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'Any willing provider' law needed.

IN 1995 THE ARKANSAS Legislature passed an "any willing provider" law to protect consumers and businesses from the economic pitfalls and anti-competitive issues that would result from exclusionary alliances in managed care health plans. Any willing provider laws enable a hospital or physician to join these plans if they are willing to accept the terms and reimbursement rates already in place. Unfortunately, the law was blocked by a federal appeals court ruling in 1998 and has never been enforced.

The result is precisely what lawmakers feared. We now live in an area where one managed care provider, Arkansas Blue Cross and Blue Shield, controls as much as 70 percent of the market and excludes hospitals and physicians not affiliated with their partner-of-choice, Baptist Health. As a result, many consumers and employers, along with large numbers of excluded physicians and hospitals, all suffer.

Now, Arkansas Blue Cross and Blue Shield has filed a lawsuit in federal district court to continue to block this law. They contend that the U.S. Supreme Court decision on Kentucky's any willing provider law doesn't apply to Arkansas.

The Blue Cross position states that "any willing provider" legislation is contrary to open competition and freedom to contract. Whose competition and whose freedom? In fact, Blue Cross' position is totally anti-competitive for all parties.

For instance, Southwest Regional Medical Center has been willing to accept Blue Cross' pay scale for years. In some cases, we're willing to accept less than Blue Cross currently pays other hospitals for the same services. But Blue Cross has never allowed their members access here, even when it would mean greater convenience, more personal care and cost savings. Our hospital has made significant capital improvements in the past four years, which means we have some of the newest and most advanced diagnostic equipment available. Yet, most Blue Cross plans exclude, or penalize, their customers from accessing it.

Also consider that the nationally respected Center for Studying Health System Change (HSC) has repeatedly expressed serious concern about health care costs in central Arkansas. We're one of 12 communities across the country tracked intensively by HSC researchers. Their latest report notes that rapidly rising health insurance costs--double-digit premium increases the past two years--are prompting employers to shift more costs to workers, with larger premiums, higher deductibles and co-payments. Employees, as a result, are finding coverage to be increasingly difficult to afford.

HSC's Alwyn Cassil noted in this publication that, "The diagnosis for Little Rock's health care market isn't good. With Arkansas Blue Cross and the Baptist Health System being the dominant insurance and hospital system in Little Rock, it's difficult for other competitors to get a toehold." The situation is grave enough that the Federal Trade Commission and Department of Justice are investigating our market in their Hearings on Health Care and Competition Law.

The solution is competition, but Blue Cross doesn't want competition. Similarly, they don't want their exclusive partner, Baptist Health, to face competition. Why? Perhaps because, while premiums are rising, they may not be rising as rapidly as Blue Cross' profits, which exceeded $50 million, pre-tax, in 2001.

How will competition help? Employers will know the insurance rates they pay will be set in a free and open market. Physicians will have the freedom to treat patients at the hospital that best meets the needs of those patients. They'll also be able to provide better care to patients because of freedoms in scheduling as a result of competition. Consumers will have more freedom to choose their physician and where they receive treatment.

Employers, who pay a great deal of overall healthcare costs through insurance premiums, deserve a competitive marketplace. Taxpayers in Arkansas deserve to know that when tax dollars are paying for health plan coverage of state employees, the plan has received competitive bids. (The state requires competitive bids before purchasing pencils and envelopes, but not when purchasing an MRI or knee replacement surgery through Blue Cross). And if they're willing to accept the same payment as those included in a health plan, the physicians and hospitals of Arkansas deserve the right to compete for patients.

In short, Arkansans deserve the any willing provider law.

Randy Cason has been CEO of Southwest Regional Medical Center in Little Rock since 1999. Health Management Associates operates it and other hospitals throughout the South.
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Title Annotation:exclusionary alliances in managed care health plans; Commentary
Author:Cason, Randy
Publication:Arkansas Business
Geographic Code:1U7AR
Date:Sep 8, 2003
Words:720
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