Health Care Costs in Grand Junction

This article comes from the Grand Junction Sentinel. I am sure there are such discrepancies within many two hospital cities.  Those that are for a more market approach to healthcare may note that the reasons why one hospital charges so much more for the same care really don't stand up for scrutiny. Mercy can charge more because they can charge more.  Thought you might enjoy this bit of knowledge from Western Colorado.

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Discrepancy in local medical costs can cause sticker shock

Procedures at St. Mary's can be twice as high 
as Community Hospital, but context is key

Anesthesia technician Fran Duke, right, puts clean sheets on the bed as surgical staff member Kristin Bentley works at the new anesthesia machine as they prepare one of the operating rooms for surgery at Community Hospital.

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By Charles Ashby
Friday, June 21, 2013

St. Mary’s Hospital and Community Hospital in Grand Junction are barely a three-minute drive from each other, but the two are far apart when it comes to what they charge patients.
Medical costs at St. Mary’s are almost always more expensive than those over at Community, and in some cases twice as high, according to a federal database on hospital costs.
While the two hospitals, and others in the region, are still cheaper than most parts of the state, St. Mary’s costs were higher in 18 of 19 diagnoses in what hospitals charge Medicaid and Medicare patients, according to a federal database maintained by the Centers for Medicare and Medicaid Services.
Dan Prinster, St. Mary’s vice president of business development, acknowledged those numbers as accurate, but said a true comparison of the two hospitals isn’t that simple.
“If you have a patient who has additional complications, they’re going to come here before they go there (to Community),” he said. “We’re at a different level as a facility. We offer many more services that they don’t.”
While patients may get comparable care at both facilities for certain procedures and treatments, the two hospitals really can’t be compared because there is a limited list of conditions the two facilities have in common that they treat, Prinster said.
St. Mary’s has services and staff that Community doesn’t, so its expenses are naturally higher, he said.
Furthermore, Community has made a conscious effort to keep its charges low, a philosophy that eventually will hurt them, Prinster said.
“I know from having looked at charge data that Community has made the decision over several years that they’re not going to raise rates in certain areas,” he said. “Our board has made the decision over the years that given cost increases for medical equipment, for pharmaceuticals, for staff and other things, is that we have to — from a fiduciary standpoint — ... adjust our rates on an annual basis. That accounts for some of the price differences.”
Chris Thomas, president and chief executive officer at Community, agreed that the two hospitals are different when it comes to the services they offer, but he said Prinster doesn’t have a clue what drives his charges.
He said St. Mary’s costs are higher simply because it can get away with charging more.
“A big part of this is, when little Community Hospital sits down with the insurance companies and says, ‘Boy, I’d like to get paid more,’ the insurance companies say, ‘Yeah, Chris. No thanks,’ and I say, ‘Okay,’” Thomas said. “But when St. Mary’s, who has 85 percent of the market share, goes in and says, ‘I’d like to get paid this,’ they get it. I’m limited in most of my (insurance) contracts to not be able to increase my charges more than 6 percent a year. St. Mary’s doesn’t have those kind of restrictions.”
As a result, the difference in costs continues to widen, he said.
According to the Medicare cost database, St. Mary’s charges more than $46,000, for example, to treat a blood infection such as septicemia, but Community Hospital charges only about $21,000 to treat that same illness.
Dr. Donald Nicolay, chief medical officer at Community, said the only thing that is different in the treatment of that infection between the two hospitals is what patients would be charged.
Prinster, however, said cost considerations don’t stop there. When complications develop while treating such life-threatening conditions as septicemia, patients prefer to be at a hospital that has more services, and can more quickly deal with unexpected situations.
Oftentimes, Community Hospital patients end up being transferred to St. Mary’s because it doesn’t have the wherewithal to treat those who develop complications, he said.
