Alaska Certificate of Need debate boils over in Fairbanks
Published Monday, January 5, 2009
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Stumble It!FAIRBANKS - Was Alaska Open Imaging a testing center or a doctor’s office?
The X-ray business is now closed but the question is at the root of an ongoing lawsuit being watched by physicians across the state because it goes to the heart of how the state regulates the profession.
At issue is whether Dr. Robert Bridges and his business partners needed permission from state regulators to open the Airport Way medical facility.
The state forced the center’s closure in early 2007 because it lacked a Certificate of Need.
Bridges hired a lawyer and opened a second X-ray clinic, Aurora Diagnostic Imaging. The new clinic is structured differently and is considered a doctor’s office. It requires no Certificate of Need.
Bridges wants to expand Aurora Diagnostic by installing a machine to help diagnose illnesses such as cancer, heart disease and Alzheimer’s disease, but he’s hesitant saying the state has been inconsistent about regulating facilities like his.
“With all of this going on, it has made me very cautious about spending the additional money in investing in things,” he said.
A state statute requires certain types of medical facilities to obtain a Certificate of Need so the state can regulate competition.
Bridges is competing with Fairbanks Memorial Hospital, which pressed the state to regulate the radiologist, believing Bridges was in violation of the state statute. The state initially disagreed but eventually decided that Bridges was, in fact, in violation.
“The basic question is who is going to be allowed to compete with hospitals,” said Robert Gunther, Bridges’ attorney. “Dr. Bridges has been very civic-minded in this and carried the lawsuit forward for the good of Alaska consumers.”
Peter Gruenstein, the hospital’s attorney, said there’s a good reason for regulating radiologists.
“You get away from some of the legal language here and it’s fairly basic and easy,” the lawyer said.
The state regulates hospitals too, and one of the regulations forces hospitals to provide money-losing services such as emergency rooms. Fairbanks Memorial Hospital pays for its emergency room by offering services such as diagnostic testing, which is a money-maker. Take that income away, and the hospital has to raise prices elsewhere.
The Greater Fairbanks Community Hospital Foundation, which owns the hospital, and Banner Health, which operates the hospital, are both nonprofit entities.
“The hospital’s interest is in reasonable intelligent regulation that benefits the community,” Gruenstein said.
Still, Bridges feels his profession is being singled out compared with other types of physicians.
“We want a uniformity of application across the board,” he said.
The Alaska Supreme Court issued a recent opinion calling on a lower court to decide whether Bridges’ former X-ray clinic was a testing center or a doctor’s office.
The opinion left open the option for the commissioner of the Alaska Department of Health and Social Services to make the determination.
Contact staff writer Amanda Bohman at 459-7544.
Community Discussion
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The certificate of need concept makes no sense to me. Regulate a profession, businesses, yes . . . but regulate competition??? This is a$$ backwards. Fair competition allows consumers a chance to get the best commodities/services at the best prices.
Cry me a river, Fairbanks Memorial Hospital, that your for-(*large*)-profit corporation loses money on emergency care services. And shame on you, FMH, that you'd be willing to compromise area residents' ability to get the best value for their/our dollars by eliminating the competition. It stinks of monopoly to me.
Instead of pulling the rug out from under the competition, why don't you, FMH, look at the root causes of why your emergency care is eating up your profits. Could it be that your suppliers are ripping you off by charging you $1 per bandaid, which you so willingly pass on to the patients by charging them $10 per bandaid? Could it be that *so* many hard-working people don't have health insurance, that the only kind of medical treatment that they CANNOT afford is visits to the emergency room?
Ever heard the adage "an ounce of prevention is worth a pound of cure?"
Ever consider being part of the solution and not part of the problem, and taking a long, hard look at the entire health care industry - including, especially, health insurers - to figure out how to substantially lower costs of health care, and to figure out how to make health insurance affordable to the vast majority of your patients so that they won't have to wait to seek medical attention until forced to do so in an emergency room?
No, FMH, by insisting on a certificate of need, it seems you'd much rather be part of the problem. Shame.
