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Show 'DAILY HERALD Sunday, January 9, 2005 AS IHC: EFFECTIVE OR UNFAIR? ntermountain Health Care in 2003 was rated the top integrated Iiihealth care network in the countrv I a company that rates by Verispan health care businesses - based on business performance level and degree of integration. In 2002, the nonprofit company re IHC corporate officers William H. Nelson Salt Lake City N. Goodwin Salt Lake City $576,053 IHC Charles W. Sorenson Salt Lake City $575,098 IHC board of directors Jackson Dr. Linda J, Leckman Salt Lake City Richard R. Price Salt Lake City Dr. Gregory P. Salt Lake City Stevens Management Inc. neonatal-perinata- SOURCE: IHC James W. ' Salt Lake City Long $266,614 cardio-thoraci- ) $815,912 surgeon c tax documents facilities in Utah County IHC Health Plans 97,682 Deseret Mutual Benefit Workmed, occupational health Orem IHC in Utah's population: ' Commercial insurance plans Employer plans Government Insurance plans Uninsured IHC plans and their in Provo United Healthcare Insurance Co. in Orem. Altius Health Plans 17 Regence 14,574 18,037 (8.2) (6.3) (7.8) BlueCross-BlueShiel- d of Utah 17,576 (7.6) 8,769(3.8) Cigna Healthcare SOURCE: Utah Hospital and Health Systems Association mar- Altius Health Plans . ' United Health Care (8.3) 42.7 24 Health Plans Regence l'9,117 Educators Mutual Insurance Association 19,007 35 40 8 (42.2) 36,727(15.9) Public Employees Health Plan health care insurance to ket share: Orem Health Center Administrators Health insurance in Utah at a glance I Highland Family Practice Center I North Orem Family Practice Center I Springville Family Practice Center I Utah Valley Family Practice Center I InstaCare I InstaCare In addition, 16 board members received no compensation in 2002. I Top commercial Orem Community Hospital t Central $817,509 Bountiful $276,370 IHC I Physicians: 2,480 Utah County health care people' covered and market share in 2003: Who provides I Utah Valley Regional Medical Center I American Fork Hospital surgeon c $772,001 care l Services Inc. Dr. cardio-thoraci- , I Outpatients: 1,880,997 IHC Physicians Group offices in American Fork and Provo I . Dr. Stephen D. Minton Provo Dr. Donald B. Doty Dr. Brent E. Wallace Roy Inc. The top five paid physicians of IHC Health Services Inc. in 2002 $340,221 $797,541 diagnostic radiologist $215,943 $422,387 Dr. Dr. Jordan A. Kimball Salt Lake City I Hospitals: 20 I Admissions: 137,281 Facilities: 210 21.6-acr- that survey, however, were from hospitals! or health systems and varied from $823,700 to nearly $1.69 million. $800,387 At a glance Part of IHC also enjoys status and pays no property tax on the e sprawling hospital complex on site of the Utah Valley Regional Medical Center near downtown Provo. IHC Health Plans, IHC Care and IHC status in Group lost their 1999 in a ruling retroactive to 1987. $300,000 in 2003, reports Modern Healthcare, citing a survey by the Chronicle of Philanthropy, a publication with news for nonprofit organizations. The five highest paid CEOs in diagnostic radiologist I IHC Benefit Assurance Co. I IHC Insurance Co., based in Cayman Islands. compensation in 2002 Dr. Brent D. Fillmore Inc. Foundation Inc. IHC Affiliated just under Dr. Farrell G. Forsberg Salt Lake City companies I Intermountam Health Care I IHC Health Services Inc. I IHC Health Plans Inc. I IHC Professional Services $722,100 Everett IHC IHC in 2002 compensation ported assets topping $2.7 billion and total revenue of more than $2.5 billion. It pays its top executive, William Nelson of Salt Lake City, more than $772,000 a year. The median annual salary for 215 nonprofit CEOs across the country, including the health care industry, was BlueCross-BlueShiel- d United Healthcare of Utah 15.8 5.6 4 SOURCE: 2003 Health Insurance Market Report , by the Utah Insurance Department in Springville Continued from A4 . unintended consequences that might affect the entire state to solve what is perceived as a Utah County issue. Stifled competition may be a problem, but "any willing provider" legislation may not be the best way to handle it, she said. Her hospital is not opposed to increased competition. Timpanogos, in fact, is adding neonatal and perinatal care and open-heasurgery facilities, services now available in Utah County only at IHCs Utah County flagship, Utah Valley Regional Medical Center, she said. "Growth at Timpanogos speaks to the fact that this community wants choice in health care, or we wouldn't be expanding," Brown said. Lane Summerhays, president and CEO of the Workers Compensation Fund, which manages workers' compensation claims for Utah and operates in a manner similar to what the new legislation suggests, said the proposed law would eliminate the capacity of insurance companies to buy health services in quantity, leaving no incentive for providers to give discounts. And that could