SUTTER'S EXCLUSIVE HEALTH PLAN EXCLUDES LOCAL PHYSICIANS
by Kevin Caldwell, M.D. and Donna Sund, D.O.
Many readers are aware of the new local EPO Health Plan being offered by Sutter Health, Anthem, and CalPERS. You may or may not be aware that Redwood Medical Offices and several other local offices are not currently listed on the provider panel. Here's why:
The new EPO plan is an "Exclusive Provider Organization." This means that in order for you to be treated, you have to go to an approved provider and an approved hospital. None of the local independent (non-Sutter affiliated) providers we contacted were offered an opportunity to join the provider panel before the initial plan roll-out on January 8. We learned of the plan in the middle of January, when patients approached our office with letters from Sutter Health/Anthem Blue Cross/CalPERS, offering them a new health plan in our area. We knew nothing of the plan until patients brought us these subscriber letters, and our patients obviously had many questions and concerns.
In the past, when a new health plan was made available, especially to large local employers, the plan administrator would contact us before the roll-out to offer us an opportunity to be on the provider panel. However, this time the list of participating doctors included only Sutter-affiliated providers (two of whom have already left the area). The only hospital on the approved list is Sutter Coast Hospital. For 30 years, Redwood Medical has always been offered participation in local health plans, and we have been providers for CalPERS/ Anthem since its onset. In fact, we provide a significant amount of the local primary care to these many employees and their families, and have done so for decades.
When we realized our office was not on the EPO provider list, we immediately contacted Anthem to learn why not. This was the reply from Anthem Senior Managing Consultant Mark Johnson: "Sutter is taking the lead on adding additional Del Norte County physicians into their EPO plan network providers." Mr. Johnson added that he would forward our concern and request to be listed on the provider panel to Sutter, but we never heard back from Sutter or Anthem until later that month.
On January 27, Sutter Coast Hospital CEO Mitch Hanna told the hospital Medical Staff that he understood providers who are on Anthem's PPO list of providers were eligible to be on the EPO provider list. He invited Medical Staff members to call him if they were interested in joining the plan. So we contacted Mr. Hanna's office the following day, indicating our interest in joining the provider list and asking for more details. But our inquiry to Mr. Hanna about the plan's terms and restrictions has gone unanswered. Now, halfway through the patient sign-up period, we are still not on the panel, and have not received any further information from Sutter or Anthem about the plan.
Some of our unanswered concerns about the EPO include:
(1) According to the letter sent to plan subscribers, the plan offers "no charge for inpatient or outpatient" hospitalization (as long as you go to Sutter Coast Hospital). But according to the actual EPO Disclosure Form, there is a $250 co-pay charge for endoscopy, cataract surgery, and spinal injection, and $50 co-pay for an emergency room visit.
(2) According to letters from Sutter Health/CalPERS/Anthem sent out on Jan. 8 and Jan. 19, "members do not need to select a primary care physician." Those same letters also state that the "EPO Plan is specifically designed to not require a primary care physician." But according to an email sent to a local doctor by Nora Nunn Powers, Anthem Regional Director of Provider Contracting, "the structure of the product requires that any request for referrals outside of the established/approved EPO panel need to be directed back to the primary care physician for referrals to other specialists."
(3) If patients present emergently to Sutter Coast Hospital and require transfer, either due to specialized needs, such as a heart attack, or because our local hospital is "full"and unable to admit more patients, can these patients be transferred, as has been traditionally done, to the closest available facility (most often Rogue Valley Medical Center), or will they be transferred to a Sutter facility at a much further distance in order to stay within the Sutter network of providers? In addition, many patients are referred from our office to specialists in southern Oregon or Humboldt County. Will the new EPO make it impossible for patients to see these usual specialists?
As of today, Redwood Medical Offices is still not on the EPO provider list. We have made several attempts to learn the details of the EPO plan, but we continue to wait for answers from both Sutter and Anthem. We hope these answers will be forthcoming, and that we will be able to continue to provide our many long-time patients with the excellent health care they deserve.
Kevin Caldwell, M.D. Donna Sund, D.O.
Redwood Medical Offices
1240 Marshall St.
Crescent City, CA 95531
Thursday, February 19, 2015
For those who missed last night's Town Hall debate with me and Sutter Coast Hospital ("SCH") CEO Mitch Hanna, this newsletter has the highlights. Although the hospital Board of Directors have still held no public meetings since they voted to downsize SCH to Critical Access and transfer hospital ownership out of Del Norte County, I appreciate Mr. Hanna's willingness to attend last night's event.
Prior hospital articles available at www.Triplicate.com
Past newsletters available at www.crescentcitytimes.com
More information available at crescentcityhospital.blogspot.
Saturday, January 3, 2015
Added Gregory Duncan. Press backspace to remove.
by Roxie Hazard, Certified Radiologic Technologist
Is Sutter Health a not for profit charity, or just a secretive "for profit" corporation in disguise? Read more and decide for yourself . . .
