Oh, no—don't tell me I've got to start agreeing with doctor and State Senator R. Blake Curd:
The orthopedic surgeon steps out from the operating table to encourage our Yes vote on Initiated Measure 17, the "Any Willing Provider" insurance proposal. IM 17 revives a bill defeated in the 2013 Legislature that would allow any health care provider who meets an insurance company's terms (quality of care, billing rates) to participate in that insurer's network.
Short form: all those state employees in Brookings who have to drive down to Sioux Falls to lower their out-of-pocket costs could go to their local hospital, pay lower in-network copays, and miss less work.
The South Dakota Association of Healthcare Organizations opposes IM 17, contending primarily that Any Willing Provider laws increase health care costs. Klick and Wright (2012) support that contention; however, only the increase in drug expenditures is statistically significant; the minor increases in physician and hospital expenditures is not statistically significant.
South Dakota already has an Any Willing Provider law for pharmacy services (SDCL 58-18-37, on the books since 1990). USD economist Michael Allgrunn and co-author Brandon Haiar (2012) analyze the cost impact of AWP laws specifically affecting physicians and find that a law like IM 17 would actually lower costs.
The cost issue is open for debate and dueling studies. The other major claim opponents make, that IM17 is "another mandate with more government control over health care" sounds entirely bogus:
The only people who would chafe under the perception of government control would be the big hospitals who are selling insurance and limiting their customers to their network. Health care consumers wouldn't feel that government is restricting their decisions; policyholders would experience control over their health care decisions shifting from their insurer to themselves. They would be able to choose from a broader network of providers.
I'm open to the cost debate, but let's put the anxiety over government-run health care to bed. IM 17 really would increase patient choice.
p.s.: No on 17 has scored more YouTube hits on their month-old ad, but Yes on 17 has lots more videos.
I wouldn't beleive any thing he says. He is big business not little guy.
Is Blake sure he's not really a Democrat?
I don't know about either side of this. When rich hospitals are fighting with over-paid rich doctors, what makes any of the rest of us think either side has the best option for us?
There must be a better third way to do this. If the SD legislators and governors gave a tinker's damn, this would have been done better without initiatives.
While looking at this area, why is it that SD pharmacists can't give us pneumonia shots? Can't give shingles vaccinations without doctors prescriptions, etc? Putting doctors into this mix drives up costs for citizens and government and reduces the percentage of need innoculations. I have pushed on this and get no response form politicians or state government.
When I see that Chiropractors are pushing for this measure, then I start to think it must not be a good idea - because Chiropractors rarely base their opinions on what is best for the consumer/patient and are always looking for the easiest way to make a buck.
I'll conceded "patient choice" is a fantastic tagline, but in this case I'm not sure it tells the whole story. Isn't it also a choice to obtain insurance at the lowest possible cost? I'm not suggesting insurance companies are looking out for their patrons, but we do know they do whatever they can to minimize costs - and having agreements in place to determine who is in their network (with pre-determined costs and fees) helps to reduce costs. If it didn't actually save money, the insurance industry wouldn't do it... so I just don't see how this measure can result in lower costs to the consumer.
What you are not saying is that a yes on 17 will change the way an insurance company will negotiate with a provider. This will be the out of network we have had since we have had any willing provider that contracts with an insurance company. Nothing changes.
So if a provider wants to be in network, but he charges twice as much as any other provider, do you want the more expensive doctor to be allowed? If so, then be prepared to answer the question. "Whats in your wallet" This was even to crooked for the legislature to pass. How about Medicare for all?
Hospitals and clinics cannot survive with medicaid and medicare patients. They need a revenue stream from patients that pay with cash or private insurance. If IM 17 passes, not-for-profit hospitals are at risk of losing patients that can pay to their competition - the for profit clinics.
