Tell Me Now: The Cost of Healthcare


Part 9 of a series
L. Lee Isley, Chief Executive Officer, Granville Health System

I would like to first thank you for the continued feedback on the “Tell Me Now” column. It seems like everywhere I go, someone wants my opinion on their service: restaurants, shopping malls, auto shops. I appreciate the opportunity to answer their questions because receiving honest feedback is a great way to make improvements. Likewise, your feedback is very important to Granville Health System as we continuously make changes designed to improve the patient experience. 

Someone recently asked me to define “patient experience.” Of course, I can recite the dictionary definition, but an excellent patient experience is something you recognize when you see it. It’s the birthday party thrown in the Emergency Department for a child who was hurt on his special day. Excellence is the employee who stays on the phone for hours helping an older couple set up their patient portal in order to navigate online medical records. A quality patient experience is the nurse who spends a little extra time with a patient who has no family support.  

Customer service for a health system means clean rooms, being treated with courtesy, reasonable wait times, quality care and working with patients to meet their medical goals. Transparent billing is also an important part of customer service as it’s important to understand your health care costs. 

Patients often contact me about their bills. I’m pleased that they feel comfortable providing feedback. Often, they come in for tests and have concerns about the out-of-pocket costs. 

You might be surprised to hear me say this, but they’re right – the cost of health care is too high. With this in mind, I examined a few of the billing statements provided by patients. For insured patients, the expenses incurred normally include a charge for the test plus insurance copays and deductibles.  

The cost charged by GHS for tests is typically covered by the insurance company. However, out-of-pocket expenses consisting of insurance deductible and insurance copays can be significant. These charges are set by the insurance company and the insurance carriers require GHS to abide by the contract we signed. Part of that contract is our obligation to abide by the insurance company’s rates and our agreement to collect the patient portion of the bill. 

GHS takes pride in offering a great value for the services we provide. In fact, WRAL-TV reported on the wide range of prices for health care in Central North Carolina, including the Raleigh-Durham area. Their story said, “In 23 of the 24 most common procedures performed at Granville Medical Center, it has the best price and performance ratio in this area. In the end, however, where a patient lives and what his or her insurance covers drives the health care decisions.” 

Often, patients think that because they carry health insurance, their procedures are covered in full by that insurance. This may be particularly true if they haven’t recently had a major medical procedure. But over the last few years insurance plans have drastically changed to align with the changing landscape of health care. Many insurance companies have built their plans with deductibles of $2,500, $5,000 and even $7,000. Some of the plans are employer-provided insurance plans and some are plans offered through the Affordable Care Act Marketplace.

I can certainly sympathize. Medical expenses rarely come at a convenient time and most families don’t have extra padding in their budget to pay for costly deductibles. Unfortunately, I see this insurance sticker-stock nearly every day. GHS remains committed to price transparency, working with patients on financial obligations and ensuring all patients receive the right care at the right time. 

Patients also wonder why tests are so expensive when only one technician was needed to perform a relatively short procedure. It’s a fair observation. Clinical staffing does affect the cost of a test. Every technician on duty contributes a wealth of experience and knowledge to the health care delivery process, but salaries and other costs associated with ensuring our community has access to highly skilled medical professionals certainly adds up. 

In addition, unlike private stand-alone ambulatory surgery centers (ASCs) or freestanding imaging centers, our hospital never closes. We keep the doors open 24 hours a day, 7 days a week and clinical departments must maintain appropriate staffing levels around the clock to accommodate the varying levels of patient census. ASCs and freestanding imaging centers simply don’t need to meet these requirements, or account for the additional costs associated with operating a large community facility 365 days a year. Unlike our hospital, these facilities are typically not open and available in the evening or on weekends and holidays and this business model allows for less cost to the individuals who need them during business hours. 

We must also ensure care is provided to everyone in the community. Please understand, this is much different than simply stating care is offered to everyone in the community. In the health care industry, GHS is known as a safety net hospital; this means we are an integral part of the rural North Carolina health care landscape, providing care to a vulnerable population, including Medicaid enrollees and the uninsured. Unlike private ASCs, Granville Health System’s mission directs us to provide care, regardless of the patient’s ability to pay. In 2015, the Health System had to account for more than $8 million in unpaid bills and charity care. 

Another large area of expense that must be offset is new medical technology and equipment. Although it’s true some of our medical equipment is paid for, it still incurs maintenance costs. The technology on these machines requires continuing costly maintenance and software upgrades to ensure the tests are precise and provide extremely detailed, accurate information.  And just like the maintenance costs for a car or a home, it would not be in the best interests of the community to neglect the upkeep on our investments. 

So, what is the answer for the high cost of medical care? It might surprise you to know that I don’t have the complete solution. I can tell you the answer is not for patients to decline tests or procedures because they can’t afford it. Not only are many of these patients suffering from chronic pain, they will often delay treatment until they experience dangerous medical emergencies. If left untreated, chronic conditions can ultimately require more expensive services as patients end up in the Emergency Department where they incur even higher costs. 

To ensure patients receive the right care at the right time, Granville Health System has invested in the Transitional Care Program which ensures hospital patients have follow-up appointments with their primary care physician, arranges for home health care services and even visits patients at home to assess their recovery. 

The Transitional Care EMS Program is an innovative way to provide continued care for patients after their hospital discharge. Granville EMS paramedics or community program nurses and social workers work with patients in their homes to help them find ways to better manage their conditions, avoiding recurring trips to the hospital. There are no charges for these services. GHS believes this investment in the health of our community will provide better care, more favorable patient outcomes and ultimately, drive down the overall cost of delivering medical services in Granville County.

GHS is also working to provide education, financial assistance, value and customer service to our patients and community. The hospital is committed to improving and maintaining the health of the community through a number of outreach programs. 

Providing a speaker’s bureau to groups, exhibit tables at health fairs, and the sponsorship of youth sports teams are also examples of how we engage the community on their health. Additionally, the Health System provides a free meal and health information through our Meal & More program and educates Granville County students on healthy decision-making through the Kids Living Healthy program. 

One way we’re addressing the changing aspect of health insurance is by offering our patients financial options. The Health System is offers a program called “Thrive”.  Thrive connects patients with flexible financial options in order to bridge the gap between their financial needs and their health care needs.  

Thrive helps patients by providing credit-based financing for their health needs and is a great solution for patients with high unexpected deductibles. 
Granville Health System continues to develop new ways to bring value to the patient experience. Patient satisfaction scores have improved with the implementation of the Health System’s “Tell Me Now” customer service program and the addition of new patient-centric technology such as InQuicker, an online check-in service for Emergency Department and ExpressCare patients. InQuicker enables patients to bypass the traditional waiting room experience to see a provider for emergent care. 

We remain committed to working with partners in supporting a healthier community, but there is no silver bullet solution to the high cost of health care. The costs are made up of a mix of insurance deductibles and premiums, investing in new technologies, the cost of providing care for the indigent, and many other factors. However, I hope this column has provided some insight into the mission of your community health system. 

In 2016 we remain committed to delivering quality care and excellent customer service to our patients. As I’ve shared in past columns, we want to earn a 10 in patient experience from you during each and every visit. 

Our mission at Granville Health System is to ensure you always have access to the appropriate care at the appropriate time. GHS will continue to develop new ways to support our commitment to deliver high value, high quality care to the areas we serve.

Thank you for the opportunity to answer your questions and address your concerns. Please consider sending me feedback about your experience at GHS by contacting me by email at

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