the state for a field hospital, extra medical workers, ventilators and other supplies. Hospital leaders said local hospitals can no longer provide needed medical care for the community on their own.

Rowenhorst said waiving the patient portion of COVID-19 treatment was originally a condition for hospitals to be eligible for federal reimbursement. But that is no longer the case.

“We can start billing out the patient responsibility if we choose to do so,” she said.

Asante hasn’t yet made a decision whether to start charging patients.

“It will be a decision that Asante makes whether they want to bill out the patient responsibility or if we want to continue our current status of not billing out any patient responsibility,” Rowenhorst said.

She said waiving the patient portion of COVID-19 treatment bills can’t last forever.

"We cannot do this indefinitely. At what point it would sink the ship is a hard question to answer. I know for sure we cannot do this indefinitely. It's a significant impact to our bottom line," Rowenhorst said.

Nationwide, some insurance companies have already stopped waiving patients’ responsibilities to cover co-pays, deductibles and other out-of-pocket expenses.

Regence BlueCross BlueShield of Oregon, a major provider of insurance in the Rogue Valley, has plans to stop the waivers.

“We strongly encourage eligible Oregonians to get vaccinated to protect yourselves and others, and are offering COVID-19 vaccines, testing and treatment with no out-of-pocket costs for members through Dec. 31, 2021. In 2022, regular cost shares apply, as with any other treatment as part of a member’s benefit,” said Jared Ishkanian, part of the strategic communications team for Regence BlueCross BlueShield of Oregon.

So far, data show the COVID-19 pandemic hasn’t had much impact on the cost of insurance. Insurance companies have been paying for COVID-19 care, but customer use of other types of medical care — from preventative care to surgeries — has fallen during the pandemic.

“Regence’s top priority is supporting our members, employees, business and community partners through the pandemic. While much uncertainty remains surrounding COVID-19 and the delta variant, our 2022 health insurance filings were not materially impacted as a result of the pandemic,” Ishkanian said.

Whether insurances companies can keep holding the line on premium costs is unclear.

The spread of the highly contagious delta variant of the COVID-19 virus has fueled a surge that is outstripping forecasts about cases and hospitalization rates in Oregon and the Rogue Valley.

Once the surge eventually dies down, Rogue Valley surgeons will face an unprecedented demand to perform delayed surgeries. Right now, only patients who will die within days without surgery are getting into operating rooms, local doctors and hospital officials said last week.

So far, Asante has written off almost $3 million in patient bills for COVID-19 care, Rowenhorst said.

Its health care system includes the Asante Rogue Regional Medical Center in Medford, Asante Ashland Community Hospital and Asante Three Rivers Medical Center in Grants Pass.

Providence Medford Medical Center is billing patients’ insurance if they have it, checking whether they are eligible for financial assistance, and seeking federal reimbursement for the patient portion of medical bills, according to Providence.

In Southern Oregon, Providence said it has sought $793,000 in federal reimbursement for the patient portion of bills, but has been paid only $122,000.

Providence expects to be paid another $145,000 but anticipates having to absorb the remaining $525,000 in uncovered patient bills, the organization said.

Although Rogue Valley hospitals are taking a financial hit from absorbing COVID-19 patient bills, the far bigger blow comes from lost revenue and added expenses during the pandemic.

The cancellation of surgeries and other care has dramatically cut their revenue.

Providence Medford Medical Center and Providence Medical Group clinics lost $46 million in 2020 due to the pandemic, Providence said.

At the same time, they had $31 million in additional costs related to overtime, personal protective equipment such as masks, and extra support for staff, including child care support, pandemic leave pay and not laying off workers, Providence said.

For its Southern Oregon facilities, Providence said it received $14 million in federal provider relief aid.

Its Medford service area suffered a net operating loss of $6.6 million in 2020, and has already suffered a loss of $6.4 million in the first six months of this year, Providence said.

Providence has facilities on the West Coast plus Alaska, Montana and Texas.

Because of its integrated system, Providence said it’s able to continue supporting the Medford area, including through temporary housing for displaced caregivers and community vaccination clinics.

“While the financial impacts from COVID have caused us to slow planned reinvestment in capital equipment, facilities and some new service development, the greatest impact has been on our current caregivers and our ability to hire new caregivers,” Providence said in a statement.

During the pandemic, Asante has suffered $60 million in lost revenue and faced $40 million in additional expenses like overtime and personal protective equipment, Rowenhorst said.

"You take those two numbers of lost revenue of $60 million and added expenses of $40 million, you get $100 million pretty quick,“ she said.

Asante has received federal funding to cover less than half of that amount, she said.

Both Asante and Providence are nonprofit health organizations.

As a nonprofit, Rowenhorst said Asante’s mission is to give back to the community and grow programs to make sure the community’s health is the best it can be. The financial blow from the pandemic will impact those goals.

"This impact will force us to make decisions around programs and which ones we can fund and which ones we cannot," she said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.