Changes will soon occur reflecting contentious differences between the region's major health insurers and hospital networks that will significantly alter access and costs.
To quote reporter Steve Twedt's May 24 Post-Gazette story: "... Highmark subscribers using UPMC facilities and seeing UPMC physicians would be 'out of network' beginning in 2015 and face so-called balance billing costs. (The reverse is, and will be, true as well -- those with UPMC Health Plan insurance have historically not been able to use WPAHS hospitals at in-network rates.)"
What is important as a physician is to remember it is about the patients, not the "systems." If these events occur, it will sever long-standing relationships of patients with hospitals and doctors. Patients will be pressured to leave physicians who primarily have admitted them to hospitals that will soon be "out of network."
Patients may find themselves moved back and forth each year to different hospitals and physicians if an employer chooses a different insurance. The threat of excluding hospitals and physicians from well-established insurance products will leave patients vulnerable victims of health care politics.
Patients develop long-lasting relationships with hospitals and doctors in many ways. For many, transportation and geographic constraints dictate their hospital/physician relationships. As this battle progresses, patients' control of their health care and access are at risk.
Even patients who want to responsibly pay full price with cash to preserve relationships with their now "out-of-network" doctors are being refused and told their money is no good. How un-American is that?
These disturbing events raise valid questions of "ownership," stewardship and who the real stakeholders of our hospitals are. Allow me to illustrate.
I purchased my car with post-tax dollars and paid local and state taxes. I own that car. No one else contributes oil changes, car washing, new tires or windshield wipers, and I don't expect it. That is to say my car is not tax exempt like a nonprofit entity (i.e., a hospital) as it serves me, not the common good.
As a result of my non-tax-exempt purchase, I supported all the things that may be covered by local, state and federal tax.
Some liken the tax exemption of nonprofit entities as being the same as "we the people" paying part of its expenses.
Just about any hospital with a long history may have gone through the oversight of several "owners." These nonprofit entities have been created and supported by nonpartisan efforts. Likewise, many insurers are further propped up by nonprofit status.
We citizens are thus stakeholders, and these hospitals are not just owned objects like my car. The nonpartisan efforts that sustain hospitals are now being betrayed and undermined by perverse partisan health care politics.
This will happen if we permit nonprofit entities to act as sole owners rather than responsible stewards of institutions that "we the people" sustain and support. Patients should not be victimized by the vagaries of embattled health systems and insurers.
If a health care system oversees the administration of a hospital of which the location or specialty services leaves patients with little choice, then that hospital should be compelled to participate with all health insurers in order to give citizens access at reasonable and competitive insurance costs.
If a health system wants to behave like it solely owns the hospitals it intends to make "out of network," then the price to pay is like the status of my car ownership -- the loss of a nonprofit tax-exempt status. By no longer behaving as a nonprofit enterprise, it violates the explicit responsibilities and promises made to serve "we the people."
Having drawn the distinction between ownership and stewardship, it will be necessary for a vigilant citizenry to make sure health care systems discern the distinction between right and wrong or we risk losing access to our hospitals and doctors.
In spite of my disdain for yet more government, it is now time for "we the people" to request our representatives to step in and keep geographically and functionally strategic hospitals available to any willing insurer under reasonable terms so that the citizens who are the main stakeholders in our hospitals are not locked out from them.
Dennis Gabos, M.D., is a physician practicing in the Pittsburgh area.