I work for a small hospital in South Dakota and have read IM 17. It doesn't sound any different from the way things are now. Hospitals/providers currently can sign up with an insurance company to be in-network. We just don't necessarily sign up with all insurance companies because that would be more paperwork than it is worth. The paperwork can be many pages to fill out and have the providers sign. IM 17, as far as I can tell, doesn't force the provider to sign up with all the insurance companies. It just states that insurance companies must allow all providers to sign up with them, if they want. That is no different than the way things are now. I don't really see a benefit to this measure. Unless I am reading it totally wrong, which I could be.
The contracts that are written with providers are not so complex that they are impossible to understand. The bottom line is how much of a network savings can be provided by being a part of the insurance companies preferred provider list. There are basically 5 major players in the health care market outside of Medicare. Assurant, Avera, Dakotacare, Sanford and Wellmark are these insurance companies with Assurant being the less of the bunch. Avera and Sanford have a string of hospitals and docs that are in each others networks. Dakotacare is doctor owned so they have a good network as well. Wellmark is not owned by doctors nor does it have any kind of ownership in the hospitals and has a very good network as well.
All of these insurance companies, all of them do not have the Rapid City emergency room docs. When this passes, and it will pass because we just don't understand the whole process of healthcare, it will not change a thing for the docs in the Rapid City emergency room, guess what, they will still charge you whatever it is they want to and you will have to pay regardless if 17 wins or looses. The only thing that is saving you, the consumer from having to go back and back to the doc for basically the same thing, but for a higher cost, is the insurance racket. You will find that the insurance company will still classify Dr. Jones as being out of network on November 5 if he was out of network on November 4. In keeping with the Who, the New boss is the same as the old boss.
Regarding chiropractors, if you have ever seen one of them and have insurance, then you know the drill. They do not want to use the insurance company to get their money and will discount their services if you pay them cash money. Can you see the angle here on what it is they are trying to do? By demanding to be in a network that they do not really want to be in, they are throwing crap up against the wall to see if it will stick. They think that if this is "mandated by the state government" then they can charge what they feel and the insurance company will have to pay the inflated charges. I think you all know where this is heading, higher insurance prices to satisfy the skulduggery while blaming it on the ACA. Yep, count on the black dude getting blamed for this pos initiative while the those that support it get more for less. Initiative 17 is a looser for consumers and a gold mine for the feee for all docs.
Do you know that there is a disproportional representation of chiropractors in the state legislatures? It is a powerful lobby, the chiropractors. Cross those doctors at your own risk.
Limiting which doctor you can go to is just trying to make a monopoly. Notice the insurance companies are not the ones that started this. It was the hospitals who want to monopolize the industry who made their own insurance company to do this on their behalf. Buying up all the little hospitals was not enough, they want to squeeze out the little doctors as well.
It is a campaign of fear, Mr. Elgersma, fear and confusion. And when old people like me get scared and confused we vote NO. No, dammit!
There is no limit on what doctors you can go to now. You can go where you please. Why does anyone think that because this passes, that will change and suddenly, there will be no provider savings because there will be no providers. How do you think those providers are presently chosen? How do you think they are then contracted and what exactly is the contract? How do they get paid when they are under contract? Who will pay them after 17 and how will they be paid? It sure won't be whatever they want to be paid. If you think that, then get out your checkbooks and make up the difference.
Jerry, as I understand it, the doctors who want in don't get to charge twice as much. They have to agree to the terms the insurer sets.
"There is no limit on what doctors you can go to now."
I'm afraid that's not true Jerry-at least not totally. My wife had Sanford Insurance and when she had breast cancer she had to Sanford and see a Sanford doctor. When her cancer doctor went exclusively with Avera my wife, even though she liked her doctor, had to get a new cancer doctor.
