Salem Political Snark

Regence dispute with Salem Health shows craziness of U.S. health care

I'm glad I ditched my Regence Medicare Advantage plan last November, switching to a Providence Medicare Advantage plan after getting a letter from Salem Health warning that negotiations were ongoing with Regence over renewing a contract for in-network services that expired at the end of the year.

For it turned out that December 31 came and went with no agreement between Regence and Salem Health. A Salem Reporter story, "Thousands of Regence members to lose in-network care at Salem Health, insurer says," tells the sorry tale.

Thousands of people insured through Regence will have to pay more to get care at Salem Health hospitals and clinics starting Wednesday, the insurance company announced.

The health system will be out-of-network on Jan. 1 for Regence BlueCross BlueShield members after the insurance company and Salem’s only hospital system failed to agree on a new contract.

...About 30,000 people in Marion and Polk counties are insured through Regence, and about a third of them use Salem Health on a regular basis, Dr. Zak Ramadan-Jradi, Regence’s vice president of network management, said to Salem Reporter in October.

It's kind of a pain to switch Medicare Advantage plans, but I figured it was better to do this than be stuck in the middle of the dispute between Regence and Salem Health -- each of whom blames the other for being greedy money-grubbers who care more about enriching themselves than caring for people.

The way I see it, they're both right.

While I'm satisfied with the medical services I get from Salem Health, it bothers me that Salem Health is gobbling up previously independent clinics, becoming ever more dominant in our local health care scene. Also, that the Salem Health CEO makes over a million dollars a year, I'm pretty sure.

I've also been satisfied with my Regence Medicare Advantage plan, which I've had since I became eligible for Medicare eleven years ago. I signed up for the plan after joking with my Salem Health primary care doctor about me turning 65 soon and asking her if she was going to stop seeing me once I was on Medicare.

She said with a more serious tone, "We lose money on each Medicare patient we see, but we basically break even on Medicare Advantage patients." That was part of the reason I signed up for the Regence Medicare Advantage plan, with added benefits (like a discount on my athletic club membership) being another reason.

However, deciding whether a giant health insurance company or a giant health care provider is more deserving of my affection is like choosing between poison ivy and poison oak. They're both irritating -- again, I'm talking about corporate management here, not regular employees or medical staff, who do a good job, by and large.

Now that I have a Providence Medicare Advantage plan, news reports of a looming strike by Providence nurses and doctors have caught my eye. This won't affect me, just Providence patients in the Portland area. It's still disturbing, though. 

For contract disputes and strikes by medical personnel are a side effect of our crazy American health care system. We're the only high income country in the world that lacks some sort of national health care where getting needed services isn't dependent on the whims of insurance companies and corporate medical providers.

We citizens put up with that crap because there's no other option. Most people aren't able to afford "boutique medicine" where if you can pay with cash, medical professionals provide a level of care that is way more convenient and accessible than what insured people get.

Unfortunately, during the next four years of the Trump administration we'll be fortunate to not have health care in this country slide backward. Maintaining the crazy status quo is the most I'm hoping for. 

I get a Salem Health Covid shot, a bit unfairly

NEXT DAY UPDATE: BAD NEWS. My wife just spoke with an over 65 friend who, along with her husband, were hoping to get a Covid shot at the Fairgrounds today, Friday. She was told that they were turned away, likely because of what Governor Brown announced this morning about the state not getting additional vaccine doses from the federal government as promised. Looks like another screw-up from the Trump administration, among many others.

It's been an interesting 24 hours, Covid-wise. 

Last night I wrote a blog post, Salem Health is allowing people to get "extra doses" of Covid vaccine, where I argued that it was unfair of Salem Health to say on their Covid vaccine web page that only people in the initial 1a group (health care providers and nursing home residents/staff, basically) could be immunized at their Fairgrounds clinic, while allowing people to get shots on a drop-in basis if they showed up at the clinic.

This afternoon my wife and I got our first shot, Pfizer variety, at the clinic. So am I a hypocrite?

Not really. In the morning I perused my Facebook feed and saw that more people were talking about getting immunized at the Salem Health clinic even though they weren't in the 1a group. A few said that appointments can be scheduled through Salem Health's MyChart.

So that got me to thinking that given our age, early 70s, and health status, my wife has asthma and I have a bladder problem that would be tough to deal with if I got a bad case of Covid, it made sense to try to get immunized regardless of how fair it would be. Here's how today went for us. As you can read below, others have had a different experience when they went to the clinic to get the vaccine.

We got to the Fairgrounds site at about 1:50 pm. You enter via Silverton Road. There was a long line of cars in front of us. But the line moved along at a steady slow pace. It took us about half an hour to get to the place where someone talks to you while you're in the car. 