Prinster points out that when there are no complications, the cost between St. Mary’s and Community is nearly identical.
Indeed, the database bears that out, showing St. Mary’s cost to be $27,158, and Community’s charge at $27,058. Charges for that condition, without complications, at Delta and Montrose are even cheaper, at $17,303 and $14,954, respectively.
Still, the Colorado Center on Law & Policy, a left-leaning group that advocates for affordable health care and responsible government spending that has studied hospital charges, says there seems to be no rhyme or reason as to why costs for the same procedures vary so widely across the state.
In a recent study of those charges, the center found that hospital costs can range from 43 percent higher than the statewide median to 57 percent lower.
Community Hospital, Delta County Memorial Hospital and Montrose Memorial Hospital were among the bottom five charging the least of all major hospitals in the state, with Montrose and Delta coming in second and third to last, respectively.
St. Mary’s, however, ranked closer to the middle, at about 19 percent below the state average.
With the exception of Denver Health, which charges about as much as St. Mary’s, all other Denver-area hospitals listed charges that were, on average, 25 percent higher than the state median, with some as high as 43 percent over that baseline.
Prinster said that’s why it’s better to compare St. Mary’s with hospitals located elsewhere in the state, such as Fort Collins, Boulder or Pueblo.
When compared to those facilities, St. Mary’s costs are more often than not much lower, and that’s by design.
“What we don’t want to do is force people to go to Denver to get cheaper care,” he said. “Every year when we do that (cost) analysis, we look at how our rates compare to similar hospitals, and on average we’re 10 to 15 percent below them. So, with our rate increases, we’re still below them. What’s fascinating is, we raise our rates, and they do, too, and some of them raise them even more.”
Both St. Mary’s and Community are in the midst of major construction projects to expand their facilities.
St. Mary’s, which opened its new $276 million 12-story building in 2010, is spending another $40 million to complete construction on the four top floors, two of which will become the new home to its rehab and surgical units.
Meanwhile, Community is building a whole new hospital and medical office building for about $73 million.
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HOSPITAL COSTS
Here’s a list of 41 charges of common ailments treated at regional hospitals, according to data from the Centers for Medicare and Medicaid Services.
Blood infection with a major complication:
• Community Hospital: $20,910.46
• St. Mary’s Hospital: $46,268.97
• Montrose Memorial Hospital: $24,270.38
Fluid accumulation in the lungs and respiratory failure:
• Community Hospital: $18,812.58
• St. Mary’s Hospital: $39,572.48
Chronic obstructive pulmonary disease with a major complication:
• Delta County Memorial Hospital: $20,283.08
• Community Hospital: $17,501.39
• St. Mary’s Hospital: $28,461.46
• Montrose Memorial Hospital: $14,539.19
Pneumonia and lung inflammation with a major complication:
• Delta County Memorial Hospital: $24,681.69
• Community Hospital: $24,361.82
• St. Mary’s Hospital: $34,133.83
• Montrose Memorial Hospital: $17,892.29
Heart failure and shock with a major complication:
• Community Hospital: $14,361.91
• St. Mary’s Hospital: $28,228.12
Major small and large bowel procedures with complication:
• Community Hospital: $36,950.88
• St. Mary’s Hospital: $49,988.05
Chronic obstructive pulmonary disease with a complication:
• Delta County Memorial Hospital: $16,416.65
• Community Hospital: $16,959.93
• St. Mary’s Hospital: $23,603.48
• Montrose Memorial Hospital: $14,115.83
Chronic obstructive pulmonary disease without complications:
• Delta County Memorial Hospital: $11,723.56
• Community Hospital: $15,416.09
• St. Mary’s Hospital: $16,533.21
• Montrose Memorial Hospital:$9,141.40
Pneumonia and lung inflammation with a complication:
• Delta County Memorial Hospital: $17,302.14
• Community Hospital: $17,223.78
• St. Mary’s Hospital: $23,314
• Montrose Memorial Hospital: $11,244.70
Pneumonia and lung inflammation without a complication:
• Delta County Memorial Hospital: $9,809.72
• Community Hospital: $12,720.14
• St. Mary’s Hospital: $18,100.51
• Montrose Memorial Hospital: $9,680.86
Heart failure and shock with a complication:
• Delta County Memorial Hospital: $10,830.43
• Community Hospital: $16,268
• St. Mary’s Hospital: $22,092.77
• Montrose Memorial Hospital: $12,705.17
Stroke or bleeding within the skull with a complication:
