Two central Oregon providers, St. Charles Health System in Bend and Cascade Surgicenter, also in Bend, are now accepting the Oregon Educators Benefit Board's cap on hip and knee replacements, according to The Bulletin.
Here are five takeaways:
1. In 2014, the OEBB, which provides health insurance for nearly 150,000 public education employees in the state, including teachers, staff members and their dependents, placed a $25,000 cap on the facility costs its policy pays for the procedures. The facility fee covers the hospital's service and does not include professional fees such as those charged by surgeons. If facilities don't agree to provide the surgeries for that price, members of the benefit board are on the hook for the rest.
2. Last spring, no facilities in central Oregon had agreed to the board's cap, and the region's only hospital provider, St. Charles Health System, charged self-pay patients $43,692 for a hip replacement and $45,126 for a knee replacement. Those who couldn't pay the difference had to travel to hospitals in Salem, Portland or elsewhere.
3. Currently, 26 facilities in Oregon provide hip and knee replacements at or below the OEBB's $25,000 cap, up from just 11 a year ago.
4. Reference pricing, the practice of placing a limit on what a healthcare policy will pay for a service and forcing policyholders to pay the rest, is still relatively rare nationwide, although some large groups use it to cut costs, including the grocery store chain Safeway and the California Public Employees' Retirement System.
5. OEBB saved $3 million on the nearly 400 joint replacements its members received last year by using the reference price. Nine of those procedures took place in central Oregon at either St. Charles Health System or the Cascade Surgicenter.