Any Willing Provider
Is Intermountain Health Care a monopoly? That is the question – or, more accurately, the assumption – underlying SB 34 (“Patient Access Reform”) – better known as “Any Willing Provider.” Because this bill could greatly affect your medical care, I’d like to walk you through the issue and my reasoning.
Because IHC dominates the health care market in Utah – in terms of facilities and health insurance, proponents of SB 34 argue the State should force IHC to cover the services of ANY doctor in the State that an IHC-insured patient chooses to use – not just those providers IHC has chosen to have on its panel of providers. That’s the main thrust of this short, but huge, 8-sentence bill.
IHC agrees that it does have a significant presence in Utah’s health care arena. By integrating health care and insurance into a system, IHC argues, it can better manage quality and costs for the benefit of patients. Though it might not state it so bluntly, IHC is concerned that SB 34 will force it to open its panels to doctors who do not meet what it determines to be acceptable standards of care or who do not agree to accept reduced rates for services.
This dispute is one our legislature can address in good fashion. But, first, we need to identify the real issues. To me, the issues aren’t whether a non-panel doctor should get 95% of what a panel doctor would get or whether the non-panel doctor can bill the patient for the balance of that bill or whether the same deductibles will apply for panel or non-panel doctors.
The issue is whether IHC is a monopoly. If it is, let’s not mess around. In that case, let’s not dabble with reimbursement rates, balance billing, and deductibles; let’s break up the monopoly – force the separation of health delivery and health insurance ownership.
. . . if IHC is a monopoly.
Hmm. But what if it’s not? What if it’s just big? And what if it’s right about improving quality and cost through an integrated system?
At this time, I could not support SB 34. It diagnoses a cancer, but then merely treats some symptoms. I’m not prepared to make such a diagnosis, and, without such a diagnosis, I’m not willing to prescribe the medicine. But I think the people of Utah deserve to have the issue thoroughly examined. The combatants in this battle should welcome such an examination.
Maybe we can compile enough data to reach some conclusions before the session ends. Maybe not. If not, this issue would be great for a task force. I believe in legislative process and the ability of committees to do amazing work on complex issues.
Because IHC dominates the health care market in Utah – in terms of facilities and health insurance, proponents of SB 34 argue the State should force IHC to cover the services of ANY doctor in the State that an IHC-insured patient chooses to use – not just those providers IHC has chosen to have on its panel of providers. That’s the main thrust of this short, but huge, 8-sentence bill.
IHC agrees that it does have a significant presence in Utah’s health care arena. By integrating health care and insurance into a system, IHC argues, it can better manage quality and costs for the benefit of patients. Though it might not state it so bluntly, IHC is concerned that SB 34 will force it to open its panels to doctors who do not meet what it determines to be acceptable standards of care or who do not agree to accept reduced rates for services.
This dispute is one our legislature can address in good fashion. But, first, we need to identify the real issues. To me, the issues aren’t whether a non-panel doctor should get 95% of what a panel doctor would get or whether the non-panel doctor can bill the patient for the balance of that bill or whether the same deductibles will apply for panel or non-panel doctors.
The issue is whether IHC is a monopoly. If it is, let’s not mess around. In that case, let’s not dabble with reimbursement rates, balance billing, and deductibles; let’s break up the monopoly – force the separation of health delivery and health insurance ownership.
. . . if IHC is a monopoly.
Hmm. But what if it’s not? What if it’s just big? And what if it’s right about improving quality and cost through an integrated system?
At this time, I could not support SB 34. It diagnoses a cancer, but then merely treats some symptoms. I’m not prepared to make such a diagnosis, and, without such a diagnosis, I’m not willing to prescribe the medicine. But I think the people of Utah deserve to have the issue thoroughly examined. The combatants in this battle should welcome such an examination.
Maybe we can compile enough data to reach some conclusions before the session ends. Maybe not. If not, this issue would be great for a task force. I believe in legislative process and the ability of committees to do amazing work on complex issues.
posted by steve u. at 2/01/2005
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2 Comments:
Good point. My suspicion has been that IHC is not a monopoly. The economists tell us monopolies don't pop up on their own very often (without government help), and even when they do they don't stay around for long (again, assuming they don't have the gov helping them).
But your point is a great one. If it IS a monopoly, then why is the attorney general not licking his chops? Of course the proponants call it a "near monopoly" - whatever that is.
Thanks for making this available.
If IHC is a monopoly, is it the job of the legislature to break it up? This is an honest question, which I do not know the answer.
I always thought it was the job of the Attorney General, or FTC, not the Legislature, but I may be completely off.
While SB34 may be targeted at IHC, no one has proven that this bill would adversely impact IHC - is it possible that it could help IHC?
I know that is not the intent, but it could be the result.
Likewise has anyone proven that it will positively impact the citizens of Utah?
(Those willing to pay the extra cost - for the extra service - can get a health plan that allows them to see anyone they choose. Today we are getting what coverage we choose to pay for. Coverage outside the network is available to those who wish to pay for it, without legislation.)
Should we all pay more, so that everyone has the choice that some want?
I'm not convinced that SB34 is all bad, nor all good.
Like you, I say it deserves close and complete investigation.
There is a Senate bill which is designed to force IHC to break-up:
SB61 "Gross Receipts Tax on Privately Owned Health Care Organizations".
The bill tax's organizations which have hospitals, physicians, and health plans with an extra 3% on their gross reciepts.
There is only one organization in Utah that meets these requirements - IHC.This bill will supposedly add more than $180 million to Utah Public Schools over the next 2 years.
Utah Schools will never see a penny of that money.
If the bill is defeated, the money will obviously not be there.
If the bill passes, IHC will divest IHC Health Plans, they have no other choice - and this is the intent of the bill*.
After selling Health Plans, IHC will not meet the requirements, and will not pay the tax.
*A KSL News Radio story I listened to on Feb 8, 2005, reported that the bill sponsors openly admit that the intent of SB61 is to force IHC to sell its' Health Plans division.
Utah has nearly 2,500,000 residents. Less than 500,000 of those residents are covered by an IHC Health Plan.
About 1 in 5 Utah residents are insured by IHC. I'm not sure those are monopolistic numbers.
IHC has been around for 30 years. When they began, they accounted for just over half (53%) of all Utah hospital inpatient days.
This is the same rate today. While 53% is a majority, I'm not sure that it constitutes a monopoly.
Their rate of outpatient days has declined over the past several years - due to competition.
Across the country, IHC is looked at as the model of efficiency, AND quality outcomes.
So, the schools will never get any of this money, and how it will impact Utah health care is unknown.
I don't know that SB34 would break up IHC. Worst case, it would cause a slow death to Utah Health Care as we know it.
Many of the experts outside of Utah think that Utah has something really good here. Stirring this pot should be approached very carefully.
I am convinced that SB61 will adversely impact Utah health care.
I commend your approach: That appropriately determining if IHC is a monopoly, and taking action if they are - should be the focus here. The focus of these two bills appear to be an attempt to legislate the fall of an organization - through concealed or obvious means.
I agree that the monopoly status of IHC should be thoroughly investigated, and hopefully put to rest. This is a very complex issue, and should be studied over months, not weeks. However, I think that the discussion is beneficial to all of Utah, and has the potential to improve our Health Care situation even further - but not on it's current course.
Representative Urquhart, thanks for taking a responsible approach to an issue that will impact every citizen of Utah. Your desire to understand the complete issue, and implementing a task force, if necessary, are refreshing.
Thanks for what you are doing for Utah.
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