LadyNYC, I dunno. This isn't Washington, where you can drive fifteen minutes and find another hospital. This isn't even Anchorage, where you can drive 15 minutes and find another doctor's office. The fact is that if the CON process was removed, FMH would quickly go bankrupt as private practices took over every profitable operation. Without FMH, there's no emergency care worth the name north of Anchorage. And in an emergency, minutes matter. FMH may not be the best trauma center in the world, but it's a damn sight better than a clinic or nothing at all.
But if there's that sort of need, why wouldn't a private emergency care clinic open? You're right -- one would open. But it'd be a for-profit operation without the decades of infrastructure FMH has built up, and folks in need would be charged a lot more. After all, it'd be the only emergency care available.
Sounds to me like the end result of abolishing the CON program is trading a nonprofit, semipublic monopoly for a private, for-profit one.
Maybe I don't understand the situation fully but it seems to me that if this doctor is licensed and able and willing to provide this service that is currently lacking in Fairbanks that he be allowed to do such. I am not saying that we don't have the services here I am merely stating that we don't have enough of the vital services available. Maybe there is a chance that the hospital will drop prices some if we have other places that we can possibly go. To me it goes back to the supply and demand idea...if the hospital is the only place they can charge what they want because the demand will always be there.
James you are oh so correct, but Juneau is so full of lobbiests for the insureance companys and hospital that we will never be able to outspend them, nothing will change untill someone gets the backbone to fight for the people insted of the almighty buck....
James, for once, you and I see eye to eye, 100%. Well said James!
FMH's non-profit report stated $66 mil was on hand in 2008! Your average for-profit hospital makes only around $40 mil. Contact Michael Maddox at Fairbanks Community Imaging, he has information that will really open your eyes about our FMH Monopoly!
The last time I ever heard of a Doctor that cared more about a patients health than money was Doc Baker on Little House on the Prairie.
As it has been stated, regulate the profession (the doctors and staff and services)and not the competition. It doesn't help that an employee of FMH is a member of the state legislature and has been a vocal proponent of the C.O.N. helping to squash competition for his employer. Also I never could understand the concept of a not for profit hospital "foundation" (FMH) being managed by a for profit company (Banner Health). FMH has a monopoly in this town and has done everything possible to eliminate competition. the attitude at FMH for the most part in my experience has been about money, where other places I've been; for example Providence in Anchorage and Mayo Clinic in Minnesota it is more about the patient and care, less about the money. Anyone that has had dealings with FMH's billing department lately will understand the frustration.
Next time someone in my Family goes to FMH, I'm gonna have to sell something to pay the bill. "Kidney for sale, slightly used" or "Left hand for sale, wedding ring included".
Last time I went to FMH's ER, they charged my insurance $63 for a couple of gauze pads and a paper cup. The total bill was well over $400. Not everything in the ER is a money-loser!
Don't forget K&K recycling(Kawasaki&Kelly)they're not gonna let anything happen to that certificate of need,(CON)!
CON has been denounced by the federal government as a bad business practice. The only thing keeping it alive is the big money lobbying power of Banner Health. I doesn't hurt that they have their own state representative in Juneau either. By the way, the administration of the hospital is for profit and made a tidy $9 million dollars last I heard.
When Mr. Kawasaki was working at the ER check-in, his personality was cold, uncaring and he's going out of his way to get you checked-in.
Just my two cents. 90 days ago, I made a trip to FMH's E.R. for treatment, at the request of my regular Doctor. One week later, I had to make a seond visit. Both visit's required that I be admitted to the hospital for less than 24 hours (after several hours of laying on an ER gurney waiting for information from a doctor). I walked in to the ER, and walked out of the hospital. I now owe FMH over $60,000.00, the portion of charges that my health insurance company did not pay. I will have to declare bankruptcy, because there is no way I will ever be able to pay off those charges. Most of the doctor's fee's were covered by my insurance, but most of FMH's charges were determined to be way over the "usual and customary" charges for these types of services.