This has been one of the lies coming from Rounds. He blames Obamacare for limiting choices but this has been going on longer than Obamacare has been around
Cory, that is the case right now. The contract is between the insurance company and the provider. The insurance companies try all the time to contract doctors and clinics and for the most part, it works very well. The insurance companies like Avera and Sanford that already have hospitals and doctors, still have outside doctors and hospitals as well. They may not be an actual Avera or Sanford network in west river, but there is a contracted network that works just the same. This bill is smoke and mirrors to try to hustle more money from the consumer and it probably will work with the blessing of the state of South Dakota as it will be a mandate. I thought republicans hated those pesky things, turns out only when it is someone else who proposes them
Owen, you are correct on the cancer treatments. Those follow a different set of circumstances with having the particular insurance companies Avera and Sanford. If you have one of those insurance plans, you will want to stay in network and get your treatments done at their centers. Both are quite good and provide services that Wellmark and Dakotacare use as well. Now if your wife choose to keep seeing that doctor, then you still could but you would pay a higher percentage of the costs. You cannot be denied seeing a provider, but you can be denied the preferred provider savings.
The contract on these plans indicate very clearly that the plan is a preferred provider organization. It was never designed to be anything but that. What that means is that a provider agrees to the terms of the insurance company in exchange for the insurance company to pay the agreed CPT billing charges. Put in a different way, if the hospital that is in the preferred provider agreement, sends the insurance company a bill for a hundred thousand dollars on the insurance company's policy holder, the insurance company pays that bill as agreed upon.
My question to those who say this is not government intrusion in the private economic sector would this, who will arbitrate what a willing provider should be paid? Would Dr. Jones and his bad reputation as a poor surgeon that uses 3 times as many office visits and unnecessary procedures, be paid the same as Dr. Killdeere who never leaves so much as a scar on open heart procedures? Can you see lawyers gearing up for their newly found easy pickins? Can you see then who will pay for this besides you and I, me either.
Something else as well, do you find it interesting that the two players in the ACA Obamacare are the ones that are really being targeted by this? Methinks the supporters of this 17 want to stick the taxpayers of America with this steamer and act like they are as pure as the driven snow.
I have to agree with jerry 2014.10.20 AT 15:51
The answer to all of this is medicare for all or Universal Single Payer. That would do away with all the goofiness and trying to squeeze every last dollar out of our healthcare that the Hospitals, doctors and particularly the insurance companies are trying to do.
Jerry-
I'm with you on this one. Regional Hospital in Rapid City
is currently experiencing personnel layoffs because of Dudley Dogoods failure to expand Medicaid. IM 17 would be a disaster for smaller rural hospitals who are barely hanging on now.
Small hospitals and nursing homes are laying off nurses and other workers even if they have every bed filled.
Help me out - I still do not understand how supporting IM 17 will hurt hospitals, small or large. I have read a few arguments on the issue, but none yet have made me understand what the fear is. Instead, they seem to fall back on a "big government" bossing around mantra, which is exactly what government is supposed to do when it comes to protecting the people from insurance company over-reaches. I retain an open mind on whether to support or oppose IM 17, but neither the "big government" nor the "patient choice" arguments make sense to me.
I am leaning toward supporting IM 17 based on the idea that if I use an out of plan doctor who will agree to my Insurance company's payment limits, then I would have insurance coverage. Is this reading incorrect? If not, then what is the problem? I am listening and will vote on election day so educate me before then.
One other factor seems relevant - our one party, pro-insurance legislature rejected the IM 17 policy. Why is that not enough by itself to tell me to support it? I have seen our one party state legislature deny those in need Medicaid and do virtually nothing for regular people in SD. Why in the world should I conclude they might be right on this issue?
bear,
I couldn't agree more on your analysis, it seems that IM17 has gotten more complicated as this discussion progresses.
My question is, who were the sponsors that got IM17 on the ballot?
my guess-30K signatures/only 15k needed-says appointment clerks at every clinic and medical office state-wide asked captive waiting patients to sign petitions.
Jerry, I'm still not getting it. You offer a hypothetical that says a rotten doctor could demand the same consideration as a good doctor. But IM 17 says those willing providers have to live up to the same standards to which the insurer holds its current doctors, doesn't it?
Roger, the sponsors were independent doctors like your Black Hills neighbor Dr. Stephen Ekrich: http://www.argusleader.com/article/20130902/NEWS/309020016/Insurer-networks-ballot-