Is Jennie Stewart Hospital being treated fairly or not?
We have written about the conflicts between medical providers and insurance companies in these pages before. The recent spate of lawsuits and public recriminations related to Medicaid Managed Care in Kentucky give particular insight into the posturing and dueling over who gets to keep how much of our tax and insurance premium money. What is usually left out over these increasingly pubic spats in the magical world of medical pricing is just how many dollars are involved.
For example, we are told by a blurb in today’s Courier-Journal that Jennie Stuart Hospital in Christian County is resisting what it terms a 50% reduction in the discount it already provides to Humana Insurance Company. The usual ominous spector of limited access to health care and no doubt loss of jobs and damage to the local economy are raised to fend off the big bad insurance company. What are we to make of this? Is Jennie Stewart gouging the public? Is Humana using its market clout and effective control over where patients go to unfairly extract money from the pockets of hospitals and doctors to fatten its share holders? How are we to know? Do we even have any right to know how this money that comes out of our pockets is used?
I looked at 2010 hospital charges on the Kentucky Hospital website. Jennie Stewart has hospital charges for the 20 or so different diagnoses that I looked at that are decidedly average, and even below average for the state. In comparison, Louisville’s hospitals routinely have among the highest charges in the state. Of course, we are aware of several recent public disputes between insurers and Louisville’s hospitals that have been very disruptive to us patients. (The consistent hospital “winner” is Paul B. Hall Regional Medical Center that charges double to triple the state average for everything that I looked at. I’m glad I don’t have to pay out-of-pocket there!)
What kind of discounts are those hospitals willing to give insurers? Do they generously pass-on those same discounts to uninsured patients as is now required by the big bad new federal health insurance reform law? [With luck, the apolitical Supreme Court will strike down Obamacare so that we can retain the privilege of getting fleeced some more! This is what some of our federal legislators are actively hoping for.] What was the result of the local disputes in Louisville? Is Humana unfairly punishing UofL doctors and Louisville Hospitals, or is Humana not beating on them hard enough? Are some Louisville primary care doctors being taken advantage of by Humana? How are we to decide who is best looking after our interests without knowing the dollars involved?
As hospitals buy doctors and the number of provider and insurance networks diminish, the ability of these commercial forces to control individual markets will expand. Who has the upper hand to call the shots will vary depending on local factors. I suppose this is the American way– to let the market decide. Perhaps I lack the necessary patriotism, but having seen what the market has given us already, I am not very happy about such a prospect.
Peter Hasselbacher, MD
May 5, 2012