drive the cost up, he rt pi IIP till said. But proponents disagree. "There's no way it'll make the cost go up," Sea Hellewell said. "Any time you have a monopoly and one company controls everything then, you know, prices go up. In my plumbing business, if I didn't have any competitors, boy, I'd charge a heck of a lot more." Opposing the legislation only protects IHCs health care hegemony, proponents say. psililiff 1 - Market dominance Dr. Ron Asay, IHC owns 70 percent of about 600 hospital beds in the county. The other 30 percent belong to MountainStar it HospiHealthcare, part of the f tal Corporation of America. Mountain-Sta-r is exclusively a hospital company, with two Utah County hospitals, Timpanogos Regional in Orem and Mountain View in Payson. It owns no clinics and ' offers no insurance plan of its own, though it accepts most insurance plans. doctors and clinics get a steady volume of patients in exchange for discounted rates and certain restrictions. IHC health plan subscribers trade a degree of choice and convenience for lower insurance premiums. And if an is pictured MATT at . patients dissatisfied with their service from finding a doctor outside the network. Doing so would cost them money out of pocket on top of the monthly insurance premiums they already pay. And because network doctors tend ' insurance company agrees to use the IHC provider network exclusively, it gets bigger discounts. "Exclusive kinds of plans typically have greater discounts," Nielson said. The discounts allow IHC to control costs. "It's easier when you have physicians under contract." IHC. But the lack of competition in Utah County makes it difficult for a solo practitioner to establish a practice here unless he or she is accepted in the IHC network, Gaufin said, adding that this means a reduction in patient choices. It's true that Utahns have fewer health care choices than they did five years ago. Since 1999, the number of ( commercial health insurance companies in Utah has declined by about 28 percent, the Utah Insurance Department noted in its 2003 Health Insurance Mar- not? Critics point out that IHCs explanation of its business model is unconvincing. IHC networks already include C Meeting patient needs JEREMY HARMONDaily Herald Springville resident Phil Lowry experienced anger and frustration over delayed medical care, and says he has suffered permanent numbness in his foot as a result. 1 Gaufin, a local neurosurgeon, com- plains that large, dominant health insurance plans like IHCs force patients to providers within a closed network. Typically, a health insurance plan pays most of the cost for treatment by doctors or clinics in its own network. Some plans pay part of the cost for providers outside the network, and some pay' nothing for providers outside the network, which is the case for two-thircustomers. of a Some doctors say (such a system affects patient care bydiscoura'ging e IHC-insur- ; to direct patients to other network providers, some providers are backlogged while competing providers stand empty or underused. In some cases, the available IHC network providers may not meet patient needs. Another MRI case history illustrates the point. A little more than a year ago, Phillip E. Lowry, 38, of Springville began to experience debilitating back pain. The pain went into his right leg, and his right foot stopped working normally. His doctor recommended an MRI scan. His insurer, IHC, had only one magnetic resonance imaging system available locally. The delay was four weeks. "I shrugged my shoulders and accepted the delay," he said. But then the pain and the impairment got worse. He went to a neurologist, who referred him to a radiologist, and both concurred that he needed an immediate MRI. He was scanned at a non-IHclinic in Provo that had immediate openings. Lowry could barely tolerate riding in a car, and he couldn't walk on the heel of his right foot. The MRI revealed a herniated disc in his lower back. Surgery was recommended. His doctor told him the condition was urgent and delay could result in permanent damage to his right leg function, he said. After a few days, however, he began to recover. The doctor attributed his recovery to his good physical condition. Lowry, a local attorney, is a runner. It turned out surgery was not necessary. He has recovered but has some permanent ' numbness in his foot. But lie was angry and frustrated that he could not get medical care when it was needed even though it was available outside the IHC network, he said, y In another case, in August 2003, a local attorney who asked not to be named suffered a back injury. Treatment by a local physician brought relief, but only temporarily. The physician was hot part of his insurance company's ; ket Report. During that same period, monthly insurance premiums went up by 31-percent. "For Utah residents, this means fewer companies to choose from and higher