Wednesday, April 26, 2017

ER Greed--Profiting Off the Vulnerable

Note:  Please attend the upcoming Board of Supervisors meeting on Tuesday, April 25th, 10 a.m., 981 H St., Crescent City, to share your views and hear about the Joint Resolution on healthcare costs
The $2,054 ER Doctor Bill

Anyone treated at the Sutter Coast Hospital Emergency Room may find their doctor bill hurts more than their injury.  Pateints are being charged over $2,000 for visits described as lasting under 10 minutes.  The ER doctor bills are over 10 times the amount allowed by Blue Cross or Medicare, and do not include Sutter's charges, which are often an additional several thousand dollars.  Adding to the injury, the ER doctors are "out of network" for most local insurance plans, which means you must pay the outrageous charges until your separate, out of network deductible, is met. 
How did such profiteering come to Crescent City?  By way of an exclusive contract between Sutter Coast Hospital (a locally owned "non-profit" corporation) and EmCare Holdings, Inc. (a national "for-profit" corporation). 
EmCare would not be here if not for our local hospital Board of Directors, which approved the contract.  In fairness, the hospital Board may have been unaware of EmCare's conduct when Sutter Health recommended EmCare.  As a former hospital Board member, I know the deceptive ways of Sutter Health executives and attorneys.  In the Board room, Sutter's leaders would frequently plead poverty while neglecting to mention the $4 billion in the Sutter Health Treasury, or their own multimillion dollar salaries.  For example, Sutter Regional President Martin Brotman (the doctor/executive who convinced our hospital Board to give the hospital to Sutter Health for nothing in return), collected a tidy $4.2 million annual salary from Sutter Health.

I have many examples of Sutter Health's deception--more than 100 documents, collected during my years on the hospital Board, containing false statements by Sutter Health executives as they attempted to take hospital ownership and triple the charges on Medicare patients. During that time, Sutter Coast was operating illegally, without a CFO, so we as a Board had no one to turn to with our financial questions. Fortunately, our community saw through the deception, forcing Sutter Health executives like CEO Pat Fry (the six million dollar per year man) and Regional President Mike Cohill to set aside the decisions they had made for our community.

Whether or not the Sutter Coast Board knew of EmCare's ways, Sutter Health executives certainly did know.  Both hospital CEO Mitch Hanna and hospital administrator Carlos Priestly have acknowledged, during recorded public meetings, that they knew of EmCare's out of network billing status.  Unfortunately, the Sutter executives did not inform the ER patients about EmCare.  Patients learned when their bills arrived. 

The truth about EmCare is spreading.  This Tuesday, April 25th, the County Board of Supervisors will discuss a resolution addressing healthcare costs (see above).  Drafted by a committee of city and county elected officials, the Joint Resolution asks the Sutter Coast Board to terminate its contract with EmCare, in addition to releasing hospital meeting records and financial statements for public review.  Sutter Health and its affiliate "charitable" corporations operate in secret, rendering unverifiable their claims of providing charitable care.  Should not the privilege of tax exemption confer the obligation of public disclosure?

Supported by people of all ages, backgrounds, and political affiliations, our effort to end healthcare overcharges is working.  To share your ideas, receive this newsletter, or obtain a confidential review of your hospital bill, contact me at or call (707) 465-1126

We don't have Sutter's advertising budget, attorneys, public relations teams, consultants, lobbyists, or billions in cash.  But we do have the truth.  I look forward to hearing from you.
Gregory J. Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery

(Disclaimer: This article represents my views as a physician and not my roles as Chief of Surgery at Sutter Coast Hospital or Director of the Del Norte Healthcare District.)

Wednesday, April 12, 2017

Healthcare, Jobs, and Profiteers

Tired of Overpriced Healthcare?  Join Us.
If you want quality, affordable healthcare, please read on. You will learn how Sutter Health profiteers are driving up your co-pays, deductibles, premiums, and out of pocket maximums--all while operating as a tax exempt charity.  Together, we can end the injustice.
Special Note:  U.S. Congressman Jared Huffman will be in Crescent City this Monday, April 10, 5:15 p.m. at Crescent Elk Auditorium, 994 G St., Crescent City
Please join me to share your thoughts on healthcare with Rep. Jared Huffman  
Healthcare, Jobs, and Profiteers  
by Gregory Duncan, M.D.  

