OPINION — The choice that Iron County residents have for who provides their orthopaedic care, and how it is to be provided, is about to become severely constricted for some in the new year as Intermountain Healthcare rolls out a new managed care product known as SelectHealth Share.
The new product boasts a network of 2,200 physicians. However, what Intermountain will not be telling the residents of Iron County is that there are only four orthopaedic surgeons in the area — two of those are employees of Intermountain and will be providers; the other two are within an independent practice and will not be providers — Dr. Ben Robinson and myself, Dr. Randy Delcore.
I own and operate an ambulatory surgery center here in Cedar City specializing in orthopaedic care. The prices for orthopaedic procedures are truly a fraction of the costs the hospital would charge for those same procedures. However, my surgery center has been, and continues to be, barred from participating in SelectHealth networks.
Read more: Dr. Delcore says SelectHealth conditions stifle competition – News report Nov. 23, 2015
This is undeniably difficult to understand when one recognizes that the surgery center, as a provider, is “willing” to accept the terms of a provider agreement and the reimbursement rates that go along with being a provider. It is even more confusing when one knows that an “Any Willing Provider” law exists here in Utah, which should mandate that “willing providers” be allowed to participate in any insurance networks they choose.
It has been claimed that the “Any Willing Provider” law may only apply in Utah’s rural areas with neither Washington nor Iron (counties) qualifying as rural areas. In fact, according to the National Center for Health Statistics, Iron County falls under the classification of a non-metropolitan area — specifically a “micropolitan” area — with a principal city population between 10,000 and 49,999. It is grouped with “non-core” (totally rural counties) in the NCHS classification. In other words, Iron County is rural and should be an area catering to “Any Willing Provider” per the law.
What does this mean for the average Iron County resident and possible future orthopaedic patient? It means that if you need to see an orthopaedic surgeon and you are signed up for SelectHealth Share, you may only choose from the two hospital-employed surgeons to care for your orthopaedic needs because there will be no coverage for out-of-network treatment. The “choice” to truly have the doctor you want is taken away because of that product.
According to the SelectHealth Share product description, large employers buying into this product will be locked into it for three years because the rate of premium increase will be guaranteed for years two and three. As a result, employers will be stuck with this insurance product for at least another two years if it proves to be unpopular with employees in the first year.
Additionally, I believe the process is flawed when decision-making for treatment of an illness or a condition in managed care plans inserts other entities into the patient-physician relationship resulting in a patient being viewed as a member of a “population.”
A SelectHealth Share product description states, “Population health is when healthcare provider organizations (health systems, hospital organizations, physician groups) take on financial accountability for the health of a population.” This will lead to discriminatory care.
Wouldn’t you prefer that the physician you see works with you personally to take responsibility for your individual health with your individual needs in mind?
It is time to stand up and say a resounding “No!” to efforts to herd you to certain doctors and pigeon-hole you into a particular segment of a population, ostensibly to lower costs. The reality of that plan will certainly lead to orthopaedic care with higher costs.
If you truly value having your “choice” of doctors, let your Human Resources and Benefits departments know that you do not want this kind of impersonal health care with very limited choices. And if you find yourself with an emergency situation, rest assured that I will be able to care for you with SelectHealth Advantage or SelectHealth Share whether I am “on call” or not — just ask.
Submitted by Randy G. Delcore, M.D.
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