Aligning hospitals, urgent care centers, outpatient surgery clinics and physicians into integrated networks is what today’s health care is about.
This is good for patients because it assures them their providers are in-network — and there are no surprises when it comes to their deductibles and co-pays.
SB 538, a bill by state Sen. Bill Monning, D-Monterey, would ban statewide contracting with insurance plans. In essence, it would prevent us from forming or operating these kinds of integrated networks.
How would this impact our local hospitals and patients?
Example: Tenet (our parent company) could not require a health plan to include both Sierra Vista Regional Medical Center and Twin Cities Community Hospital in a single, integrated network of care, so that when a pregnant woman enters Twin Cities to deliver and unanticipated complications arise, the baby can be seamlessly transferred to the neonatal intensive care unit at Sierra Vista.
Insurance plans are complaining that some hospitals outside of our county are somehow coercing them into unfavorable contracts.
In response, SB 538 prohibits all hospital systems in California from negotiating with health plans so that all of their hospitals, outpatient facilities and affiliated physicians could be combined in a single contract.
Four insurance plans already currently control 85 percent of the California market (and 88 percent and 93 percent of the small employer and individual markets). The last thing these plans need is more leverage. This explains why businesses, hospitals and physicians are opposed to SB 538, which would give health plans just that.
Contracting as a system also enables hospital companies to include smaller, more rural hospitals in its health plan contracts, giving them benefits from capital investment and lower costs as part of a larger system. Otherwise, they would struggle to stay afloat on their own.
San Luis Obispo County residents and employers deserve a health-care system that is accessible, reliable and seamless, providing the right care at the right time and at the right place, and without any part of that system becoming too dominant.
Hospitals throughout California strongly oppose SB 538 because it hands more power to health plans while leaving our patients to navigate a fractured, disjointed system of health care.
If you’re concerned, contact Sen. Monning. Reach his San Luis Obispo office at 805-549-3784.
Mark Lisa is chief executive officer at Twin Cities Community Hospital in Templeton. Tim Menton is interim CEO at Sierra Vista Regional Medical Center in San Luis Obispo.