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editor's picktopical
What does a knee replacement cost? Hospital price transparency could lead to better quality, lower prices

You may not do a lot of shopping around when you need a joint replacement or full-body PET scan, but now an estimate of charges should be online at every hospital, according to the federal Centers for Medicare and Medicaid Services. 

That's the rule from CMS.

Lincoln's two hospital systems — Bryan Health and CHI — have their own price estimators available online. Bryan also has the government version of a "machine readable," albeit not so  user-friendly, list of charges. 

On the CHI St. Elizabeth website, that hospital's cost estimator link is at the bottom of the front page. The required CMS listing of charges could not be found.

Bryan's price estimator and government listing is about five clicks in, starting on "Patients and Visitors," then "Pricing, insurance, billing and financial assistance," "Price estimates," an explanation and then "Online price estimator." 

The government's listing, that was to go up Jan. 1, is found under "Procedures, supplies, medications, miscellaneous." 

In that format, said Bryan spokesman Brad Collee, it's able to be tracked by procedure code and does not appear to be as much for consumers. It mostly allows the government to gather data, and to compare pricing at hospitals, he said. 

Using the hospitals' own price estimators, which have a lot of caveats, the St. Elizabeth cost for a knee replacement is listed in a range from $32,005 to $55,426, with a median cost of $42,932.

With Bryan's estimator, that median cost is $41,298, both without any negotiated discounts from insurance providers. 

A full-body PET scan would be $6,512 at CHI St. Elizabeth and $6,421 at Bryan, before any discounts. 

Inserting a pacemaker would cost $9,500 at CHI.

A heart catheterization would be $13,600 at Bryan. 

Again, it's not as simple as one number; there are a lot of considerations. But you'll get a basic idea. 

"They're going to see probably a really big number on (the price estimator)," Collee said. "We hope that doesn't discourage people. ... "

Almost all of the time, people won't be paying that price, he said. 

Those prices don't include insurance discounts, and they don't include doctors' charges, including radiologists, pathologists, surgeons, anesthesiologists. 

In a Thursday telephone conference, CMS Administrator Seema Verma talked about her federal agency's hospital price transparency efforts, with rules that went into effect this month requiring a public list of prices online. 

"We believe patients are the most powerful force in our health care system for driving quality and value," she said.

But with all the legislation and regulations over the past 10 years, the rate of increases in health care in America has not come down, she said. 

Costs continue to skyrocket, she added, and millions of Americans are unable to get the care they need.

"The status quo is unacceptable," Verma said. "Price transparency is critical."

When patients are left in the dark, she said, there's little opportunity to take cost into account. Sometimes, there are large price discrepancies for the same procedure in the same geographic location. 

Verma said some degree of public pricing has been available for years, but most were available only in print form from an administrative office, or posted in a form that couldn't be aggregated with other information. Online, basic information can now be compared between facilities. 

Bryan has had its own price estimator online for a number of years, Collee said. 

The CMS-required listing is an important first step, Verma said, and there's no reason hospitals couldn't do more, as Lincoln hospitals have. 

"We are just getting started as we work to increase price and quality transparency throughout the entire health care system," she said. "We have to do more." 

Greater transparency could increase competition in the health care market, she said, which could lead to quality going up and prices coming down. 

"We understand that it's more complex than just putting out the information," she said.

GWYNETH ROBERTS, Journal Star file photo 

A male cardinal hangs around the Pioneers Park Nature Center on Jan. 11, 2019.

editor's picktopical
Senator wants teachers to be allowed to restrain violent students

Lawmakers introduced 83 bills and one proposed constitutional amendment Friday, the second of 10 days of bill introduction in the 106th Nebraska Legislature.

After falling to a filibuster in the last legislative session, Sen. Mike Groene of North Platte will once again offer legislation that would allow teachers and administrators to use physical restraint on students who become violent toward themselves or others.

Any physical act to restrain a student would not be considered corporal punishment under Groene’s bill (LB147), nor would educators be disciplined if they were “acting in a reasonable manner” based upon a recorded history of disruption or abuse by the student.

Two years ago, Groene introduced the bill to address a “breakdown of discipline in the classroom,” but although his plan was backed by the Nebraska State Education Association, it met resistance from several senators who had experience as teachers or administrators.

Unable to reach the 33 votes needed to end a filibuster last session, Groene pulled his bill.

Other proposals introduced Friday include:

Vapor products

A bill (LB149) by Sen. Dan Quick of Grand Island would make it illegal for people under the age of 21 to buy vapor products or flavored liquids to be used in vapor products. Anyone selling vapor products to persons under the age of 21 could be cited with a misdemeanor.

Native women

Sen. Tom Brewer of Gordon sponsored a bill (LB154) requiring the Nebraska State Patrol to author a study on the number of missing Native women in Nebraska, the barriers to providing state resources to address the issue, and proposed legislation to address the problem. The report would be due to the Legislative Council by June 1, 2020.