• Community Hospital: $19,931.47
• St. Mary’s Hospital: $24,025.42
• Montrose Memorial Hospital: $12,592
Blood infection without  a major complication:
• Delta County Memorial Hospital: $17,303.91
• Community Hospital: $27,058
• St. Mary’s Hospital: $27,158.90
• Montrose Memorial Hospital: $14,954.40
Inflammation of the esophagus, gastrointestinal tract or other major digestive disorders without major complications:
• Delta County Memorial Hospital: $10,339.65
• Community Hospital: $13,953.12
• St. Mary’s Hospital: $16,699.77
• Montrose Memorial Hospital: $8,590.93
Skin or connective tissue inflammation:
• Delta County Memorial Hospital: $8,544.95
• Community Hospital: $11,641.08
• St. Mary’s Hospital: $21,005.58
• Montrose Memorial Hospital: $11,164.12
Miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without major complications:
• Delta County Memorial Hospital: $8,597.86
• Community Hospital: $11,695.88
• St. Mary’s Hospital: $13,354.75
• Montrose Memorial Hospital: $11,812.36
Hip and femur procedures not including major joint replacement with complications:
• Community Hospital: $28,152.73
• St. Mary’s Hospital: $36,832.12
• Montrose Memorial Hospital: $27,593.74
Major joint replacement or reattachment of lower limb without major complications:
• Delta County Memorial Hospital: $31,814.80
• Community Hospital: $37,524.77
• St. Mary’s Hospital: $34,378.06
• Montrose Memorial Hospital: $31,441.26
Kidney and urinary tract infections without major complications:
• Delta County Memorial Hospital: $10,958.25
• Community Hospital: $10,073.53
• St. Mary’s Hospital: $14,433.41
• Montrose Memorial Hospital: $11,141.69
Heart pacemaker with a complication:
• Montrose Memorial Hospital: $34,939
• St. Mary’s Hospital: $64,094.60
Stroke or bleeding within the skull without a complication:
• Delta County Memorial Hospital: $12,147.29
• St. Mary’s Hospital: $22,598.36
• Montrose Memorial Hospital: $9,385.70
Short term loss of blood flow to the nervous system:
• Delta County Memorial Hospital: $8,854.87
• St. Mary’s Hospital: $16,546.46
Seizures without a major complication:
• St. Mary’s Hospital: $19,283.85
• Montrose Memorial Hospital: $7,573
Blockage of an artery of the lung without a major complication:
• Delta County Memorial Hospital: $14,768.68
• St. Mary’s Hospital: $23,736.04
• Montrose Memorial Hospital: $13,054.44
Permanent heart pacemaker:
• St. Mary’s Hospital: $64,094.60
• Montrose Memorial Hospital: $34,939
Perc cardiovascular procedure with a drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,519.17
• Montrose Memorial Hospital: $34,859.20
Perc cardiovascular procedure with a non-drug eluting stent without a major complication:
• St. Mary’s Hospital: $45,493.55
• Montrose Memorial Hospital:$34,072.92
Heart failure and shock without a complication:
• Delta County Memorial Hospital: $7,911.91
• St. Mary’s Hospital: $15,955.39
• Montrose Memorial Hospital: $7,594.50
Heart arrhythmia and conduction disorders with a complication:
• Delta County Memorial Hospital: $13,749.77
• St. Mary’s Hospital: $23,247.50
• Montrose Memorial Hospital:$13,753.24
Heart arrhythmia and conduction disorders without a complication:
• Delta County Memorial Hospital: $6,109.94
• St. Mary’s Hospital: $11,970.62
• Montrose Memorial Hospital: $8,613.79
Fainting and collapse:
• Delta County Memorial Hospital: $7,344
• St. Mary’s Hospital: $16,640.82
Chest pain:
• Delta County Memorial Hospital: $5,345.43
• St. Mary’s Hospital: $12,033.37
• Montrose Memorial Hospital: $7,877.40
Major small and large bowel procedures with major complication:
• Delta County Memorial Hospital: $69,319.75
• St. Mary’s Hospital: $105,751.25
Gastrointestinal hemorrhage with complication:
• St. Mary’s Hospital: $20,359.18
• Montrose Memorial Hospital: $13,632.23
Gastrointestinal hemorrhage without complication:
• Delta County Memorial Hospital: $13,628.12
• St. Mary’s Hospital: $14,011.36
Gastrointestinal obstruction with complication:
• Delta County Memorial Hospital: $16,624.83
• St. Mary’s Hospital: $21,347.64
Gastrointestinal obstruction without complication:
• Delta County Memorial Hospital: $9,029.35
• St. Mary’s Hospital: $12,163.70
Minimally invasive removal of the gall bladder without complications:
• St. Mary’s Hospital: $25,684.89
• Montrose Memorial Hospital: $19,444.82
Fractures of the hip and pelvis without complications:
\• Delta County Memorial Hospital: $13,324.25
• St. Mary’s Hospital: $14,299.92
Medical back problems without major complication:
• Delta County Memorial Hospital: $10,025.12
• St. Mary’s Hospital: $18,586.62
Signs and symptoms without complications without major complication:
• St. Mary’s Hospital: $19,006.70
• Montrose Memorial Hospital: $7,925.31

