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Re: [snowkiteidaho] Re: Statesman letter to editor

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  • Jon Bolt
    Hi Bill. I hope none of the doctors in our group take my communications personally, as clearly the problem is systemic and far beyond any individuals. Thanks
    Message 1 of 9 , May 8, 2013
      Hi Bill.  I hope none of the doctors in our group take my communications personally, as clearly the problem is systemic and far beyond any individuals.  Thanks for your efforts to share the information with peers.   It would be so encouraging if various participants in our complex healthcare delivery chain could get together and somehow demonstrate some sort of meaningful action, however modest, to begin to address the apparent cost bubble around Boise, without deferring to lawsuits to force the matter.  I doubt the big suit between hospitals seeking to define what constitutes fair competition in Canyon County will have much impact on the problems already evident in Boise & Ada county.  Those go beyond just the hospitals...the two digestive clinics I referenced are totally independent of any hospitals, and so is my orthapedic surgeon's practice, and I believe the anesthesia group too.  It seems across the entire delivery chain, regard for money has far eclipsed civic stewardship on the values scale.  Of course the "Gunsmoke" days are long gone where "Doc" often took chickens or buggy repair in exchange for treatment.  But if you ever have a mind to swap a couple lessons on kite tricks for some propofol, let me be the first to know wouldya???!!!
      Thanks for your sensitivity & sharing w/ peers...
      I promise to discontinue this temporary off-topic hijacking of this forum...

      On Tue, May 7, 2013 at 8:21 PM, Bill Binegar <billyg2477@...> wrote:

      John nice article. Being one of the physicians in the group I wish I had better answers than what's already been indicated. Of course the new lawsuit presently going on between the big hospitals are a concern with not allowing fair competition. I do try to be involved in being a member of the ID Medicare committee as well as on a panel for Blue Cross. And more recently just joined a new group of physicians called IDID which is a group of independent Idaho physicians. Your findings are indeed interesting and I look forward to sharing them with the above committees as well as other fellow physicians And of course seeing what I can do within my own practice.
      Regards, Bill

      Sent from my iPhone

      On May 7, 2013, at 6:54 PM, "robbnukebruce" <robbnukebruce@...> wrote:


      No, Jon, you should've ended on a rant about the Socialists taking over and how it's time to head for the hills with a load of guns. It would have fit right in with the rest of the letters. I love reading those.

      I suspect your findings also stem from the same reason we pay more for gas here; we're further away from any competition. I'll bet if you try checking rates in OR or WA they won't be as cheap as CA.

      And on topic, maybe some morning wind at LP later in the week?

      --- In snowkiteidaho@yahoogroups.com, Jon Bolt <idakiteman@...> wrote:
      > Thanks Bruce. I was gonna end it w/ a cute closer...
      > "So, if you have a colonoscopy in Boise, the scope isn't the only thing
      > you'll take in the rear...".
      > I've also done that same exercise for an MRI, and for a hand operation I
      > may need. The pricing disparity between Boise and SD/SFO areas is as bad
      > or worse (and these are the "allowed prices" my insurer agrees to pay these
      > providers...prices the providers say are discounted below their "standard
      > rates"!!). For all 3 procedures I have yet to find a medical cost
      > component in Boise (doctor/surgeon, facility, anesthesia) that is lower (or
      > even simply matches) the more affluent SD & SFO metro areas. Boise is
      > consistently higher, sometimes ridiculously. Example: for a hand operation
      > I may need, St. Al's Day Surgery Center facility charge is over $11k (for
      > just one hour!!), St. Lukes Orthopedic Surgery Center it's $7k, Treasure
      > Valley Hospital is $4400, and the Orthopedic Surgery Center of La Jolla
      > (located within some of the most costly real estate in SD) is $2000. In
      > Boise, the surgeon price is 1.75X and anesthesia 1.5X vs. SD and SFO. Mind
      > you, I didn't shop the SD & SFO areas to find the lowest prices...that's
      > WAY too time consuming. I just picked one provider in each place that was
      > "in network" and located close to homes of my relatives...no shopping. I
      > doubt they both just miraculously happened to be the lowest priced
      > providers in those cities. Anyway, while I've only investigated 3
      > different medical procedures, I suspect the pattern is far broader across
      > most other procedures.
      > I'm coming to the conclusion it's likely our local medical industry has
      > become so consolidated (e.g., around St. Luke's & St. Al's), it lacks the
      > competition to assure fair pricing. The result is our local industry
      > gouges the local public badly (a public having far lower household income
      > than SFO or SD, and less able to afford the gouging). In the power utility
      > business, when private companies are granted rights to a public resource
      > for generating private income, and there are too few of these companies to
      > assure healthy competition, a PUC solves the problem of protecting the
      > limited asset and also protecting the public from industry predation. It
      > may be time to consider a Medical PUC in Idaho, or at least SW Idaho. It
      > would determine which private companies are permitted access to the State's
      > biggest resource (it's citizens), and assure fair prices for all. The free
      > market doesn't appear to be working in Boise in a way that offers fair,
      > competitive value for medical care.
      > The next time you need a medical procedure, even if you have insurance and
      > are tempted to say "Why do I care, I only pay the out-of-pocket amount?",
      > realize it's the full price that is driving higher insurance costs with
      > ever higher deductibles. You may find disparities in local pricing with
      > little/no difference in quality...and where you're comfortable give your
      > business to the low cost provider. You can choose the doctor, the
      > facility, and the anesthesiologist to get the best value and do your part
      > to influence lower costs. In my case, my wife is visiting our daughter in
      > the SFO area, and will have a medical procedure done there instead of here.
      > ...likely more than you wanted to know....but got me riled up when I
      > started uncovering this...
      > On Tue, May 7, 2013 at 10:14 AM, robbnukebruce <robbnukebruce@...>wrote:
      > > **
      > >
      > >
      > > Nice letter today in the paper, Jon. Well written, which is more than I
      > > can say for most of them.
      > >
      > >
      > >

    • R. Stone Lee
      Hi Jon and group, I’m mostly a lurker in this group but I thought as an “ex-MD” I’d chime in a little bit. In my opinion, the price differences may be
      Message 2 of 9 , May 8, 2013
        Hi Jon and group,
        I’m mostly a lurker in this group but I thought as an “ex-MD” I’d chime in a little bit.  In my opinion, the price differences may be brought on by several different factors. 
        First, and I think most importantly, most consumers are insulated from concerns about price because of insurance.  Therefore, the usual market forces driving people to “vote with their feet” are markedly blunted.  As a result, the providers charge what the market buyers (basically the insurance companies) will bear.  There are not many people who do the kind of research that you did here, and even fewer who will act on that information, knowing that they will only pay at most 20% of the amount charged.
        Second, the great majority of patients tend to blindly follow their primary physician’s recommendations.  Very few docs are going to be willing to send their patients out of the area, and even fewer of those actually are aware of the cost differentials.  So, that doctor will refer to his buddy down the street, not really caring about the cost to the patient and insurance, and the patient will generally accept that recommendation.
        Third, antitrust laws prevent hospitals and physicians from sharing information about their billing practices and billing rates, so basically, those entities are relegated to set prices in a vacuum.  Of course there are the informal coffeehouse conferences, but sharing of this information can lead to severe sanctions from the feds. 
        The fact that CMS has now released that information is huge, and hopefully, more consumers like you will become educated and “vote with their feet.”  Thanks for posting, even off topic, and I apologize to the group for using it as a soap box.  Awareness of this problem is the first step to fixing it.
        Of course there are many more factors involved, but this at least scratches the surface. 
        R. Stone Lee
        (aka Bob)
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