Thanks to the Del Norte Triplicate, where the following article was originally published:  Click here to read Triplicate article              
Healthcare costs are out of control.  In turn, insurance premiums have skyrocketed.  Businesses are paying higher workers' compensation rates.  As employment costs rise, wage growth stalls and jobs are outsourced.  Patients face high deductibles and more "out of pocket" fees.      
Rather than addressing the problem (costs), healthcare legislation has simply shifted the costs onto others (cost shifting).  Insurance companies pass the cost onto employers and workers.  Public health programs shift the cost onto taxpayers and increase the national debt. 
Healthcare cost shifting is rampant in Del Norte County.  Sutter Coast is the only hospital in the county, and is using its monopoly to charge high prices.  As a former hospital Board member, I can report that Sutter's fee increases were so stealthy, I was initially unaware of the pattern.  But thanks to patients who provided their hospital bills, I discovered Sutter Coast Hospital is charging up to ten times more than other local providers for identical tests, and thousands of dollars more for imaging studies and procedures (as compared to neighboring hospitals).
How is Sutter able to charge high fees?  Market power.  Sutter's statewide takeover of community owned hospitals provided the market power needed to raise prices on insurers, union trust funds, government, and individuals.  At the same time, Sutter Health claims a charitable tax exemption, allowing it to escape millions in taxes locally, and billions statewide. It's a great business model--for Sutter executives and attorneys.  During my two years on the Sutter Coast Board, Sutter Health reported profits exceeding $1 billion. 
Executive pay at Sutter Health also rose--former CEO Pat Fry saw his multimillion dollar salary triple during Sutter Health's statewide hospital takeover.  Mr. Fry's retirement year salary was $7.5 million, not including fringe benefits, such as paid membership to a "social/business club," and his hiring family members for lucrative jobs at Sutter Health.  Now you know where your Sutter payments go--multimillion dollar salaries, nepotism, and "We Plus You" signs across California.
Sutter's Board meetings are closed to the public.  Sutter Health executives have refused official record requests from our County Supervisors and City Council.  Tax law requires Sutter to operate exclusively for charitable purposes.  I ask readers:  Is Sutter operating exclusively for charitable purposes?  Should tax exempt charities be permitted to operate in secret?
The latest chapter in high fees at Sutter Coast Hospital involves a corporation called EmCare.  Under an exclusive contract provided by Sutter Coast, EmCare is operating "out of network" (meaning the ER doctors are not preferred providers for most local insurance plans) and is charging thousands of dollars for a single doctor visit.  For a high complexity visit, Medicare allows $176.  For the same service, EmCare charges $2,054.  EmCare's "out of network" status means its inflated fees are applied to your separate, out of network deductible (which means you must pay them).  Sutter Health executives are aware of EmCare's out of network status, but are not notifying patients.  This month, I asked Sutter Coast to cancel its contract with EmCare.
Sutter Coast CEO Mitch Hanna publicly stated my effort is a "witch hunt." I understand Mr. Hanna's need to point fingers and change the subject.  Sutter Health is enriching him and his fellow executives.  Lacking any justification for Sutter's high prices, Mr. Hanna resorts to name calling.  Expect more name calling from healthcare profiteers as harm to patients is exposed.
Overpriced healthcare hurts us all, which is why so many joined our successful effort to stop Sutter from tripling out of pocket charges on Medicare patients.  Recall the hospital pickets and Town Hall meetings where Republican, Democrat, and Tea Party members stood shoulder to shoulder in support of stopping Sutter Health executives from enacting their plans on our community. Your support forced a multibillion dollar corporation to change course. Statewide, union leaders and businesses are supporting our effort.
If you are tired of overpriced healthcare, please join us.  To receive a confidential review of your hospital bill, or share your ideas, contact me at or call (707) 465-1126.
Please join our bipartisan, grassroots effort for affordable healthcare.  I thank everyone who put me in office, and I look forward to hearing from you.
(Disclaimer: This article represents my views as a physician and not my roles as Chief of Surgery at Sutter Coast Hospital or Director of the Del Norte Healthcare District.)
Gregory Duncan, M.D.