Laurel was driving. The person asked us if we were health care workers. Laurel said, "No, but we have appointments through MyChart; we're over 70 and have pre-existing conditions." Those words earned us an "OK, you're good to go; turn left up ahead." Turning right meant you were leaving the Fairgrounds because you weren't accepted for an immunization.

Now, what's rather strange is that a friend texted me later in the day.

They said that they'd also gone to the clinic in the afternoon today. The couple told the screener that they had MyChart appointments and were over 65. They were turned away. This points to a certain unfairness, since seemingly the only difference between them and us was that we'd mentioned pre-existing conditions.

At any rate, after getting the go-ahead to be immunized we parked and walked into the Jackman Long building housing the clinic after having our temperature checked via a forehead thermometer. 

I was instantly impressed with how efficient, friendly, and professional everybody working there was. 

We were pointed down a MyChart path, since we didn't need to fill out any paperwork, having handled that online. So if you have a MyChart account, click on the Menu with the three bars in the upper left corner, choosing "Covid Vaccination Clinic." The next steps are straightforward.

Laurel and I were given a card that said we got the first Pfizer dose on January 14 and needed to return to get the second dose on February 4. Card in hand, we then joined a line of people waiting to be immunized. Photos were taken to mark the happy occasion.

Laurel Hines

Brian Hines

It didn't take long to reach the end of the line. A staffer apologized for a short delay in the immunization process which lasted less than five minutes. Dr. Ralph Yates, the Chief Medical Officer of Salem Health, was at the head of the line checking cards. Yates saw me a few times early in 2020 about my sciatica problem. 

I told him that I was his sciatica success story, being much improved now. I thanked him for assuring me that I was going to get better, which meant a lot to me when I was despairing that the pain wouldn't go away, Then I thanked him for the marvelous immunization clinic Salem Health was putting on. Yates said that no other county is doing something like this (many more should), and that he was proud no vaccine doses have gone to waste.

We then were directed to tables with an open shot-giver.

Here's a photo of Laurel finishing up with the person who immunized her. The shot was virtually painless, though the needle has to remain in your arm for 10 seconds, which was no big deal.

We then waited in another area for 15 minutes to make sure we didn't have an allergic reaction to the shot. I spent the time texting my daughter and a friend about how we'd just gotten our first Covid immunization. The whole process took shout 90 minutes, including the time in our car.

In case anybody is worried about contacting Covid by going to this immunization clinic, rest assured that the Fairgrounds building is so large, there's plenty of room to socially distance. Naturally everybody wore a mask. 

After we were done, my overwhelming feeling was gratitude for everybody who is working hard to keep the Salem Health clinic going until everybody in Marion County who wants the vaccine can be immunized. This includes the National Guard troops who were much in evidence at the clinic.

I also have been feeling a huge relief that my wife and I got our first shots.

For about eleven months Covid has been an oppressive weight on everybody's mind. There's no escaping the reality of the pandemic, though unfortunately some people try to deny the truth of it. I knew I'd feel good after getting immunized. What I didn't know was how good. 

So I have very little to criticize about the immunization clinic.

As noted in my first post, I still hope that Salem Health will be more transparent about who, exactly, can get a shot. There's clearly a difference between the overt policy on the Salem Health Covid Vaccine web page that says only people who live in Marion County and are part of the 1a group can be immunized, and the actual policy of allowing people in the 1b group to get the vaccine.

Maybe there is a good reason for this. Sometimes rules deserve to be broken, because the rule is too rigid. That could be at play in this case.

However, on January 23 the 1b group will join 1a as officially eligible to be immunized in Oregon -- seniors 65+, teachers, other school staff. Will Salem Health then allow people in the next highest priority group, like store clerks or younger people with underlying conditions, to be immunized? I'm worried that this will create confusion and perhaps even some reluctance to be immunized if the process is viewed as unfair.

Unfair or not, I'm really happy that Laurel and I went to the clinic today. 

Dispute between Regence and Salem Health features two unlikable combatants

I'm a Regence Medicare Advantage member, so have been following the dispute between Regence and Salem Health with considerable interest.

But if I wasn't aware of it before, a full page Regence ad in last Sunday's Statesman Journal (April 21) made the contract impasse difficult to miss. Heck, it was two-thirds the length of our dog!

The headline said, "Salem Health is asking for a bigger raise than you can afford." And down at the bottom, "Salem Health is demanding  a double-digit increase that you can't afford."

Well, maybe. 

Right now I'm not going to believe what Regence says, nor am I going to believe what Salem Health says. Choosing sides between a massive health insurance organization and a massive health care provider is a lot like being offered a choice between brussel sprouts and artichoke hearts. 

I don't like either one. 

But until the United States gets with the rest of the industrialized world and offers us citizens a cost-effective way to obtain health care without going through the maze of administrative bullshit that even Medicare is prone to (though Medicare is way better than private insurance), I'm going to have to keep on dealing with Regence and Salem Health.

