A Hospital War Reflects a Bind for Doctors in the U.S.
By JULIE CRESWELL and REED ABELSON
For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.
But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.
Today, Boise is a medical battleground.
A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center.
Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit.
In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment.
Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.
In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint.
Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition.
Small Employers Weigh Impact of Providing Health Insurance
By REED ABELSON and STEVEN GREENHOUSE
Like many franchisees, Robert U. Mayfield, who owns five Dairy Queens in and around Austin, Tex., is always eager to expand and — no surprise — has had his eyes on opening a sixth DQ. But he said concerns about the new federal health care law had persuaded him to hold off.
“I’m scared to death of it,” he said. “I’m one of the ones sitting on the sidelines to see what’s really going to happen.”
Mr. Mayfield, who has 99 employees, said he was worried he would face penalties of $40,000 or more because he did not offer health insurance to many of his full-time workers — generally defined as those working an average of 30 hours a week or more. Ever since the law was enacted in 2010, opponents have argued that employers who were forced to offer health insurance would lay off workers or shift more people to part-time status to compensate for the additional cost. Those claims have drawn considerable attention — and considerable anger in response — in recent weeks.
John H. Schnatter, the chief executive of Papa John’s, the pizza chain, said some franchisees were likely to reduce their employees’ hours to avoid having to provide coverage. And an unhappy Denny’s franchise owner in Florida warned that he would raise prices 5 percent as a “surcharge,” adding that disgruntled customers could offset that by reducing their tips.
Some health care experts said comments like those came from outliers and sometimes resulted from confusion about a highly complicated new law, the Patient Protection and Affordable Care Act. Many of the provisions do not go into effect until 2014. Federal officials are still tweaking the fine print, like defining exactly what constitutes a 30-hour workweek. Even so, restaurants and hotels are among the industries likely to be squeezed the hardest by the law because they are low-wage industries that do not offer coverage to most of their workers.
Health Insurers Will Be Charged to Use New Exchanges
By ROBERT PEAR
WASHINGTON — The Obama administration said Friday that it would charge insurance companies for the privilege of selling health insurance to millions of Americans in new online markets run by the federal government.
The cost of these “user fees” can be passed on to consumers. The proposed fees could add 3.5 percent to premiums for private health plans sold in insurance exchanges operated by the federal government.
In a separate action, federal officials said that consumers would soon have access to nationwide health plans similar to those available to members of Congress and other federal employees. These plans will be offered by private insurance companies under contract with the United States Office of Personnel Management. The agency already provides insurance to eight million federal employees, retirees and dependents.
“This new initiative will promote competition in the insurance marketplace and ensure individuals and small businesses have more high-quality, affordable insurance choices,” said John Berry, director of the personnel agency.
The steps announced on Friday show the White House rushing to carry out the health care law signed by President Obama in March 2010. They also illustrate the rapidly growing role of the federal government in the nation’s health care system.
Consumer advocates, insurers and some state officials had expressed concern about delays in publication of the rules proposed on Friday.
Starting in October, consumers are supposed to be able to enroll in new health plans, for coverage beginning on Jan. 1, 2014, when most Americans will be required to have insurance. At least two nationwide health plans chosen by the federal government will compete with private health plans in the insurance exchanges being established in every state.
Can anybody find the flaw in the following argument?
SPC
The Feds Will Administer the Insurance Exchanges for Twice What it Costs to Administer Medicare
The Obama administration just released another set of regulations, the "Draft Notice of Benefit and Payment Parameters for 2014."
Among many other things in the 373 pages, they have announced their proposed assessments to cover the cost of running the federal exchange.
In order for the feds to administer the new insurance exchanges, they have proposed a fee of 3.5% of premium on each insurance policy sold in the exchanges (page 224).
This from the Kaiser Foundation 2011 "Primer" on Medicare:
"The costs of administering the Medicare program have remained low over the years––less than 2% of program expenditures."
Many times over the years I have heard from advocates of a single-payer Canadian-style health plan that Medicare proves the federal government can do it cheaper than the private sector and should therefore take it all over.
So much for the notion that the feds are the model of insurance efficiency.
Among many other things in the 373 pages, they have announced their proposed assessments to cover the cost of running the federal exchange.
In order for the feds to administer the new insurance exchanges, they have proposed a fee of 3.5% of premium on each insurance policy sold in the exchanges (page 224).
This from the Kaiser Foundation 2011 "Primer" on Medicare:
"The costs of administering the Medicare program have remained low over the years––less than 2% of program expenditures."
Many times over the years I have heard from advocates of a single-payer Canadian-style health plan that Medicare proves the federal government can do it cheaper than the private sector and should therefore take it all over.
So much for the notion that the feds are the model of insurance efficiency.
This author is well known for perfect legal articles. Most of all I like medical law articles. You must be a professional lawyer or know a lot of them. I wish you to write medical law articles to Attorney Online and submit to Attorney Directory contacts of good lawyers.
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