M. Cole Johnson: Judge correctly upheld law in St. Luke’s case


February 14, 2014 

Dr. David Pate’s recent comments in the newspaper would have you think Judge B. Lynn Winmill’s decision was based on misinformation, confusion and errors of fact. He would have you believe that archaic laws were applied in an incorrect manner to the detriment of the health care consumer. Dr. Pate explains St. Luke’s health care decisions are in part made by our local community business leaders for our benefit. Fortunately, the case was decided on the facts, and in my opinion to the benefit of the health care consumer.

Dr. Pate indicates in his op-ed piece that Judge Winmill praised St. Luke’s for its foresight and vision. The article (Feb. 2 in the Statesman) alludes to the judge’s musings as well, describing the state of health care in an “experimental stage where hospitals and other health care providers are examining different models trying to find the best fit.” As stated, these are musings of the judge. The legal profession has a name for these musings: dicta. These are utterances of the judge in the decision that have no bearing on the outcome of the case. Dr. Pate, wearing his attorney’s hat, knows this.

Now examine the facts. St. Luke’s has three of the top five highest-paid hospitals and its top hospital has a reimbursement rate 21 percent higher than the average Idaho hospital. Acquisition of the Saltzer group would allow increase in costs of 30-35 percent for lab services; billing for outpatient visits for the Saltzer group at the hospital based rate would increase by 60 percent. As least part of the 60 percent increase comes from the taxpayer in the form of facility fees. These fees are allowed by Medicare for ancillary services provided by small rural hospitals to provide solvency for those rural hospitals. St. Luke’s and other health care systems found a way to circumvent the intent of the program by managing physicians and billing their services through the hospital’s billing systems, increasing their profits and splitting the income with the physicians they manage. Obtaining the Saltzer group would weaken the insurer’s position in negotiations due to the monopoly created by the acquisition, thus increasing reimbursement costs to the health care provider and increasing premiums.

Dr. Pate reminds us that our friends and neighbors on the hospital boards provide oversight for us. This quote by a St. Luke’s board member in The Kansas City Star dated Dec. 28, 2013, speaks for itself: “Let’s be realistic, employing physicians is not achieving better cost, it’s achieving better profit.”

Dr. Pate would have you and I believe the archaic antitrust laws violated in this case should not apply. We should all be so fortunate as to choose to follow only those laws with which we agree. Dr. Pate, and any citizen of the United States, is welcome to petition for change in the laws through the legislative branch of government. Fortunately Judge Winmill applied the law correctly when he said, “antitrust law is in full force and must be enforced.”

I, as part of the health care system, want to provide quality, cost-effective, timely care to my patients. I believe any provider has the same goals. The purchase of the Saltzer group by St. Luke’s, as stated in the decision by Judge Winmill, would not have furthered that goal.

M. Cole Johnson, D.O., is a family practice physician in Twin Falls.

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