Monday, February 27, 2017

Investigation reveals massive fees at Sutter Health monopoly hospital

Investigation reveals massive fees at Sutter Health monopoly hospital
Learn the facts behind Sutter Health's high charges while it operates as a tax exempt charity
Whether you have private insurance or Medicare, you will pay much more at Sutter Health hospitals.  Research comparing fees at regional healthcare facilities, including Sutter Coast Hospital, shows charges and "out of pocket" costs are highest at Sutter, by far.  From x-ray, MRI, and lab tests, to surgical procedures and doctor fees, you pay more at Sutter:

The charge for knee x-rays at my office is $84, which includes the doctor's fee to interpret the x-ray findings (known as the "reading fee"). Medicare allows $38 for taking the x-rays and reading the study.  Sutter's charge for the same x-rays at their facility in Brookings, Oregon, not including the reading fee, is $181.  For the same x-rays at Sutter Coast Hospital, not including the reading fee, Sutter charges $515.

The pattern is similar for laboratory tests.  At a reference lab less than one mile from Sutter Coast Hospital, the bill for a blood test for liver function was $18.  Sutter's bill for the same test was $117.  

For MRI, surgical procedures, and colonoscopy, Sutter's charges are even higher--thousands of dollars more than other providers.  If you need urgent care, consider these reports from ER patients at Sutter Coast:

--doctor bills exceeding $2,000 for less than 10 minutes with the doctor
--a $595 fee for the ER doctor to apply a brace
--patients routinely subjected to unnecessary tests 

Why is this important?  Because overpriced healthcare harms us all: 
  • high health insurance premiums reduce employee wages
  • out of pocket healthcare costs hurt individuals and families
  • expensive healthcare drives jobs overseas
  • healthcare overcharges erode retirement and trust fund budgets
  • Sutter's charges raise worker's compensation costs to businesses
Q.  How can Sutter charge higher fees? 
A.  Market power.  Sutter Health's market power and high fees have gained national attention:  

In Crescent City, Sutter Coast Hospital receives an annual $2 million federal subsidy as a "sole community provider."  Its monopoly status also allows the hospital to charge higher fees to patients.  

Q.  Do Sutter's profits stay local?
A.  No.  Every two weeks, Sutter Health transfers all local hospital profits to the "Sutter Health Treasury."  Sutter executives nearly tripled their salaries after taking ownership of locally owned hospitals.

Q.  Can Sutter's high fees be addressed?
A.  Yes, with your help (see below).  Sutter is already reacting to growing opposition over its business practices:

Be aware of Sutter Health public relations campaigns. When you see the advertisements, remember they are crafted to divert your attention away from Sutter's high charges and misuse of its tax exemption.  Also remember who is funding Sutter's PR campaign--anyone who goes to Sutter, pays for health insurance, or pays taxes.  Sutter's "charity" status allows it to avoid taxation while accessing billions in tax exempt bonds.  

What Can You Do To Help?

1.  Share this newsletter with interested friends, and post on Facebook.  

2.  Ask Sutter for your itemized bill.  For a confidential review of your charges, send me your hospital bills.  I have found overcharges and fees for services not provided, forcing Sutter to issue refunds.

3. Share your healthcare ideas and concerns with me.  Email gregoryduncan1200@gmail.comcall 707-465-1126, or stop by my office at 1200 Marshall Street in Crescent City to pick up flyers and sign our petition.  
Click here to listen to my radio interview covering the history of Sutter Health

Next issue:  Sutter Health's executive salaries and public relations campaigns, all funded with your healthcare dollars and Sutter's tax-exempt treasury

Disclaimer:  This publication reflects my personal views and is not representative of my roles as a member of the Del Norte Healthcare District Board, or as Chief of Surgery at Sutter Coast Hospital.
Gregory J. Duncan, M.D.| (707) 465-1126 ||

Thursday, January 19, 2017

It's Time to Address the High Cost of Care

It's Time to Address the High Cost of Care
High Fees, Out of Network ER Doctors Raise Your Out of Pocket Costs

For years, patients have been paying high fees at Sutter Coast Hospital, along with inflated charges to the hospital's "out of network" ER doctors.  It's time for the high fees to end.