costs for their health insurance," the department reported. &''f SMITHDally Herald visit at the Central Utah Medical Clinic. Nielson's daughter Mary Hunt left. nearly every physician in Utah County, and they don't see the pricing leverage that could be lost with "any willing provider." IHC directly employs about 70 physicians in Utah County. IHC spokesman Cowley said most of the 600 or so independent doctors who practice in Utah County are in IHCs provider network. When pushed, he couldn't give the ex-- , act number, IHC says it accepts doctors into its network who provide the best records of results for the lowest costs. In addition, it accepts numbers and types of providers according to a formula based on the population in a given market area, according to Murphy Winfield, vice president of provider relations for or-pr- Convincing or ' a cardiologist, talks with patient Ivan Nielsen, ofManti, during a check-u- p " provider network, and the insurance wouldn't pay. When the pain returned several weeks later, he went to a doctor within the network, but this time the procedure itself was painful and brought no relief. His insurance paid most of the cost. Desperate for relief, he went to another physician also within his insurance network. Again the procedure was painful and brought no relief. The attorney has resorted to pain medication, hoping to get better. But the experience has left him frustrated that despite paying his premiums, his insurance won't pay the one physician who actually brought him relief. He is frustrated that the policies of a large insurance company would not accommodate his needs as a patient. Most of the time the system works just fine, said Gaufin, who belongs to the IHC network and has great respect for IHC. But too much control can hamper efficiency and quality. And sometimes, IHCs decisions to accept some providers and not others splits a practice. That is Payson otolaryngologist Dr. Randal Gibb's complaint. For 10 years, Gibb's partner in his Payson ear, nose and throat practice sought acceptance in the same network as Gibb. When Gibb went on vacation, his patients with IHC network insurance would have to wait for his return or make other arrangements because IHC wouldn't pay for patients to see his partner. But network doctors outside his clinic would not have ready access to patient records, Gibb noted. IHC has recognized that it's an issue at 26 clinics across the state, IHC vice president Winfield said. Many of those have been resolved and partners accepted into the network, including Utah County clinics and Gibb's partner. Under provisions available in some health plans, patients can go to providers outside the network, but those or plans, known as swing-ou- t options, typically are more expensive, Winfield said. And again, s about of IHC health insurance subscribers are not allowed to seek care outside the network. "If a physicianhospital or lab is willing to accept the contracted rate from point-of-servi- two-third- an insurance company and be subject to the same quality assurance and utilization review as any other provider, it should foster competition, increase freedom of choice among both patients and physicians, strengthen competing institutions, open avenues of referral between competing systems and ultimately decrease costs and increase efficiency," Gibb wrote in support of the proposed "any willing provider" . legislation. Bottom line Across from the Utah Valley Regional Medical Center, in Dr. Ron Asay's modest office at the Central Utah Clinic, an antique electrocardiogram machine sits on a shelf in a handsome wooden case with brass fittings. It probably still works, the cardiologist said. It's a link to the past, but it's the future of health care that concerns him. Asay wonders what IHCs dominance means for the future of health care in Utah County. "Philosophically, I don't think it's good for the community," Asay said. "You have patients now who don't have any choice about what doctor they see or what hospital they go to for care." He is convinced that increased competition would drive down the cost and improve the quality of care. "If you had two competingproviders, suddenly the little things would matter," he said. Asay is an independent cardiologist who does 90 percent of his work with IHC patients. The "any willing provider" legislation would not affect his practice because he is accepted already in IHCs provider network. "But I think some form of it will pass. The concept is good," he said. He wants to maintain his indepen- dence. He is loyal to the IHC hospital, though he still sends patients to the provider that in his judgment will best meets their needs. If he were an IHC physician, he wouldn't have that choice. "The bottom line is what's best for the patients," Asay said. , I N.S. Nokkentved can be 0 reached at or at, nnokfeentvedherafdextra.c;orn. 344-293- ' ' |