On the whole, I'm siding with Regence in this dispute. Here's one reason why.

Last year I got a November 6, 2018 letter from Regence regarding my Medicare Advantage plan. It said that the contract between Regence and Salem Health would end on December 31, 2018. However, Regence went on to say:

"However, to help protect our Medicare Advantage members from high out-of-pocket costs, we have made the business decision to provide in-network benefit coverage through December 31, 2019. This means you should not experience any change in coverage if you receive care from the hospitals [Salem Health and Salem Health West Valley] through Dec. 31, 2019. Your in-network benefit will apply."

That was good news.

I appreciated that Regence sent out the letter well before the end of the annual open enrollment period, October 15 to December 7, during which I could have changed Medicare Advantage plans. I've been generally happy with Regence Medicare Advantage.

However, on December 21, 2018 Salem Health Hospitals & Clinics sent me a letter with a different message. After noting that Salem Health's contract with Regence for professional services (care provided by health care practitioners) expired on June 30, 2018, the letter said:

A separate contract with Regence continues to cover Salem Health's hospital facility bills through June 30, 2019. This means that our physician and other professional services are only covered under your out-of-network insurance benefit, while our hospital facilities will continue to be covered for in-network services until June 30, 2019.

Now it's hard for me to believe that Salem Health wasn't aware that Regence had told its Medicare Advantage members that Regence would bill at in-network rates for care provided by Salem Health hospitals through December 31, 2019. Thus it seemed that the December 21 letter from Salem Health was a scare tactic.

If so, it worked. 

Shortly before an upcoming repeat colonoscopy on February 12, I got to thinking about how much more it would cost if I had to pay Salem Health for hospital care at out-of-network rates. Sure, Regence had told me I'd be paying at the in-network rate through the end of 2019. But the Salem Health letter said that the in-network rate would end June 30, 2019.

So I phoned Regence. A note I scribbled on the November 2018 letter from Regence says "Called 2/7/19. Was told this letter is correct. Salem Health was wrong."

I also was told by the Regence person I talked with that they'd gotten lots of calls about the discrepancy between what Regence said in its letter and what Salem Health said in its letter -- which, again, was wrong. Or at least, deeply misleading.

The way I understand the situation, it seems that while the contract between Regence and Salem Health for hospital services ends either on December 31, 2018 (according to Regence) or June 30, 2019 (according to Salem Health), in either case Regence has agreed to bill at the in-network rate until the end of 2019.

I have no idea why Salem Health chose to mislead Regence members.

Yes, the in-network contract was going to end, but Regence apparently was going to absorb the cost of the difference between in-network and out-of-network rates for all of 2019. So I and many other Regence Medicare Advantage members got needlessly worried when we got the December 21, 2018 letter from Salem Health.

This whole thing reminds me of the pissing match that's been going on between DirecTV and the Pac-12 Networks for more years than I can remember. DirecTV says the Pac-12 Networks is asking for too much money. The Pac-12 Networks says other TV providers have paid what they're asking, so why can't DirecTV?

In between sit DirecTV customers, like me, who couldn't care less about who's right and who's wrong. We just want to see our favorite Pac-12 teams on our television. And the last I looked, the subscriber cost being fought over is less than a dollar a month.

Likewise, a Salem Reporter story, "Patients caught in the middle as Regence, Salem Health dispute rate increase," says:

Regence leaders said the health system is seeking “double-digit” increases to current prices, which would be passed on to customers in the form of higher premiums.

Salem Health leaders have not disputed that figure, but said the move would bring Regence in line with what other commercial insurers pay.

...Neither side has been willing to publicly state the precise amount of the increase or what Regence currently pays for care. Regence has repeatedly claimed Salem Health is more expensive than Oregon hospitals of “similar size and quality.”

Parr said Salem Health has offered to have an independent accountant look at the hospitals rates for other commercial insurers to ensure Regence isn’t paying more. Regence has declined, calling it a “negotiation tactic to drive up the cost of care for our members,” spokesman Jared Ishkanian said.

Geez. I wish both the Regence and Salem Health negotiators would take a big dose of MDMA, a.k.a. Ecstasy, and swear endless love toward each other, then come up with a contract that's agreeable to both sides.

Not having taken Ecstasy, my mood as I write this blog post is considerably less positive toward both Regence and Salem Health.

Like I said above, it's irritating that Salem Health was willing to send out false/misleading information to Regence Medicare Advantage members about a shift to out-of-network hospital rates midway through 2019.

And it's been irritating to have Regence tell me that it's no big deal if I can't use Salem Hospital -- there's hospitals in Silverton and Tualatin that Regence has contracts with.

Hey, Regence: I live in Salem! If I need hospital care I don't want to go to an out-of-town hospital.