Eminent domain

Brewer also introduced a measure (LB155) that would eliminate the ability of electric suppliers to the state to acquire land rights to put in transmission lines for privately developed renewable energy sources through eminent domain.

Property tax amendment

Schools would be limited to raising 33 percent of their operational funding through property taxes under a proposed constitutional amendment (LR5CA) by Brewer.

Gay conversion therapy

Omaha Sen. Megan Hunt’s bill (LB167) would make therapy to change an individual’s sexual orientation or gender identity illegal, while a second bill (LB168) would classify gay conversion therapy as a misdemeanor.

Mandatory minimums

Certain class I felonies would no longer carry mandatory minimum sentences under Sen. Ernie Chambers' bill (LB176). Class IC felonies, punishable by up to 50 years in prison, would switch from a mandatory minimum of five years imprisonment to a minimum of five years, while class ID felonies would move from a mandatory minimum of three years in prison to a minimum of three years.

Death penalty study

Lincoln Sen. Adam Morfeld introduced a bill (LB207) that would form a Death Penalty Defense Standards Advisory Council to develop and recommend “guidelines and standards for death penalty defense systems,” including the American Bar Association’s Guidelines for the Appointment and Performance of Defense Counsel in Death Penalty Cases, and how such guidelines may be implemented in Nebraska. A report would be due to the Legislature by May 1, 2020.

Wage sharing

A bill (LB217) by Lincoln Sen. Patty Pansing Brooks would make it illegal for employers to retaliate against employees who discussed their compensation with another employee.

editor's pick
Century-old Masonic Lodge in Beatrice faces demolition

BEATRICE — A nearly 100-year-old building is being demolished to make way for green space.

The Masonic Lodge at Sixth and Grant streets is being demolished by Tiemann Construction.

The building and lot are owned by St. Joseph’s Catholic Church. The Rev. Robert Barnhill said that contrary to speculation, the lot will not be used for additional parking.

“It will be landscaping just to beautify the area," he said. "It’s a prominent corner with the post office and courthouse, which has beautiful landscaping. It will be for curb appeal.”

Construction workers speculated it will take about a week to clean the area once the structure is demolished.

The building has been unused since the local Masonic Lodge built a new location at Seventh and Ella streets. The new building is smaller, and lodge officials said at the time of construction it would better fit the group’s needs.

The 4,000-square-foot building being demolished was used by the Masons for 85 years.

Barnhill said the planned transition was years in the making and took fundraising efforts by the church.

“It wasn’t donated, the land was purchased,” he said. “It took planning to get funding, and after five years to have the funding again for demolition… .”

The building was a Christian church when built in the 1920s before the Masons took possession of it.

The demolition is the latest project of St. Joseph’s to enhance the block on which it's located.

New playground equipment was installed in 2016 on the site of a former convent that was torn down in September 2015.

topicaltop story
Bill would require Nebraska doctors to tell women seeking abortions about medication reversal

Sen. Joni Albrecht of Thurston introduced legislation Friday that would require medical personnel to inform patients who are seeking abortions through medication that the process can be reversed if the patient subsequently decides to change her mind.

Albrecht said she already has 24 senators on board as co-sponsors. 

Rebekah Buell Hagan, 24, of Roseville, California, joined about a dozen senators and anti-abortion advocates at a news conference in the Capitol Rotunda to tell her story of changing her mind, reversing the procedure and subsequently welcoming the birth of Zacharia, a baby boy.

"I am so grateful," she said.

Hagan said she already was a single mother with a 10-month-old baby when she learned she was pregnant.

"I was completely alone and terrified," she said. "Out of fear and panic, I decided to have a chemical abortion."

Before taking a second medication that would have completed the abortion process, Hagan said, she changed her mind.  

"Oh, my goodness," she said, "I thought 'What did I just do?' I was scared, ashamed, sad."

When Hagan was told that she could take a different medication administered through a medical protocol that could reverse the abortion process and allow the mother to give birth to a healthy baby, she said she seized the opportunity.  

Hagan said she is married and the mother of Zacharia, now 5, and his older brother.

Albrecht said her bill provides an opportunity for "a second chance" in case a woman changes her mind about an abortion after already beginning the chemical process.

The legislation would help complete and strengthen the principle of informed consent, she said. 

Fifty-five percent of abortions performed in Nebraska are performed through medication.

Albrecht distributed literature suggesting there is "about a 25 percent chance that the unborn child will survive mifepristone," the initial drug that is administered to perform a chemical abortion. 

But if abortion pill reversal protocol is implemented, "the unborn child's chance of survival increases to 64 to 68 percent," according to the literature.

"This legislation would simply require that when a woman goes in for an abortion, she must be given all the information she needs to make a truly informed decision, including the information she needs to find help if she changes her mind," the literature distributed in support of the bill stated.