Sutter Health has received national attention for its high patient care charges. See this NY Times article on the inflated charges at Sutter's hospital in San Francisco: 

As a first step in addressing local healthcare costs, I am compiling a list of fees for common procedures at local clinics and Sutter Coast Hospital.  Thus far, Sutter Coast has not provided any of the data I requested on their fees. However, using data from bills provided by patients, Sutter's charges are much higher than other facilities--up to 10 times higher for lab tests compared to the reference lab on 1771 Northcrest Blvd.  Colonscopy charges are roughly three times higher at Sutter Coast compared to Medford, OR.  MRI scans at Sutter are roughly double the cost of the same study in surrounding communities.  

In Crescent City, in addition to Sutter's fees, we have another problem:  The contract Sutter Coast signed with its ER physicians allows the doctors to charge patients "out of network" rates, as was confirmed last week by Sutter Coast Hospital administrator Carlos Priestly.  Please see the 12/29/16 article by Jessica Cejnar in The Del Norte Triplicate for more details: 
Those of you who have received treatment at the Sutter Coast Hospital ER know the shock of seeing huge doctor bills.  To add to the injustice, there is no sign in the ER notifying patients they will be charged higher, out of network rates--you find out when your bill arrives.

Sutter Coast administrator Carlos Priestly claims that the hospital treatment consent form addresses the out of network ER issue.  But I read the hospital's consent form--it makes no mention of EmCare (the corporation which hires Sutter Coast's ER doctors), nor does it disclose the fact that the ER doctors are "out of network," or the actual charges which patients incur.  Sutter Coast administration knows its ER doctors are out of network, but are not disclosing that fact to patients.  As a first step, I asked Mr. Priestly to post a sign in the ER, notifying patients that the doctors are out of network.

Other Highlights from the last Healthcare District meeting:
  • Sutter Coast Hospital administrator Carlos Priestly confirmed the hospital does not have sufficient staff to utilize all its beds, which means patients are either held in the emergency room or transferred to another hospital. Mr. Priestly said Sutter Coast is working to address its staff shortages.
  • Mr. Priestly confirmed the census at Sutter Coast has been consistently over 25 patients.  Remember 25 is the acute care bed limit for Critical Access hospitals, and that in 2013, the hospital Board voted (over my dissenting vote) to downsize Sutter Coast to Critical Access.  Thanks to community opposition, the hospital Board later reversed its decision to implement Critical Access, which would have tripled out of pocket costs to local Medicare patients and increased the number of patient transfers to outside hospitals.  But we must stay alert--hospital CEO Mitch Hanna has publicly stated, "we are not closing the door" [on Critical Access].
How You Can Help:

If you would like to end Sutter's high charges and out of network doctors, here is how you can help:

1.  Write our local newspaper, asking the Sutter Coast Hospital Board of Directors, and hospital CEO Mitch Hanna, to put an end to ER physicians charging inflated, out of network rates.  Ask Sutter to publicly post its charges for common tests and procedures.  Letters to The Del Norte Triplicate may be mailed to 312 H. St., P.O. Box 277, Crescent City, CA  95531 

2.  Review your hospital or clinic bill:  contact me at (707) 465-1126 or by email.  I will confidentially review your charges, including "out of network" doctor fees.

Disclaimer:  This publication reflects my personal views and is not representative of my roles as a member of the Del Norte Healthcare District Board, or as Chief of Surgery at Sutter Coast Hospital.

Gregory J. Duncan, M.D. | | (707) 465-1126
Diplomate, American Board of Orthopedic Surgery
Finally, please accept heartfelt thanks from Dr. Kevin Caldwell and me for supporting us in our recent election to the Del Norte Healthcare District Board.  Your votes energized our commitment to expanded, improved healthcare for residents and visitors to our region.  We look forward to working with you!

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