Health-care union organizers gathered Thursday in downtown Fresno to push a petition drive for a November ballot initiative that would prohibit hospitals from overcharging patients.
At issue is whether hospitals grossly inflate charges for procedures and products as common as mammograms, X-rays, aspirin and bandages.
Service Employees International Union-United Healthcare Workers West said local hospitals routinely mark up prices.
Some examples that the union provided:
- Clovis Community Medical Center charges $17.83 for a vitamin B tablet that costs pennies at a pharmacy.
- Madera Community Hospital charges $1,116 for a mammogram, more than three times the state average of $320.
- Community Regional Medical Center charges $16.20 for a four-inch bandage that costs $5.47 at pharmacies.
"Enough is enough, it's time we dealt with this issue," said Dave Regan, president of SEIU-UHW West.
But hospital representatives said the union's goal in stumping for the initiative is to gain membership.
Two years ago, the union proposed a similar initiative, said Jan Emerson-Shea, vice president of external affairs for the California Hospital Association. They gathered signatures but withdrew the ballot measure when they struck an agreement with the hospital association to work collaboratively on a number of public policy issues, she said.
Now, Emerson-Shea said, they've revived the pricing initiative and are also promoting another to limit hospital executive pay. Their motive for the ballot drive, she said: "They're trying to leverage hospitals by putting this initiative on the ballot. They want ... nonunion hospitals to enter into neutrality agreements so they can come in and organize and hospitals won't object."
SEIU-UHW West spokesman Sean Wherley said the union hasn't been satisfied with progress in reducing health costs in the past two years, and that's the motive for reintroducing the initiative -- not just increasing union membership.
"New members are always the goal of a union," he said. "But this effort right now is about making health care accessible to Californians.
"We want them to commit to do more on that front."
Under the Fair Healthcare Pricing Act initiative, which the union is trying to qualify for the ballot, hospital charges would be limited to no more than 25% above the facility's cost of providing care, Regan said. The union estimates that the initiative would reduce hospital charges by at least $3 billion a year statewide.
In response, Emerson-Shea said hospitals agree that charges are misleading, but an association plan that is now being developed would update charging but would require federal government approval.
Mark Foote, chief financial officer at Madera Community Hospital, took issue with the $1,116 charge that SEIU said the hospital gets for a mammogram. The charge typically is about $339, he said.
And overall, Foote said, the amount a hospital "charges" is not necessarily what anyone pays. "The SEIU doesn't want to tell you that. They just want to tell you we are charging outrageous prices."
In a memo to Community Medical Centers staff Thursday afternoon, Tim Joslin, chief executive officer, said: "Charges are irrelevant to most. At Community, roughly three-quarters of our patients are covered by some form of fixed, government reimbursement ... so we're paid a fixed amount per day or per hospital stay that is not impacted by what we 'charge.' "
But Regan said California hospitals on average charge 320% above the cost of providing care. And according to the union, two hospitals in the central San Joaquin Valley had markups above the state average: Saint Agnes Medical Center had a markup of 339% in 2012 and Adventist Medical Center in Hanford, a 321% markup.
Saint Agnes and Adventist officials were unavailable for comment Thursday.
Foote said Madera Community, with a markup on charges of 143%, ranks lower than other Fresno area hospitals. "We would be in the lower 25% of all those rankings," he said.
SEIU said Clovis Community Medical Center had a markup of 294% and Community Regional Medical Center had a markup of 255%. Fresno Heart & Surgical Hospital, also operated by Community Medical Centers, had a markup of 285%.
But Joslin contested the union's allegation that Community receives excess or unfair revenue.
"Each year Community's operating 'margin' of revenues over expenses is a thin, single-digit percentage -- last year less than 4%. Most business enterprises would shut their doors with margins that low," he said.
Joslin said the hospital pricing initiative would be "highly disruptive to the delicate financial balance I've just described. Estimates are that the proposition would cost Community Medical Centers tens of millions in lost revenue dollars annually."
Patients, healthcare professionals and the community at large would all be losers, he said. "Unfortunately, the proposed proposition totally ignores the financial realities of providing safety-net healthcare in a market with complex and significant health and economic challenges."
Asked Thursday about hospitals statewide having slim profits and the risk of closure if they had to reduce charges, Regan said hospital scare tactics won't work: "We are not going to be bullied by people who are profiting over the ordinary illnesses that we have."
Hospital markups force people into economic tailspins when they end up in the hospital with common ailments and mishaps, he said.
Flanked by union workers, Regan introduced Carlos Rojas of Sanger.
Compared to some patients, Rojas was lucky, Regan said -- he had insurance when he spent seven days at Community Regional Medical Center in 2012 for an injured finger. The bill was $60,000. His cost: $3,000.
Rojas said he was flabbergasted: "They mostly gave me pills, they didn't do very much for me."
Elia Maldonado, a Fresno resident, was uninsured in 2012 when she was treated for a gallstone at Clovis Community Medical Center. Her bill for the surgery was $23,000. The doctor charged $5,000 and she was charged $180 for an ultrasound, she said.
She tried to make payments, but a collections agency said she would have to pay $5,000 a month. "Peace left my home," she said through an English interpreter provided by the union. "My whole family was under stress."
Another hospital patient, Gregory Price Sr. of Fresno, said he was charged $4,490 for a three-hour stay in the hallway at Community Regional Medical Center's emergency department. When he was on a construction job in 2012, he fell off a roof and injured his right side and hip.
When the bills came, Price saw he had been charged $51 for two Vicodin tablets. "This is ridiculous," he said.
Price, 60, said he was uninsured then and couldn't pay the hospital bill. He offered to pay $30 to $45 a month, but the debt was handed off to a collections agency. He tried to get a loan to pay the medical debt but was rejected because of the bad credit with the hospital, he said.
The whole experience has left him shaken. "If I was injured now, I would go home and medicate myself," he said.
Regan said the patients' stories make the point that "people should not go bankrupt because something goes wrong with them."
Approximately 505,000 signatures of registered California voters will be needed to qualify the Fair Healthcare Pricing Act initiative for the November ballot. Signatures must be submitted in mid-April.
The reporter can be reached at (559) 441-6310, email@example.com or @beehealthwriter on Twitter.