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Jeff Branscome writes about Spotsylvania County.

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County’s siding with HCA becomes more clear now

Some of you have questioned why the Board of Supervisors and the county would approve a message on its Web site to call Anthem to request they come to an agreement with HCA and the Spotsylvania Regional Medical Center for accepting the state’s leading health care provider.

Tuesday’s agenda clearly explains why the county is taking an HCA-favorable position.

The county is working on an agreement to have Anthem provide healthcare insurance to all government and schools employees—which is tens of thousands of people who mostly live in this county.

No one has been told what the real problem is. HCA and Anthem each have different reasons why an agreement has not been made.

Instead of the Board of Supervisors finding out what the real problem is and trying to forge a solution, they have sided with HCA and are asking residents to complain to Anthem.

HCA is a for profit hospital. HCA would obviously want the best pay rates for its doctors its services. Anthem, on the other hand, would prefer not to see healthcare costs rise in the region because it may be asked to pay doctors more at HCA.

Does this synopsis reveal anything to you?

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Permalink: http://news.fredericksburg.com/spotsygovt/2010/06/21/countys-siding-with-hca-becomes-more-clear-now/

  • bhaas

    Interesting and timely that Dan has opened this thread at this time.

    I just finished watching the re-broadcast of the BOS meeting where Mr. Connors brought up the subject and urged Anthem customers to call and “urge” Anthem to agree with the Spotsy HCA facility. He was joined, first by Mr. Pitts and then by Mr. Barnes who volunteered to have the County post the Anthem phone number on the County web site.

    Hence, I stand corrected…the County DID take an official stand in the negotiations between Anthem and Spotsy HCA. Perhaps that is proper since Spotsy appears about to adopt Anthem as it’s HC Ins provider.

    Does anyone know how those negotiations are going? Is the “pressure” resulting in positive action?

  • http://Z2KS LarryG

    Maybe I’m looking at this wrong. If Anthem negotiates lower prices from HCA, one might presume that it will benefit the Spotsylvania County citizens who have Anthem health insurance.

    right?

  • bhaas

    Heheh…You’re right Larry.

  • http://rightwingliberal.wordpress.com/ D.J. McGuire

    Sounds to me that the BOS would just prefer that a deal be done so the staff isn’t lefy high and dry.

    Based on Jim Hall’s piece, Anthem and HCA don’t appear to be in the same universe. HCA says it just wants the payments Anthem gives Mary Washington; Anthem says HCA is asking for rates higher than MW.

    Bizarre.

  • http://rightwingliberal.wordpress.com/ D.J. McGuire

    Ugh! That should be “left”, not “lefy”.

  • SteveThomas

    Again, if both sides seems to be amenible to HCA getting the same deal MWH gets, why not just have that be the meeting point?

    I don’t think it is untoward to have the BOS ask people to call to request a solution. They’re not asking for people to call and berate Anthem or say anything bad. Just to find a solution- which IS in the public’s best interest. Btw, if the rates Anthem forces are so low HCA can’t attract docs to compete with MWH, it’s not a good thing for Spotsylvanians.

    HCA is covering Anthem customers’ costs to get them down to their effective copay in the interim. I think that speaks volumes about where they are coming from.

  • opiniontoshare

    How much tax money goes directly to the county from Anthem vs. HCA? And how hard has the BOS worked to get an Anthem office opened here vs. an HCA hospital? Answers to those questions might explain why the BOS seems to be trying to put more pressure on Anthem.

  • http://Z2KS LarryG

    yeah….. Steve and DJ …. this is TAXPAYERS money spent to provide health insurance for county employees – right?

    what’s the best deal for taxpayers here?

  • newsreader

    yes, this synopsis does reveal something to me.; specifically, that you are wholly ignorant regarding the subject about which you are writing. A hospital does not negotiate rates “for its doctors.” A hospital negotiates rate fr hospitals services. Doctor almost exclusive negotiate rates with insurance companies themselves.; Alas, I bemoan the demise of journalism as we once knew it. Once upon a time a beat reporter at least had a modicum of knowledge regarding the subject about wihc he or she wrote.

  • http://Z2KS LarryG

    not to be too harsh on “journalists”, the situation is pretty widespread with most consumers to include elected officials and the root cause of the problem is that most consumers of health care do not really care what the services cost nor who is providing them, much less shop around for the best value because with the way we “do” insurance now days, you are either “covered” or you or not.

    So the average person not only has no clue what HCA would charge for an MRI nor what MWC would charge nor how those prices compare to other providers much less engage in normal consumer behavior of refusing to pay more for something than you should.