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Fried Chicken to Die From

This recipe is from Cooks Country... It is amazing... and as Sue would say you wouldn't eat this everyday so its okay to eat this occasionally. It makes a chicken that easily beats KFC or the pressure fried types.  Everything needs to be close at hand and sequenced when the frying begins. I used my very cool infrared sensing thermometer to gauge the heat. I didn't quite have 3 quarts of oil... and I used a pint of peanut oil along with a medium wesson oil container.. it still worked. It took the time required to reach the meat temps required. The dutch oven my Kirkland version of the famous french Le Cruiset worked out beautifully.

Batter-Fried Chicken

From Cook's Country

August/September 2009

Why this recipe works: As far as technique went for our Batter-Fried Chicken recipe, deep-frying easily beat out shallow-frying. With shallow-frying, the batter always burned on the bottom. To ensure a crisp crust, we replaced the milk in our initial batters with plain old water. It turned out that when wet batter hit the hot frying oil, the moisture in the batter vaporized, leaving behind the solids that adhered to the chicken. With milk, the sugars in the milk solids browned too fast and produced a soft crust.
Using equal parts cornstarch and flour in the batter ensured a crisp crust on the chicken. And baking powder added lift and lightness without doughiness. We flavored our batter with black pepper, paprika, and cayenne for simple but unambiguous flavor.

Serves 4 to 6

Total time:

Halve breasts crosswise and separate leg quarters into thighs and drumsticks.

Ingredients BRINE

• 1 quart cold water
• 1/4 cup salt
• 1/4 cup sugar
• 4 pounds bone-in, skin-on chicken pieces (see note)

BATTER

• 1 cup all-purpose flour
• 1 cup cornstarch
• 5 teaspoons pepper
• 1 teaspoon paprika
• 1/2 teaspoon cayenne pepper
• 2 teaspoons baking powder
• 1 teaspoon salt
• 1 3/4 cups cold water
• 3 quarts peanut or vegetable oil

Instructions

• 1. MAKE BRINE Whisk water, salt, and sugar in large bowl until sugar and salt dissolve. Add chicken and refrigerate for 30 minutes or up to 1 hour.
• 2. MAKE BATTER Whisk flour, cornstarch, pepper, paprika, cayenne, baking powder, salt, and water in large bowl until smooth. Refrigerate batter while chicken is brining.
• 3. FRY CHICKEN Heat oil in large Dutch oven over medium-high heat to 350 degrees. Remove chicken from refrigerator, pour off brine, and pat dry with paper towels. Rewhisk batter. Transfer half of chicken to batter. One piece at a time, remove chicken from batter (allowing excess to drip back into bowl) and transfer to oil. Fry chicken, adjusting burner as necessary to maintain oil temperature between 300 and 325 degrees, until deep golden brown and white meat registers 160 degrees (175 degrees for dark meat), 12 to 15 minutes. Drain chicken on wire rack set inside rimmed baking sheet. Bring oil back to 350 degrees and repeat with remaining chicken. Serve.

Fry in 2 batches.. if using a Foster Farms chicken don't bother with the back and neck pieces save them for soup. The foster farms fryers are generally larger than the eastern raised chickens. 

