20 MONTEREY COUNTY WEEKLY june 20-26, 2024 www.montereycountynow.comcom light at the end of tunnel,” an opportunity to finally shine the light on Monterey County’s high hospital prices. Alongside a coalition of representatives from other local unions, they’re working with OHCA to bring the board to Monterey County later this summer for a public meeting where workers and anyone else concerned about high prices can share their stories. The union coalition is also working on gathering more allies to their cause, including politicians. “At the end of the day, all the politicians locally have a stake in it,” Azpilcueta says. “They need to work with us on finding solutions on how to control these crazy prices in Monterey County.” At the next OHCA meeting (at 10am Wednesday, June 26), the board is expected to formalize its April decision to impose a spending growth cap on hospitals and other medical facilities, beginning with 3.5 percent in 2025 and 2026, landing on 3 percent in 2029. It is open to the public, instructions on how to participate online are available at hcai.ca.gov/public-meetings. The first year is a test run, with no penalties for hospitals that spend over the limit. Beginning in 2026, OHCA will have enforcement power—the penalties are yet to be determined. According to Montage Health Chief Development Officer Kevin Causey, the system’s net increase in spending for 2023 was at “a very reasonable 3.8 percent,” he said in an email statement, taking into account all health care provided by Montage throughout the county. Montage Chief Financial Officer Matt Morgan states the nonprofit health care organization operates in compliance with all state and federal regulations, including the spending target mandates. “Montage Health has a history of passing along financial savings to our community directly, and we intend to do just that as a result of our current efforts to reduce costs,” he says. Natividad officials declined to speak in specifics about the 3-percent cap, but CEO Chad Harris says: “At the end of the day, for us, it’s about the services and continuing to provide these services and be sustainable in the long run. We have been here for 138 years, and we want to be here for 138 more.” At SVH, Radner agrees that ensuring the sustainability of the system is critical, but also that the cost of care is too high. “There is no question the cost of commercial health care is too expensive nationwide and in Monterey County,” he says in an email. “We have worked diligently over many years to expand access to affordable quality care to everyone in our community regardless of their insurance provider.” These hospitals provide care to anyone regardless of insurance. Under California law, hospitals must make “charity care,” or discounted care to low-income uninsured patients or low-income patients with high medical bills. Running a hospital is unquestionably expensive. According to CHOMP’s nonprofit Form 990 filed with the IRS, in 2022 its total expenses were just over $1 billion and revenue was $828.4 million, resulting in a loss of $188.7 million. (CHOMP’s total assets were listed at $217.5 million.) Expenses include $415.2 million in salaries, other compensation and employee benefits. Labor union representatives argue that salaries include millions for CEO pay at local hospitals. Packer made over $2.5 million in 2022, up from $1.5 million in 2018. Even so, the combined salaries of Packer and all other Montage vice presidents are around 2 percent of all salaries and benefits. At Natividad, Harris earned a little over $455,000 in 2022, according to State Controller records. Radner was appointed on June 6 by the SVH board as CEO after serving for six months as interim CEO; the board is set to approve a contract and salary on June 27. His predecessor, Pete Delgado, earned $1.35 million in 2022. Insurance companies are already dealing with a different kind of cap, thanks to the Affordable Care Act of 2010, which sought to rein in profits. The so-called 80/20 rule means that insurance companies must spend at least 80 percent of revenue from premiums on medical care and quality. If they spend less than that, they must rebate customers to get to 80/20. As to whether the 3-percent cap imposed by OHCA on providers will make a difference for regular patients, McDougall is skeptical. “Three percent on top of a lot, compounded annually, is still a lot,” he says. “Monterey County is still going to suffer this anomalous situation until the hospitals change their business practices. “For the whole state, this reining in the total expenditures at least slows this runaway train in the state of California.” Sound Off The state now has an easier way to file a complaint over high hospital bills for those who qualify. By Pam Marino For years, filing a complaint over a high hospital bill for uninsured patients and those in low-income categories was difficult to navigate, so state officials created a streamlined way under the Hospital Fair Pricing Act, which went into effect on Jan. 1. The act requires hospitals to have a discount payment policy and a charity care policy in order to provide financial assistance to patients who qualify. The Hospital Bill Complaint Program is available to those who believe they were wrongly denied financial assistance since Jan. 1, 2024, as long as they are either uninsured or have high medical costs and their family income is not more than 400 percent of the federal poverty level. (For a family of four, 400 percent of the poverty level is $124,800.) Patients may file online in English or Spanish at tinyurl.com/ hospbillcomplaint. Instructions for how to submit by mail in many different languages are included on the same link. If a complaint is considered eligible, it will be investigated and administrative penalties against the hospital may be assessed. At the end of the process, a patient may have a right to reimbursement plus interest if it’s found that they paid more than what they should have under the hospital’s discount payment or charity care policies. Since going into effect in January, the Department of Health Care Access and Information has received 96 complaints as of June 4, according to a spokesperson. The first complaint was received on Jan. 3. Of those, 79 were accepted as cases, 13 were closed as “non-jurisdictional” and four complaints were closed as incomplete. One complaint has been resolved. For complaints about issues that occurred before Jan. 1, patients may be able to file a complaint with the California Department of Public Health at tinyurl.com/Pre2024complaints. A RAND Corporation study of hospital prices between 2018-2020 found that the average percentage hospitals charge over baseline Medicare/MediCal prices in California is 307 percent. CHOMP and Natividad charged nearly 500 percent over, with SVH charging 471 percent over the baseline. Monterey-area Hospital Prices RAND CA benchmark total facility price 500% 400% 300% 200% 100% 0 307 493 471 492 CA CHOMP SVH Natividad Benchmark “There is no question the cost of commercial health care is too expensive."