BARGAINS FOUND FOR OUTPATIENT SURGERY LOCALLY

Although outpatient surgery in Southeast Missouri is more costly than most areas of the state, procedures in Cape Girardeau generally are some of the best bargains in the region.

A state report issued Tuesday shows that Doctors Park Surgery Inc. in Cape Girardeau has some of the lowest costs in the region, well below the state's median in most categories of outpatient procedures.

But administrators at the city's two other medical centers -- Southeast Missouri Hospital and St. Francis Medical Center -- said Tuesday the report doesn't adequately account for the many factors that determine fees for various procedures.

Under a new state law, Missouri hospitals and outpatient centers disclosed their outpatient prices to the Department of Health. Those prices have been published in a 20-page booklet, available to the public for $3.

In Southeast Missouri, some of the highest charges are at Poplar Bluff's Lucy Lee Hospital and Doctors Regional Medical Center.

But the study shows a wide price variation throughout the region. For example, a tubal ligation at Lucy Lee Hospital generally costs about $3,349. The same procedure at Doctors Park Surgery in Cape Girardeau is about $1,455.

Ron Wittmer, president of Doctors Park Surgery, said the facility works hard to keep costs low.

"We try to stay below the state median for all our procedures," Wittmer said. "One of the reasons we're able to do that is because out-patient surgery is all that we do.

"Basically, what we try to do is combine cost convenience with quality," he added. "It's the same surgeons performing procedures at Doctor Park Surgery that operate at the hospitals in Cape Girardeau."

The facility was rated by the Department of Health as having consistently low charges in Southeast Missouri for breast, gynecological, digestive/urinary, ear, nose and throat, and musculoskeletal procedures.

Out of the 15 outpatient procedures Doctors Park Surgery performs that were covered by the study, in only two were charges above the state median.

At St. Francis, charges generally hovered near the state median -- higher in 15 categories, lower in 10 and at the median in two.

The medical center was rated consistently low in endoscopic procedures and consistently high in eye operations and CAT scans.

Southeast Missouri Hospital's charges are rated consistently low in endoscopic and CAT scans procedures and consistently high in gynecological and magnetic resonance imaging procedures.

Of the procedures Southeast performs that were covered by the study, the cost is higher than the state median for 22 categories, and lower in five.

But Southeast Administrator James Wente said bald statistics can mislead.

"So much of the price has to do with the condition of the patient," Wente said. "It's not as simple as a set fee for a particular procedure.

"There might be other complications that require additional testing and other medical services that add to the cost."

Wente said some facilities accept only paying patients, while Southeast often has to provide services for uninsured emergency room patients who are unable to pay their bill. Those costs must be passed on to paying patients.

Also, the government underpays reimbursements for many procedures provided for Medicaid and Medicare patients.

"Just having a few numbers on a page is not really sufficient for drawing conclusions about health care," Wente said.

"I don't think it's unreasonable for consumers to have some idea of prices for whatever their purchasing, and this is probably a good first step.

"But I do think one has to be careful drawing conclusions because of all the variables."

John Fidler, president and chief executive officer at St. Francis Medical Center, said another factor in the cost variance is that some hospitals are "referral" facilities that specialize in certain procedures.

Cataract surgery at St. Francis, for example, costs about $3,841, compared to $1,945 at Doctors Park Surgery.

"Eye operations are an area we specialize in," Fidler said. "We're a regional referral facility, which means we get a lot more complicated cases.

"We do high-risk cases that require more technology and research, which will drive up costs."

The cost of CAT scans is higher in Cape Girardeau than the state median, but Fidler said that's also because of differences in technology.

St. Francis uses a $2 million piece of equipment that can detect problems another hospital's $250,000 machinery can't.

"I think the report is good, basic information," Fidler added. "But in the final analysis, the patient has to ask: `Where can I get the best health care -- with the highest probability that someone will determine what my needs are -- that's cost effective and safe."

Wente said health care is a complicated subject that belies simple cost-comparison analysis.

"I think if you're really going to price-shop health care, it's important to take a look at the hospital -- its history, reputation, and how others in the hospital feel about the service they received -- then look at whether prices are reasonable," he said.

Fidler said it's difficult to balance the high cost of life-saving medical technology with its value to a small community like Cape Girardeau.

"There has to be some premium paid for immediate, life-saving health care," he said. "You're talking about life and death on a local level."