In doing so, Sen. Michael Waddoups disputes a key finding of a state-funded health care study: When providers offer price cuts to insurance plans that steer patients away from their competitors, they may harm surgical centers and out-of-network physicians, but they do not restrict overall competition.
Waddoups, in letters to Attorney General Alberto Gonzales and Health and Human Services Secretary Michael Leavitt, says selective contracting is "an abuse of managed care organization market power" that "may unlawfully restrain trade."
"Left unchecked, this practice could severely impact quality of care, patient access, and the exercise of independent physician judgment, in addition to interfering with overall health care competition," Waddoups wrote, urging the officials to "commence formal investigations of the business practices of the hospital and insurance industry."
Similar letters were sent to Utah Attorney General Mark Shurtleff and Insurance Commissioner Kent Michie. The letters were signed by Sens. Gene Davis and Peter Knudson, members of the legislative health care task force that Waddoups leads. And some were dated May 11, six days after economist David Argue released his report on competition in Utah's health care markets.
Argue found a high degree of selective contracting in Utah, and not just with Intermountain Healthcare, the state's largest owner of hospitals, clinics and commercial health plans. MountainStar, owner of St. Mark's Hospital, offers deeper discounts to non-IHC insurance plans that do not do business with ambulatory surgery centers.
But as long as there are dueling networks, and as long as consumers can choose health plans that pay for out-of-network providers, "the competitive process is maintained and consumers benefit even if the number of specific independent alternative providers might decline," Argue concluded.
Waddoups suggests that analysis is shallow if not flawed. In his letters, the Taylorsville Republican points to other negative effects not addressed by Argue's report. Managed care organizations often fail to cooperate with out-of-network surgical centers to schedule procedures in a timely, businesslike manner, Waddoups said. Nor do they clearly explain out-of-network plan benefits. Sometimes, he said, they employ "trickery" to limit what services are covered or deny coverage altogether.
"Patient-Physician choice is paramount in citizen satisfaction," Waddoups wrote to Leavitt. Neither the federal nor state officials have responded to the legislator.
Despite Waddoups' concern for patient choice, the task force has yet to give serious consideration to a proposal that would require insurance companies to let patients go to the doctor or hospital of their choice as long as the doctors and hospitals agree to accept 95 percent of what in-network providers are paid. So-called "patient choice" or "any willing provider" legislation generated a lot of support in the 2005 session but was overshadowed by concerns about Intermountain Healthcare and its ability to restrict competitiveness.
Waddoups said Monday he has not abandoned the topic, though he doubts there is enough backing in the Legislature to mandate an "any willing provider" benefit.
"I'm not saying it's dead, but it's not one of my major objectives for the task force."
lfantin@sltrib.com