Before you folks start typing maybe you should do a little reading.
Here's the FMH Foundation site
http://www.fairbankshospitalfoundation.c...
and here's Banner's
http://www.bannerhealth.com/
I'd rather have one hospital that's as good as most any in the nation for it's size and population served than two or more that are not. FMH is bigger than it used to be so it's not as user-friendly a place but remember the people who work there are still your friends and neighbors.
FMH and Banner are still two non-profits working together to provide health care in Fairbanks. The whole North Star Borough is less than 90,000 people. That's not a very big trough to feed from since Bassett Army Hospital takes care of a lot of active-duty and veterans. If we let for-profits take away only the money-making modalities how do we expect FMH to last?
banner health,sucks! hope the people that yell for "banner health in fairbanks" go to their emergencey room,and get their bill like soccermom!
They are non profit? Give a break! They are thives.
What a lot of people don't realize is when they say an ER is a money losing department, they aren't talking about the ER at FMH. In fact, the ER at FMH is the only one in Banner Health that does make money. FMH is the golden goose of Banner Health and they'll fight tooth and nail to keep it.
Most Alaskans have pretty good health insurance, hence FMH gets reimbursed for most their "services" provided to patients. However, the rest of the hospitals in Banner Health end up losing money because they don't make up the difference with their diagnostic imaging income. FMH is the highest grossing hospital of any Banner Health facility because they charge so much for their services.
If FMH were to break loose from Banner Health, they could easily cut prices by as much as 50% and still make money. But since we have to feed the corporation in order to keep the rest of Banner Health from going bankrupt, FMH will continue to charge outrageous prices for their "services".
Everytime there's a price increase at FMH, the employees never see a raise or a bonus. In fact, due to the recession, FMH employees are having their benefits cut back on just to keep the company from yet again going under. The whole process is a joke if you ask me.
Taters, I'd like to have a hospital as good as any other in the nation too, but I'll settle for FMH 'til then.
Suppose I buy bandaids for a buck and sell them for ten bucks. Now suppose I sell 2 and give away 6, why I've lost 40 bucks, I'll be bankrupt in no time (except that I really made 12) I'm sure that any numbers we'll ever see will show the hospital losing money, all the while hiring more people and throwing bigger Christmas parties or whatever.
Small businesses can't get away with that kind of stuff because they are dependent on the good will of the community they serve and as always that thing called competition. I am not in favor of the "certificate of need"
I have over 30 years experience in hospitals and have worked in seven small to medium-sized hospitals, both in Alaska and outside. We are lucky to have that hospital and that staff.
I hope we see as little as possible of FMH losing money. Any well-run organization has to have funds to work with and to grow with as the community grows.
Our healthcare system is broken. We desperately need to re-do the whole mess from the bottom up. Healing people should not be about denying benefits to those who are insured, it should be about managing care and providing the best service possible to ill or injured parties. I realize there should be some profit involved so the people providing these services can make a living. That's only fair. What is *NOT* fair is the greedy and despicable behavior of the current system the feeds off the sickness and injuries of patients in a way that leaves them fiscally, emotionally, and physically bankrupt.
I'm no longer a young person so I recently started to look into purchasing a private health insurance policy, just in case.
I spent hours trying to navigate HSAs, PPOs, Indemnity plans and the rest at ehealthinsurance.com to figure out what was the best option for me. After much research I finally chose a plan that I thought would provide me with the best coverage in case of an emergency with some modest benefits for the occasional doctor's office visit. $129 a month premium with $5k deductible, $7.5K maximum out-of-pocket expense per year, $500 prescription deductible and so on, with an optional $21 dental premium for tooth work.
Before I purchased the program, I wanted to find out more about the underwriting process, where Aetna gathers record information and the like about a patient to see if they are a good candidate (risk) for coverage. I had one elective surgery on my thumb 9 years ago and have used an antibiotic cream for a skin condition for a few months. That's it. I paid for the doctor's visit for the skin rash out-of-pocket, which came to $275 for 10 minutes at the Tanana Valley Primary Care clinic and $200 for a 1 ounce tube of patented antibiotic gel. Same product in Canada: $45. I was stunned by the prices: hence, my search for some kind of health care policy!