This article investigates the workings of Sutter Health Corporation, a multibillion dollar California healthcare company which has transitioned from its former role as manager of community owned hospitals, to its new role as controlling entity of multi-hospital corporations. Why is this important? Because Sutter now charges 60% more than the statewide average for healthcare. If you have health insurance of any kind, or you have ever been treated at a Sutter facility, Sutter Health's pricing power impacts you. The following is my experience with Sutter Health, as a former employee of Sutter Coast Hospital ("SCH"), a locally owned community hospital for which Sutter Health is the manager.
It's been just about a year since the online report of Sutter's self-funded $170,000 "independent" Strategic Options Study on the future of SCH. Sutter muted the telephone lines so participants could not hear each other's questions during the internet presentation. "The Study" was followed by an extensive radio and newspaper advertising campaign. Ironically, after two years of Sutter executives denying they were considering downsizing the hospital to a Critical Access facility, the Sutter funded "Study" reported the best option was to convert to Critical Access Hospital. That means more money for Sutter Health--triple the amount which SCH is now able to charge to Medicare. Go figure.
The highlights of our local on-going hospital controversy:
2011: the hospital Board deliberately excluded our community from its decision to "Regionalize" SCH (transfer hospital ownership to a SF Bay Area corporation controlled by Sutter Health). Community outcry forced Sutter to hold up the transfer of ownership.
2012: County Board of Supervisors requested the hospital Board release its meeting minutes and financial data. Sutter refused. Today, Sutter continues to refuse.
2012: The Del Norte Triplicate prints the following quote: "Meanwhile, another local doctor serving on the hospital's Board of Directors has called regionalization "a merger that may save the hospital" from financial ruin and closure."
2013: The headline article in the Curry Coastal Pilot reads: "CEO: Sutter Coast Hospital losing money."
2013: Hospital Interim CEO announced Critical Access designation is "not being discussed." (Note that later in 2013, the hospital Board voted to downsize the hospital to a Critical Access facility).
2014: According to members of a City/County/Healthcare District committee, Sutter Health's Regional CEO claims Sutter Coast Hospital turned profitable in 2014. Really? The Critical Access application has not been approved yet! I thought the hospital needed to Regionalize and downsize in order to stay afloat. Now we learn that's not true!
As an employee of Sutter for over 16 years, I watched Sutter morph from manager of three local community hospitals striving to become the "employer of choice" in Sacramento to a powerful, monied, extremely successful business machine. While they frequently speak of their "not-for- profit mission," Sutter's actions seem more about enhancing profits. Ask Pat Fry, Sutter President and CEO -- it was Sutter's "enhancing profits mission" that made his 53% wage increase possible in 2012!
Sutter's list of attorneys, executives and consultants are proven capable to ensure whatever Mother Sutter wants, Mother Sutter gets. If Sutter was a private, for-profit corporation, we'd all be impressed. BUT, Sutter Health and SCH are not-for-profit corporations. Their income is based on billions in tax exempt bonds and tax-free operations. According to the IRS tax code, Sutter is required to operate for tax-exempt (charitable) purposes, not to the benefit of any individual. It would seem Mr. Fry's salary increase, from $2.3 million to $6.4 million between 2007 and 2012, may be inconsistent with a charitable, tax-exempt purpose.
Last month, Sutter Health announced a new corporate structure plan that will collapse five existing Regional corporations into two Divisional corporations in 2015. Here's a quote from Sutter about the new structure: "Within this new design, we emphasize the total patient experience; how we present externally facing products to our customers; innovation, data and analytics; and a stronger discipline in driving change across our Sutter Health network." Who knows what that means? I don't. Perhaps it's "Sutter Speak" for "we plan to have even greater monopoly power across our network."
Sutter still holds closed Board meetings, refuses to release meeting notes or financial data, spends hundreds of thousands of tax-exempt dollars on self-funded "independent" studies and advertising campaigns, charges 60% more than average, pays its executives millions, makes conflicting statements, operated SCH in violation of California law, and pays no taxes to the communities it serves.
So what do you think? Is "We Plus You," just "Smoke Plus Mirrors" from a not-for-profit acting like a for-profit? I think it is. But even more distressing is that our hospital Board continues to discount or acknowledge questions and concerns from over 4,000 area residents . . . friends, neighbors and patients of SCH.
It's time to end Sutter's secrecy and restore fair market prices to Sutter's facilities. If you would like to join this effort, please write me at firstname.lastname@example.org
If you would like to join our city and county leaders, which have already asked the California Attorney General to investigate Sutter Health, please ask the Attorney General to investigate Sutter by writing to:
The Honorable Kamala Harris
Office of the Attorney General, Antitrust Division
300 So. Spring St., Los Angeles, CA 90013
Please forward this article to friends, and post on social media sites.
Working together, something very good could come of all this.
Roxie Hazard, CRT
Portions of this article were originally published in The Del Norte Triplicate, available online at http://www.triplicate.com/