    Just FYI – MRI’s in other countries cost about 1/10th what they do in this country – using the same exact equipment.

    and finally.. I find it ironic that the BOS and the County are asking taxpayers to talk to Anthem about what?

    About keeping their premium prices as low as they can so as to save their employees and taxpayers money?

    Nope.

    They apparently want Anthem and HCA to agree to whatever MWC and Anthem have agreed to – a very UNCOMPETITIVE, and anti-capitalist concept that our two erstwhile Republican commentators here have had ZERO to say about it.

    How about some Republican words on this situation guys?

    What would Republicans do about this if they were in charge?

  • SteveThomas

    Not to speak for anyone else, but if it were me I’d be asking people to call Anthem and encourage a solution also. SRMC is incredibly important to our local economy and it needs to succeed for us. Apart from that, as a conservative, Anthem appears to be operating in a monopolistic fashion, which is not very free market (conservatives are trying to stop the Feds from operating in the same fashion). So Larry, we would probably disagree here.

  • Reader

    Dan, Spotsylvania Regional Medical Center is not negotiating for doctors, it is negotiating rates for the care provided within the hospital by nurses, technologists, aides, and related ancillary services. Physicians are independent practitioners paid by third parties – like Anthem. Your article misrepresents this fact by stating “HCA would obviously want the best pay rates for its doctors.”

  • http://MAVRICKinc7@msn.com Martin (Marty) Work

    Anyone have an ICD 9 Code Book handy” Doctors negotiate with insurance companies and contract out their ICD-9 services, at at the coded level of health care being delivered to any one patient and conforming to what the insurance company has contracted with the doctor to pay for services rendered.

    Anyone ever review a hospital billing under terms of quality assurance and utilization reviews and discover that a bowl of jello goes for $750 per cup? I doubt it. Quality assurance and Utilization reviews by the insurance carries usually pick up on these discrepancies. If you see a hospital bill covering a 3 day stay for $30, 000, the patient could care less. Howver, the hospital does care, because they too have a contract with the insurance carrier to accept what the insurance company intends to pay out for services rendered and it doesn’t add up to $30,000 for a 3 day stay or a cup of jello at $750 per cup. You be the judge on quality of care delivered but when it comes to market share in the health care business, all bets are off, until another Contract is written and agreed to by the parties of interest.

    I believe Doug Barnes and County Attorney Strohman have been assigned to accomplish this end with Anthem.

    Next time you show up at the hospital for an MRI, ask radiology whether you’re getting a 2 tesla or 3 tesla film at the end of your day and which one is more diagnostic than the other.

  • Dan Telvock

    I stand corrected: HCA wants the best rates for its service providers.

    But is it out of the realm of possibility that the doctors have complained to HCA about Anthem?

    Give me a break.

    How about this: One side has one story. Another side has another story. How about someone step up and tell the truth. These are private entities and there is nothing I can request through the Freedom of Information Act that would possibly shed some light on this.

    And secondly, it is not my beat. I cover Spotsylvania County government and not the medical beat.

    The clarification you are all pointing out really doesn’t affect anything. Whether it is a doctor HCA is pushing for or its own staff, someone is not giving the full details of what the problem is.

  • bhaas

    I agree with Dan…this whole discussion started because HCA and Anthem told diametrically opposed stories to Jim Hall.

    The important issue now is; what is going on in the negotiations? Are there even any nogotiations going forth? Why the devil is there two different stories here? This sounds like a grade school recess dust -up. Where is the adult supervision?

  • opiniontoshare

    Didn’t one side say they were offering rates that were “comparable” to what MWH gets while the other side side said they wanted what MWH gets? “Comparable” is subjective. Is comparable a 15% difference in rates, a 10% difference, or what?

  • Dan Telvock

    It becomes very difficult to find what is really happening with two private entities. This is not my beat. I think Jim Hall, the medical reporter, will get more answers when he returns. But like a few posters added, I don’t want to say anything that is incorrect.

    The problem has been reported in the newspaper. There’s just two different sides to the story.

  • http://Z2KS LarryG

    But Steve Thomas says that since Anthem is a monopoly that government should get involved?

    That’s strange… if you ask me. I don’t have Anthem and I have no clue what my company has “negotiated” with HCA… but I strongly suspect they’ll pay the same thing that they pay for MWC or any other hospital provider – as …. now pay attention here Steve – as dictated by the Federal Government as a requirement of any plan offered to govt employees including Congressman.

    So.. Steve – it’s the Federal Government that wanted to expand this rule to all providers as part of health care reform.

    so .. should the govt be involved in this issue or not?

