Department of Consumer and Business Services Workers’ Compensation Division Oregon 350 Winter St. NE Kate Brown, Governor P.O. Box 14480 Salem, OR 97309-0405 1-800-452-0288 503-947-7810 www.wcd.oregon.gov BULLETIN NO. 290 April 19, 2021 TO: Oregon hospitals and workers’ compensation insurers SUBJECT: Hospital fee schedule — adjusted cost-to-charge ratios for Oregon and out-of-state hospitals This bulletin provides updated adjusted cost-to-charge ratios. Apply these ratios to hospital inpatient and outpatient services according to ORS 656.248 and OAR 436-009-0020. This bulletin replaces Bulletin 290 issued March 17, 2020. Hospitals that are licensed or authorized to be hospitals in another state have a cost-to-charge ratio of 1.000. The following are adjusted cost-to-charge ratios for the Oregon hospitals: Adjusted Adjusted Adjusted Adjusted cost-to-charge cost-to-charge cost-to-charge cost-to-charge Hospital name ratio ratio ratio ratio (CAH = critical access hospital) effective 5/1/21 Notes 4/1/20 – Notes 4/1/19 – Notes 4/1/18 – Notes 4/30/21 3/31/20 3/31/19 Adventist Medical Center 0.285 0.305 0.366 0.359 *Adventist Health System/West Asante Ashland Community Hospital 1.000 1 0.357 0.358 0.419 Asante Rogue Regional Medical Center Hospital 0.292 0.304 0.317 0.316 Asante Three Rivers Medical Center 1.000 1 0.268 0.284 0.295 Bay Area Hospital 1.000 1 0.384 0.392 0.396 *Bay Area Health District Blue Mountain Hospital District 1.000 1 1.000 1 1.000 1 1.000 1 (CAH) Columbia Memorial Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 Coquille Valley Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 Cottage Grove Community Medical Center (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *PeaceHealth Curry General Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Curry Health District Good Samaritan Regional Medical Center 0.534 0.535 0.535 0.557 *Samaritan Health Services, Inc. Bulletin 290 Page 2 Adjusted Adjusted Adjusted Adjusted cost-to-charge cost-to-charge cost-to-charge cost-to-charge Hospital name ratio ratio ratio ratio (CAH = critical access hospital) effective 5/1/21 Notes 4/1/20 – Notes 4/1/19 – Notes 4/1/18 – Notes 4/30/21 3/31/20 3/31/19 Good Shepherd Medical Center (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Good Shepherd Health Care System Grande Ronde Hospital, Inc. (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 Harney District Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 Hillsboro Medical Center *Tuality Healthcare, Inc. 0.410 0.424 0.491 0.459 Formerly Tuality Community Hospital Kaiser Sunnyside Medical Center 0.431 0.440 0.438 0.441 *Kaiser Foundation Hospitals Kaiser Westside Medical Center 0.376 0.385 0.417 0.416 *Kaiser Foundation Hospitals Lake District Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Lake Health District Legacy Emanuel Medical Center 0.492 0.508 0.496 0.492 *Legacy Health System Legacy Good Samaritan Medical Center 0.392 0.391 0.400 0.397 *Legacy Health System Legacy Meridian Park Medical Center 0.402 0.399 0.395 0.407 *Legacy Health System Legacy Mount Hood Medical Center 0.335 0.337 0.338 0.342 *Legacy Health System Legacy Silverton Medical Center 1.000 1 1.000 1 0.699 0.556 Lower Umpqua Hospital District 1.000 1 1.000 1 1.000 1 1.000 1 (CAH) McKenzie-Willamette Medical Center 0.219 0.229 0.237 0.245 Mercy Medical Center, Inc. 0.304 1.000 1 0.324 0.332 *Catholic Health Initiatives Mid-Columbia Medical Center 1.000 1 1.000 1 1.000 1 1.000 1 Oregon Health & Science University 0.453 0.470 0.442 0.464 Peace Harbor Medical Center (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *PeaceHealth Pioneer Memorial Hospital – Heppner (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Morrow County Health District