St. Luke's Health System argued Friday that if its planned buyout of the Saltzer Medical Group is blocked temporarily by a federal ruling, it likely won't ever be able to acquire Saltzer, the nearly 50-physician practice based in Nampa.

Without a deal, 341 jobs could be lost, said Jack Bierig, a Chicago-based attorney for St. Luke's.

With a deal, more than 140 jobs and free services provided by St. Luke's competitors could vanish, say Saint Alphonsus Health System and Treasure Valley Hospital, both competitors of St. Luke's. They ant to block the acquisition this year.

A buyout would reduce competition for primary care in the market served by Saltzer and would irreparably harm Saint Alphonsus and Treasure Valley Hospital by taking away patients, the hospitals' legal team argued.

U.S. District Judge B. Lynn Winmill focused on two questions during a hearing on the lawsuit filed by Saint Alphonsus and Treasure Valley Hospital, a small Boise hospital partly owned by physicians. The questions were the definition of Saltzer's market — whether it includes just Nampa, or stretches to western Ada County — and whether a buyout would permanently and immediately hurt St. Luke's competitors.

Winmill signaled that he is weighing the case in light of a national trend toward consolidation that is fueled by changes in federal law and worries about lower reimbursements for independent doctors.

David Ettinger, a Detroit-based lawyer for Saint Alphonsus, repeated the health system's claims that Saltzer's prices would immediately rise after the acquisition because Saltzer would start charging St. Luke's rates.

Winmill said he expects to issue a decision on the preliminary injunction next week. He also asked both sides if they are ready to go to trial within six months, which would lead to a final ruling on whether the acquisition is legal.

But by then, the Nampa-based group would break into smaller practices, many of which are likely to be bought up by Saint Alphonsus, Bierig said.

He said he wondered "whether in fact that [result] is what Saint Al's is hoping for."

Bierig added that the buyout isn't meant to control the health care market or trample competition, but to control how Saltzer physicians are paid.

He said the acquisition is a step in a plan by St. Luke's to manage patient care in a way that gives doctors incentives for high-quality care — instead of paying them based on how many patients they see or how many procedures and tests they do. The plan includes opening a larger health-care facility in the Nampa area, setting up agreements with insurers to promote high-quality care and better patient health, and eventually lowering costs by having a full suite of coordinated medical services.

The plan will not shift referrals to other St. Luke's providers in the short term, Bierig said. "We hope over the long run, [referrals] will be substantially affected as we see benefits arise," he said.

Audrey Dutton: 377-6448