Five facts revealed by internal documents

1. Why is St. Luke’s making such a push into Canyon County?

One reason: Giving western Treasure Valley residents the option of going to St. Luke’s without having to drive an hour.

Another reason: Money.

Canyon County residents going to St. Luke’s emergency rooms in Boise and Meridian brought St. Luke’s about $140 million of its local revenues in 2010.

“Canyon County is very significant to St. Luke’s,” said a presentation slide that showed how much of St. Luke’s local business is made up of Canyon County patients going into Ada County for medical care.

2. “Epic” gave some St. Luke’s doctors an epic headache

Couldn’t get an appointment with a St. Luke’s doctor? One of the nation’s most popular electronic medical records systems might have been to blame. Several doctors in Southern Idaho griped to St. Luke’s executives about difficulty finding time to see patients as St. Luke’s rolled out the expensive new system.

A St. Luke’s pediatric group had to stop taking new patients for a while because of the transition to the Epic system. Some doctors had to cut back their schedules by 50 percent as they struggled to get acclimated to the new setup.

A top executive at St. Luke’s called the productivity problems stemming from the new system “really worrisome.”

3. St. Luke’s offered $5,000 to health-care providers who successfully recruited certain primary-care doctors

Some years back, St. Luke’s offered a hefty bonus to doctors and “midlevels” — nurse practitioners and physician assistants — to recruit internal medicine physicians, who at the time were in short supply. The requirement? The newly hired doctor must work for St. Luke’s for 30 days.

The hospital system said it sometimes offer bonuses for other positions as well, such as pharmacists or specialized nurses. The amount varies, and the bonuses are offered only when there’s a shortage of certain high-demand employees.

4. St. Luke’s executives told board members their goal is to slow the rising cost of health care

Internal documents turned over by St. Luke’s say the health system’s goal in teaming up with Utah-based insurer SelectHealth — they signed a contract that rewards St. Luke’s financially for efficiency — was to “decrease the premiums that patients pay.”

St. Luke’s was frustrated by years of talk and no action with Idaho health insurers about changing how health care is paid for, and the perverse incentives that have been created by the pay-per-procedure system of insurance.

St. Luke’s said that payment system was partly the fault of providers, including itself.

The documents also show that St. Luke’s got SelectHealth to agree to offer insurance plans built “exclusively” around a network created by and composed mainly of St. Luke’s clinics and affiliates.

Those plans are the cheapest available in some parts of Idaho, but patients generally cannot see Saint Alphonsus providers unless they want to pay out-of-network rates.

5. One patient’s out-of-pocket lab costs increased 490 percent

When a cancer patient wrote an email to St. Luke’s CEO David Pate saying her costs for bloodwork spiked from $40 to $236 after her doctor joined St. Luke’s, she prompted a string of emails among St. Luke’s employees and leaders.

Her bloodwork was suddenly billed as occurring in a hospital, and her insurance plan wouldn’t cover that, leaving her with the full charge.

“Unfortunately she has a really good handle on what happened,” said one email. Another said she worked for the Idaho Statesman, making the situation “sensitive.”

Finally, a hospital leader suggested St. Luke’s “defuse this specific instance with a one-time refund and hope the issue dies there.”

The patient, Michelle Philippi, is an advertising sales manager for the Statesman. She did not share her employment information with St. Luke’s in the email and is not sure how people knew where she worked.

A St. Luke’s employee called on Christmas Eve and told her not to worry about the bill. “They just wrote off the whole $236,” she said. “I’m obviously happy with how it turned out, but I feel for people who didn’t know” why their costs rose.

A spokesman for St. Luke’s couldn’t say whether the hospital gave refunds to other patients.