Aetna can deny an applicant coverage simply for the use of a prescription medicine and once denied, the applicant is put on the "Denied" list and most likely, no other insurance company will touch them with a hundred-foot pole.
This is not the worst of it. Let's say I have the need to visit the emergency room at FMH and I'm unconscious. The accident was a bad one and I need some surgeries and a few days of recuperation in the ICU before I am discharged. Although I have a health insurance policy with Aetna and FMH is an Aetna PPO service provider, the people working in the emergency room are *NOT* Aetna providers and are private contractors. This means that I, unconscious, bleeding me, has no option or choice to ask for an Aetna provider, if there was one on staff at the time, and might be responsible for the entire bill, which would certainly bankrupt me.
How did we get here? More importantly, how can we get to a place where people are treated like humans and medical care is not about $10,000, out-of-coverage MRIs on patients with no choice to go somewhere else?
Soccermom, I feel for you. You should fight them and get your fees reduced. If you end up paying for the medical costs, there will be a lower cost to the hospital because they don't have the added overhead of the insurance process, so you should at least get a discount for that from them. Don't give up! There are some books at the Noel Wien Library on the subject or you can maybe find a used/cheap copy of Neil Davis' topical book, The Health Care Morass (http://healthcaremorass.blogspot.com/). My Mom read it and it comes highly recommended.
Taters - while many of the folks at FMH are true caring professionals, my experience, especially from the E.R. is the exact opposite. I once was a critical care tech at a Humana hospital in Floride. When I got hired I was told my primary purpose was to make money for the corporation. I asked what about quality health care and was promptly told that was secondary and that seems to be the attitude especially at FMH's E.R. Last year, 3 times in one week my wife was brought into the e.r. there by ambulance for being light headed and short of breath. Each time the e.r. doc wouldn't release her without doing a full cardiac workup including stress tests - very expensive procedures that were not needed - finally when it happened again I convinced the ambulance crew to take her to Bassett and the fantastic doctors there diognosed here problems with a few simple blood tests. We made quite a lot of money for FMH that week. As far as the level of care there and the confidence I have in the faciltiy - well I have had my wife at the Providence Cancer Center and Alaska Regional Hospital for 9 months as I have absolutely no confidence in FMH. I should state though that the technicians and admin staff I have dealt with are nothing but true caring profesionals. Bottom line - if I can get quality medical care (to include imaging) done by just as qualifed staff but for a lot less money - I have to go where I can save money. The CON limits my choices and does nothing but protect FMH's hold on the community. Ther eare alot of folks that need a choice when it comes to health care. It troubles me that there are alot of folks in this community that need a more cost effective option.
All I can say is I used to process Medicare A nursing home bills from AZ Banner Health, the company I worked for has elder ehab centers in the Mesa/Phoenix area, and they always tried to rip us off left and right.
I know I won't be taking my family to that hospital...not to mention I had a friend die in the waiting room there too.
Gee, one of the first things with any profession, check with the existing market to see how your business would effect the local populace.
Obviously, effecting the local Hospital's ER cares financial state should have been a no-brainer for this Doctor. Or, is he really a Doctor of Wall Street?
Or, is Dr. Bridges saying the radiological services provided by the city hospital is performing incorrect analysis of their services?
<shrugs>
It does seem odd to open a separate business such as this in such a small city unless he was providing a unique service such as "X-Rays at Home"!
And, since I know one of the good looking girls in the Radiological Services of Fairbanks Memorial, I am going to be biased on this one. <GRIN>
Used to work for FMH.... the biggest thing I noticed is they are more interested in touchy-feely lets all be family than actually getting something done right.
If doing it right interferes with that family feeling of warm fuzzies... watch out!
I sympathize with the hospitol's arguement that they are being required to provide service to all without regard to ability to pay, but that problem needs to be addressed directly rather than consealed by forcing other people to pay an above market price through the Certificate of Need law.
