<img src="http://www.joplinglobeonline.com/images/zope/extra.gif" border=0>‘Any Willing Provider’ legislation dies in Jefferson City<font color="#ff0000"> w/ health choice info</font>

By Wally Kennedy

wkennedy@joplinglobe.com

After coming close last year with “Any Willing Provider” legislation, proponents in Joplin thought 2009 might be their time. Not only did it not happen this spring — the proposal didn’t even get out of committee.

Having failed in the General Assembly, advocates pushing for what they characterize as more health-care choice in Joplin are exploring the possibility of a statewide initiative petition that would ultimately go before Missouri voters.

“We are talking about that, but it would cost several million dollars in advertising,’’ said Holly Cuoco, who heads Missourians for Choice in Health Care, based in Springfield. “We can’t talk about it as yet because of the legal issues that need to be explored. But we could make a decision in the next month or so. All we would need is about 300,000 signatures from across the state.’’

They want to change a system that they claim is operating in Springfield and Joplin in which patients with private insurance must see only doctors at certain hospitals because of contracts between the health systems and insurance companies. Patients who go “out of network” pay more.

Battlefront

In announcing 160 layoffs last year, George Caralis, interim chief executive officer at St. John’s Regional Medical Center’s, cited competition over commercial insurance contracts as one of the “battles” the hospital was fighting.

That “battle” between St. John’s and Freeman Health System surfaced nearly two years ago in Joplin, when a local group, Choice in Health Care, began campaigning to open up what it said was a “restricted” health-care market.

“Freeman,” the group alleged on its Web site, “has refused to open (its) networks and allow choice. In fact, (Freeman) threatened to raise (its) prices if people were allowed to choose. Freeman has told people they can’t have access to both hospitals — or else they will unilaterally raise their prices to punish them. Their threat is that they will not participate in the future if forced into any health-care network that offers choice of Freeman or St. John’s.”

Michael Pence, of Joplin, a former chairman of the board at St. John’s, also was a leader of the grass-roots Choice in Health Care group, which collected thousands of signatures on petitions from area residents to support its campaign.

The group also supported last year’s “Any Willing Provider” legislation in Missouri, which passed in the House of Representatives, but did not get out of the Senate.

“Most markets have insurance companies where people can sign up with everybody,” Caralis said last fall. “How does this affect the patient? Without choice, the patient goes where the insurance plan says he will go. Unlike virtually everything else in life, there is no choice in this market.”

For its part, Freeman officials initially said the allegations by Choice proponents were sour grapes because St. John’s lost contracts to major employers such as the Joplin R-8 School District and the city of Joplin.

Officials with Freeman also counter that they can keep costs low with health-plan contracts that offer discounts in exchange for large groups of patients who must seek care there.

Gary Duncan, Freeman’s president and chief executive officer, said this week it would be difficult to quantify the savings to patients and health-care providers from the approach that is now in place.

“Insurers will raise prices when they are not sure of volumes. It’s just that simple. That’s the thing that’s going to drive pricing,’’ Duncan said.

Whatever the arguments, Caralis has acknowledged that Freeman’s strategy may work.

“I would guess from the market perspective that the split in commercial is 60 to 40 percent or 65 to 35 percent (in favor of Freeman),” he has said.

Nationwide plan?

Duncan also said this week that the advocates of choice in health care should wait to see how health-care delivery is reshaped by Congress.

“The president and Congress have been given a mandate to come up with the framework for a new national health policy and have it in place by July 1. I think all of health care is waiting to see what that framework’s going to be,’’ he said.

“We could have a totally new plan coming down the pike. Any willing provider could be a thing of the past. Nobody knows what’s going to happen but something is going to emerge,’’ he said.

Traction

Cuoco said the grass-roots movement is gaining some traction in the Springfield and Joplin medical markets, but it is a statewide issue.

“What people need to know is that this is not an issue that is specific to our region. The same issue exists in St. Joseph and Cape Girardeau, and even in St. Louis and Kansas City where it appears that patients have a choice when it comes to health care,’’ she said. “We need to let people know that this is a Missouri issue.’’

Pence also agreed it is a statewide issue.

“Nobody has complete choice, but in some places, it feels like choice. That’s why it was so important for the state Legislature to tackle this issue.

“If it has no chance of coming out of the Missouri House or Senate, it will never arrive at the governor’s office for his signature,” he said. “Initiative petition is the only way. You’ll have to gather the signatures and spend a bunch of money to educate the voters. That’s where the big bucks come in.’’

Pence also said the commercial-insurance industry “has the keys to the gate. They control the access to care. If you have Medicare, you can go anywhere. But if you have supplemental insurance to go along with your Medicare, you give up your Medicare choice. That goes to the provider.

“Missouri is one of the states with tight control on access,” he said. “There are 33 states where they don’t have that control.’’

Proponents of the Any Willing Provider legislation last year included the Missouri Retailers Association and the Missouri State Chiropractors Association; opponents included the Missouri Chamber of Commerce and Industry, the Missouri Hospital Association and Anthem Blue Cross and Blue Shield.

HB 303

House Bill No. 303, this year’s version of the legislation, was sponsored by Rep. Bob Schaaf, a St. Joseph physician. It failed to make it out of a House committee on March 10. The vote was 5 to 4.

Schaaf also said Missouri should not rely on Congress to fix the problem.

“We have to deal with the rules that are in place now and fix them the best way we can,’’ he said. “It affects every person in the state potentially. There are some regions where the evils of it are more egregious than other regions. Springfield and Joplin are the worst, but it’s a problem everywhere.’’

“We thought it would sail through this session because of the success of House Bill No. 1857 last fall,’’ said Pence. “The House passed it overwhelmingly, 112 to 24. But it went to the Senate on the very last day of the session. You knew it was not going anywhere.”

Hospital revenue

According to Missouri Department of Health records, St. John’s took in 54.8 percent of its revenue from Medicare in 2006. Freeman (in Joplin and Neosho), by comparison, took in 35.9 percent of its revenue from Medicare that year.

St. John’s also gets almost 19 percent of its revenue from Medicaid, compared with 13 percent for Freeman.

In other words, 73 percent of St. John’s gross patient revenue comes from public funding, which has a lower reimbursement rate than private insurance; for Freeman it’s less than half.

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