Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, September 24, 1993 TAG: 9309240055
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: By CAROLYN CLICK STAFF WRITER
DATELINE: LENGTH: Long
The region, which has defined itself as a medical mecca for Southwest Virginians, could face a new wave of competition between the two biggest players: the Carilion Health System, with its hub-and-spoke network of hospitals, and Lewis-Gale Hospital, which is allied with the independent 126-doctor Lewis-Gale Clinic next door.
Employers and employees would likely face new decisions about benefit choices, and the working poor no longer would play the kind of risky roulette that lack of insurance inspires. If Clinton's framework is enacted, the area's poorest citizens, those on the federal Medicaid program, would be brought into the mainstream.
There likely would be a jockeying for position among insurers who have been accused by the administration of swamping the system with paperwork and of second-guessing doctors.
But that leaves big questions for small companies like the Roanoke-based Benefit Plan Administrators Inc., which has tailored a product for employers with workforces of 100 or so, a product that is different but still competitive with industry giants like Aetna and Prudential.
And for everyone from doctors to hospital administrators to consumers, the big question remains Clinton's calculations for financing the goal of health security for every American.
"I could list 15 things I think are great about the plan," said Dr. Christopher Alexander III, a Roanoke physician and delegate to the American Medical Association. "But I am very concerned about the cost of implementing the plan."
With competing networks of physicians and specialties, Carilion and Lewis-Gale are likely to push harder to reduce costs as a means of attracting employers and consumers grouped in big regional alliances.
"Carilion is developing this network; the same with Lewis-Gale," said Dick Robers, president of the Blue Ridge Regional Health Care Coalition. The coalition works on behalf of about 60 employers to negotiate lower rates for workers and their families.
Already, the coalition is doing what Clinton believes is key to lowering the cost of health care - compiling and analyzing data to determine what providers are charging for common medical services.
"That's where the competition comes in," said Robers. "We are going to have this information within the next six months to say to our members, `Look, here's what a tonsillectomy costs at Lewis-Gale, and here's what it costs at Roanoke Memorial Hospital.' "
RMH and Community Hospital of Roanoke Valley are Carilion's flagship operations.
But will that pressure to compete within the framework of managed competition jeopardize the quality of care many Americans currently enjoy?
Some physicians have expressed fear that the bottom line will triumph over quality if Americans are not offered a range of options, including costlier fee-for-service benefits. Even then, a two-tiered system could develop, where the wealthiest continue to have access to the greatest range of care.
"It's very easy to get into cheap medicine, but I believe we need to strive for value," Alexander said. Patients "will get their money's worth, but without being extravagant."
"If we are going to have savings . . . people must share in the responsibility to accomplish this," Alexander said. That means if a doctor determines that a test is not needed, then the system should be willing to back up the doctor with adequate malpractice reform, Alexander said.
Archie Cromer Jr., chairman of Carilion's board of directors, suggests there may be lingering concerns about quality in a world of HMOs (health maintenance organizations) and PPOs (preferred provider networks) "because everything is going to be dollar-driven. Everyone knows if you limit the dollars, you can't buy everything."
But he believes Carilion, with its chain of hospitals and other businesses, is positioned well for the coming transformation. If there is expansion, it will come slowly, and he said there may come a time when the system will have to take a look at operations, such as its Syndicated Collection Agency Ltd., that could become obsolete under a Clinton plan.
For the poorest of Roanoke Valley's citizens, those receiving health care through the federal Medicaid program, the Clinton draft is "a major ray of hope," said Ted Edlich, executive director of Total Action Against Poverty.
By abolishing Medicaid and assuring access to the health care system regardless of station in life, Edlich believes Clinton is moving toward real welfare reform.
Under the current system, single mothers who receive government benefits have been faced with a catch-22: If they take a minimum-wage job, most likely one without health benefits, they lose Medicaid coverage for themselves and their children.
Under Clinton's proposal, "it becomes more likely that work begins to pay," he said. "Now, work, even in a minimum-wage job, becomes an option.
"I think he certainly outlined not the final piece of legislation, but the groundwork of what will surely be one of the great pieces of social legislation," Edlich said. "It will be one of the great building blocks of this country."
But for Arnold Masinter, president of the Benefit Plan Administrators Inc., which administers self-insurance plans, there is a real worry that the Clinton proposal will render his business - at least the health insurance component - obsolete.
"We are not going to know for maybe two years how this is going to play out and what our role would be in health plans," said Masinter. "We think we can still have a role, because the customers of companies like ours are generally quite satisfied with our plan and services."
He disputed Clinton's contention that the insurance companies have flooded the market with a wide variety of confusing forms.
"The way most claims get paid, the doctors' offices and hospitals generate a form out of their computer system," he said. "They don't fill out our form. They have a standard HCFA [Health Care Financing Administration] form."
For the average citizen, Clinton's speech offered tantalizing prospects for change. But many expect passage of the legislation will be long and arduous.
"He wants the full eight years [in office]," said Frank Wilkerson, owner of The Lunch Box restaurant in downtown Roanoke. "He's going to hold it over our heads until the election."
For the self-employed Wilkerson, the ability to deduct the cost of providing health care for his wife, who operates the restaurant with him, and daughter would be welcome. But he wonders if the government still would allow him to contract out with an employee who is covered under her husband's separate insurance policy. He does not pay for insurance for that employee or deduct taxes from her check.
In the meantime, he staggers under health insurance bills that have at least leveled off in recent years.
"The insurance right now, it just about kills you," he said.
by CNB