In the end you end up with a tempura style of fried chicken.  

yum yum! : ) Pat

Biscuit Cobbler

I think that this recipe was part of some family web pages that were deleted in the last revision. Linzi called me this morning as I was on my extended walk and asked for this ditty. This is the only kind that Linzi really likes.

Biscuit Part:
2C of All purpose flour
1TB of baking powder
4TB of sugar
1/2 tsp of cream of tarter (or not)
1/4 tsp of salt
1/2 Cup of Butter
3/4 Cup of whipping cream, light Cream or milk

This is the topping.

The fruit goop:

4Cups of chopped ripe fruit
1/4 Cup of minute Tapicoca
1 Cup of Sugar (varies depending on your taste and the tartness of the fruit)
4 Tbs of Butter (sliced to drop on the top of the goop after assembly in the cobbler)

Directions: 
Fresh style: Oven at 300 degrees
Assemble goop into a well buttered baking vessel (like an 8inch square baking pan) , drop dough on top and bake the entire thing in  slower oven to allow for the goop to encorporate its tapioca. Take out when bubbles show up around the matrix and the biscuit looks done.

Controlled style
Combine the ingredients of the goop in a saucepan. Under 400 degree heat, stir and heat until the mixture solidifies.
 Roll out the biscuits and place on top of the goop. Bake in a moderate oven until the biscuits floating on the goop seem done and not goopy. 

Texas style: Oven at 300 degrees
Put the biscuit dough on the bottom of the baking pan. Spread the goop on top. As the biscuits come up they integrate with the goop. 

We have one more week before we have tree ripe fruit. Enjoy!

Waiting for the Heat

There is no denying it. Its Summer in Merced California.

Today we are waiting for the triple digit heat to begin.

Contrary to most diatribes coming from the rest of the family, it is not always 100 degrees plus over here in the valley. It is even true that at this time of the year we often get the last vestiges of rain for the year right in front of graduation ceremonies.

Its hard to talk realities to people who feel that 72 degrees is too hot to bear.

We will reach that thresh hold today at  9 Am. Most of the time the weather does not get in the way of outdoor activities. When it gets this hot we find things to do indoors or make sure that outdoor activities are completed in the morning. Sure we do not need jackets at anytime. You can go to the fair and not feel cold in the evening watching the performances.

Most people around here make sure that their liquid consumption increases with the weather. We drink more liquids. The Central Valley had to have beverage bars at all fast food restaurant settings. When every you eat you have to adjust your liquid content. Drink Drink Drink. This becomes pretty strange when in the late Fall the opposite occurs and the habit of glupping down liquid gives way to a more reasonable level.

Everyone on my block knows that the vegetation needs to be watered prior to the temperature changes today. 100 degree temps mean that water have to be in the ground deeply as the air temperature rises. All lawns were watered this morning before 9AM and they may get a short cool off shot this afternoon just to keep the roots from drying out.

The summer flowers love this heat. They also must have some water everyday in this streak. I have planted the front patio with annuals just like I try to do every year. There is always a battle that goes on when planting annuals. Do you plant for the short term. This requires replanting three times during the growing seasons. Or... can you use a planting scheme that allows for various plants to flower at the peak and then die off and then allow the next more sun related plants to take over and then plant one more time in the fall for the cool frost sturdy plants to keep blooming through the winter and into the start of the Spring.

This year I am trying a new strategy. The petunias which produce such sturdy color got eliminated because after July, they will not survive here. Marigolds (the dwarf variety) will do well up into September. Portulaca, or Moss Rose love the sun and will continue to produce all the way up into the Fall. They will not be as full as they will until there is consistent heat. Their drop off could be in October when the weather shifts. White Alysumm do well throughout the year and provide that garden fragrance. They need to be the base for the cool weather plantings that will occur in the early Fall and provide for the flowers in the Winter.

Overall I think that this garden is a pretty forward looking patio garden. Before each planting, I always add a couple of scoops of osmokote slow release fertilizer to the pots. My watering schedule for most of the summer is daily. I have learned the hard way that very large pots have to be used in this climate to raise annuals off the ground. Most of my pots are over 5 gallon in size.
It has been really fun to have a patio garden. We had it put in 8 years ago. There is something really nice and earthy about a saltio tile patio.

: ) Pat