Providence Hood River Memorial Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Providence Health System – Oregon Providence Medford Medical Center 0.308 0.319 0.316 0.324 *Providence Health System – Oregon Providence Milwaukie Medical Center 0.403 0.431 0.427 0.459 *Providence Health System – Oregon Providence Newberg Medical Center 0.363 0.388 0.379 0.386 *Providence Health System – Oregon Providence Portland Medical Center 0.437 0.439 0.446 0.450 *Providence Health System – Oregon Bulletin 290 Page 3 Adjusted Adjusted Adjusted Adjusted cost-to-charge cost-to-charge cost-to-charge cost-to-charge ratio ratio ratio ratio Hospital name effective 5/1/21 Notes 4/1/20 – Notes 4/1/19 – Notes 4/1/18 – Notes (CAH = critical access hospital) 4/30/21 3/31/20 3/31/19 Providence Seaside Hospital (CAH) *Providence Health System – Oregon 1.000 1 1.000 1 1.000 1 1.000 1 Providence St. Vincent Hospital and Medical Center 0.401 0.421 0.412 0.423 *Providence Health System – Oregon Providence Willamette Falls Medical Center 0.409 0.413 0.416 0.437 *Providence Health System – Oregon Sacred Heart Medical Center at Riverbend 0.494 0.424 0.462 0.505 *PeaceHealth Sacred Heart Medical Center, University District 0.494 0.424 0.462 0.505 *PeaceHealth Salem Hospital 0.466 0.457 0.477 0.484 *Salem Health Samaritan Albany General Hospital 0.521 0.536 0.546 0.568 *Samaritan Health Services, Inc. Samaritan Lebanon Community Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Samaritan Health Services, Inc. Samaritan North Lincoln Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Samaritan Health Services, Inc. Samaritan Pacific Communities Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Samaritan Health Services, Inc. Santiam Hospital 1.000 1 1.000 1 0.513 0.520 Sky Lakes Medical Center 1.000 1 1.000 1 0.397 0.410 Southern Coos Hospital and Health 1.000 1 1.000 1 1.000 1 1.000 1 Center (CAH) St. Alphonsus Medical Center – Baker City (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Trinity Health St. Alphonsus Medical Center – Ontario 0.416 0.404 0.510 0.447 *Trinity Health St. Anthony Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Catholic Health Initiatives St. Charles Bend 0.365 0.423 0.447 0.476 *St. Charles Health System St. Charles Madras (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *St. Charles Health System Bulletin 290 Page 4 Adjusted Adjusted Adjusted Adjusted cost-to-charge cost-to-charge cost-to-charge cost-to-charge Hospital name ratio ratio ratio ratio (CAH = critical access hospital) effective 5/1/21 Notes 4/1/20 – Notes 4/1/19 – Notes 4/1/18 – Notes 4/30/21 3/31/20 3/31/19 St. Charles Prineville (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *St. Charles Health System St. Charles Redmond 1.000 1 0.517 0.507 0.554 *St. Charles Health System Tillamook Regional Medical Center (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Adventist Health System/West Wallowa Memorial Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Wallowa County Health Care District West Valley Hospital (CAH) 1.000 1 1.000 1 1.000 1 1.000 1 *Salem Health Willamette Valley Medical Center, 1.000 1 0.212 0.212 0.223 Inc. *Corporate name Notes: 1 This is a rural hospital excluded from the adjusted cost-to-charge ratio based on a determination of economic necessity under OAR 436-009-0020(5)(k). If you have questions about how the adjusted cost-to-charge ratios are calculated, contact the Information Technology and Research Section at 503-428-2843. If you have questions about how to apply the adjusted cost-to-charge ratios, contact the Medical Resolution Team at 503-947-7606. Sally Coen, Administrator Workers’ Compensation Division Distribution: WCD-LY, OH contact list, GovDelivery electronic mailing lists .