    I keep asking and I’m not getting a firm answer here.

    BTW – “near monopoly” is also a weasel-word as there are a bunch of non-Anthem providers in the area…. but I’ll play along and pretend for Steve’s sake that it is ONLY Anthem so I can then ask Steve – does this situation justify the big, bad, incompetent, corrupt government intervening ?

  • SteveThomas

    I don’t think so Larry. I gather you don’t currently commute north for a living; but 60 pct of Spotsy’s workforce does, representing like 75 pct of households. If you look at what they are offered at work- not their choice, usually- it’s CareFirst or another DC-based provider. Those providers do not insure in our area so who do they work out deals with? Anthem, the biggest carrier here.

    I also think the key is not publicly lashing Anthem; just encouraging a solution. No one, including me, is taking anyone to the woodshed here.

  • http://MAVRICKinc7@msn.com Martin (Marty) Work

    Larry…you’re burning the candle at both ends, with no where else to go. WHY? It doesn’t serve a useful purpose and only the health care community can wage this battle for market share. Face it, you’re becoming nothing more than a distraction and we are the ones worse off for your single minded pretense on the subject of solutions. Can’t bring myself to say “back off”, you’re headed in the wrong direction and it appears all you want to do lately is pick fights. This is something you’ll have to decide for yourself.

  • http://Z2KS LarryG

    Steve – do you know how many Fed Govt workers we have who have access to about a dozen different plans. How about active duty servicemen and woman who have TRICARE for themselves and their families?

    The ONLY reason Anthem is the biggest carrier here guy is because the county and the school system have about 4000 employees who get whatever insurance the county decide to contract for.

    In other words, it’s the county who is deciding that they are going to choose Anthem – at the same time Anthem is not agreeing with HCA.

    I would tell you again that with all of the Fed Govt Plans, Tricare and Medicare – that the reimbursement rates don’t vary by hospital – because the Fed govt won’t allow it.

    If the Govt did not do this – we’d have dozens of companies engaging in the same thing that Anthem is …

    the only reason they’re not is that the govt tells them they cannot.

  • http://Z2KS LarryG

    Marty – the only thing I am advocating here is that folks use their heads in recognizing that as big as Anthem is that there are other providers because so many of our residents are Fed govt employees or active duty service folks with plans also.

    To ask why this is only a problem with Anthem and not Tricare or Medicare or the dozen other plans that Fed Govt employees have.

    and then of course – to also recognize the irony that it is the county itself that is enabling Anthem to have “near monopoly” status since they are the ones who have chosen Anthem for their county and school employees.

    Then finally.. to recognize how the Fed govt steps in and tell’s it’s contracted providers that they cannot do this kind of stuff while the county tries to get folks to “call”.

    Why would the county not simply say – as a contract provision – that whoever they select to be the provider – has to provide the same reimbursement no matter whether it is HCA or MWC – you know..like the Feds do.

  • Dan Telvock

    I think it is important to note and make clear that the county already uses Anthem for its insurance. I am not sure if school employees are covered by Anthem.

    At tonight’s meeting (actually yesterday now) they decided to keep the current insurance program. As of right now, none of them can go to the new hospital here without paying more.

  • bhaas

    Apparently, negotiations are continuing….or have they stopped with no resolution???

  • SteveThomas

    Dan, that’s not correct about paying more; SRMC is comping Anthem members so their copay is the same as if they were covered. It’s a good interim move by HCA until they work out the anthem deal.

  • Dan Telvock

    Steve, where did you get that info? Based on Jim Hall’s last story, HCA said it would do its best to minimize costs, but there is no guarantee.

    If Spotsylvania Regional does not join Anthem’s network by the time it opens, patients with Anthem insurance would be “out-of-network” there and could face higher costs, depending on their plans.

    Tobin said the hospital promises to minimize this impact, if it occurs.

    “They can come to our hospital, and we will work with them to make sure that there is no financial penalty,” he said.

  • opiniontoshare

    “If Spotsylvania Regional does not join Anthem’s network by the time it opens” – What do you mean “by the time it opens” – it’s already open.

  • Dan Telvock

    Opinionstoshare, that was a quote from Jim Hall’s story before the hospital opened. SOrry

    Again, this is from Hall’s story:

    “If Spotsylvania Regional does not join Anthem’s network by the time it opens, patients with Anthem insurance would be “out-of-network” there and could face higher costs, depending on their plans.

    Tobin said the hospital promises to minimize this impact, if it occurs.

    “They can come to our hospital, and we will work with them to make sure that there is no financial penalty,” he said. “

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