I too recommend Mr. Davis' book "Navigating the Health Car Morass" to gain valuable insight to the medical billing system and our health delivery systme in general, but I disagree with his conclusion that a 'single payer' system is the answer to the problem.
The medical system is driven by the influence of essentially a single payer system already. The government, through the influence of Medicare and Medicaid, currently drives the medical system. The disconnect between receipt of service and payment for service creates excess demand and shortage of supply at the same time.
Private insurance companies are not free to provide the variety of coverages, nor negotiate directly with their customers, to provide the various amounts of financial protection that would be available in an open market.
Neither are medical service providers free to negotiate with their customers to find the most cost effective service in a givern market.
Advances in technology have made many more medical services available over the last 100 years. The down side is that the advances come with a price that few can afford individually if they need the service. Insurance plans are developed to spread the risk of needing the service beyond the individual.
Medical service doesn't come cheap, shared risk through a third party payor system will probably always be required to make the system work, but we cannot pretend to make the system work by concealing cost or regulating the provision of service. Overregulation is at the heart of most of the problems with our medical service delivery system.
My Uncle was a patient in Denali Center before they built the new on attached to the hospital. He was on 40 mg of morphine every hour ( he was dying of bone cancer) Several of the night staff (this occured during the night) saw him wandering around and did nothing. His room was right next to an emergency exit door, the door the oxygen tanks were brought through. The delivery company disconnected the alarm, maintenance "forgot" to hook it back up. 3 hours later he was found right outside that door curled up in a fetal position frozen to death. When I got there at 7am, I was walking towards his room when a nurse walked up and said "Your Uncles dead" and walked away while I stood there in shock. Guess what they said? It wasn't the fault of some of the nurses all jacked up on speed, it wasn't the fault of the maintenance guys failure to hook the alarm back up, it was the building was too old. Our Family was told by the Administrator that this type of death had never happened, come to find out he was the third one. So, the lovely community raised a butt load of money to build a new Denali Center (connected to the hospital now). The old Denali Center building was in such poor condition that the only thing it could be used for was a free clinic. FMH and Banner Health are the people we trust our lives with. These are the people we pay to take care of us. Do they really care? Probably about as much as the Fat Cats on Wall street care about us.
If they cared, it would show... It doesn't.
If somebody wants to open a hospital and offer all the services to anybody that comes in , okay. However, don't let companies come in and just do the highly profitable services. After a while we won't have a hospital.
guess what people the fmh is a local community owned hospital and is run by the banner health care but it is answerable to the fmn. i had heart sugary and more time in the hospital in the last six month than in the last 60 years and have yet to find a nurse or doctor who was not first class and caring and professional. if you don't want to pay for the services feel free to anchorage delta or whitehorse or juneau. i worked all my life and bought health insurance if you didn't so sad.
Have you ever noticed that when something is community owned, you have to stay in the bent over forward position. These community owned places like FMH and GVEA make BIG profits, but the community doesn't ever benefit . WTF?
mcgillagorilla-Nice to hear that your surgery went well and that you have had excellent care.
mcgillagorilla: Ditto here. Have made approximately three visits to the ER in the past six months. If I were married, the wife would be jealous or I might have divorced her for one of the nurses. ;-)
Of course, anybody complaining here should have seen the medical care I received elsewhere for the past 5-10 years in other states.
Also, luckily my insurance picks up the bill. All I can say is, thank God I finally have some apparently caring health care services.
angryalaskan: Think that's the position I've been in for the past 5-10 years. The phrase, "Hey! I can see Russia from here!" comes to mind. (No real pun intended to the country.)
No one is saying the personal service isnt anything less than outstanding, what is being said is that it is a huge rip off. People shouldnt have to declare banruptcy to be healthy. And if there is someone who is willing and and able to provide the same service for less, I dont see a problem. It is the cost of health care that makes it such a difficult situation and a serious problem Here is too preventitive maintenance!! :)
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