Open Letter to Greg Fialko, Director of Benefits, Ohio University Human Resources:
Dear Greg,
In your message to OU faculty and staff, dated 3/4/2009, you inform us that you determined to exclude Holzer Clinic and Hospital from the Tier I list of providers, although Holzer is part of the PPO Anthem Network.
While I understand and applaud any reasonable cost saving efforts, I am afraid that this tactic is not among these. It also looks very much like a bait-and-switch operation:
Holzer has been part of the network ever since its appearance in Athens. It provides high-quality medical service in a notoriously underserved area. Many people have established relationships with physicians at that facility, and now we are suddenly told that we basically can't use them any more - who is able to afford $45 per office visit, a family deductible of $1,200 and a family co-insurance limit of $5,000?!
As an Athens resident, you know, too, that we are living in an area that is medically severely underserved. For the longest time, we were lacking high quality medical facilities. Even with Holzer, we are still far from the type of service available in urban areas. But I can tell you (and I suspect many others will do, too) that Holzer is providing medical care at a level that, sadly enough, used to be unavailable in Athens.
I am speaking from my experience as a cancer survivor. In Winter 2003/2004, I saw a local (non-Holzer) doctor who didn't seem to have time or interest to explore the symptoms I presented and dismissed them as stress-related stomach upset. Had my symptoms been taken seriously and properly examined, my cancer could have been detected and treated at a much earlier stage. A simple x-ray of the thorax would have done the trick.
Most likely, I would not have ended up with the serious side effects I suffered, including partial paralysis and later a life-threatening pneumonia due to aggressive chemo. In other words, with better, more thorough diagnostic care, I could have avoided disability and pain. Additionally, my treatment would have also been cheaper for the insurance, and some follow-up costs, such as for the surgery of my paralyzed hand, would not have occurred.
On the other hand, it was due to the diligence and persistence of a Holzer physician that a second, unrelated cancer was detected in 2007 at a very early stage so that I could be treated swiftly and successfully before it had a chance to become lethal. Had this cancer gone undetected, my life expectancy would have decreased dramatically and I would have ended up with debilitating and expensive treatment options.
My story is by no means an exception. Before Holzer, a colleague in my school almost lost his life after a routine colonoscopy performed in Athens. A visiting colleague with a severe heart condition lived in constant fear of having any cardiac problems because of the lack of heart specialists. I know of many similar stories. You may say that this is only anecdotal evidence, and maybe you'd be right. However, for those who have to go through these ordeals, it's not anecdotal, it is cruel reality.
I am also upset about this tactic because it seems that OU has made no serious attempt to negotiate better rates with Holzer. In your message, you claim that fairness considerations made you decide to exclude Holzer from the Tier 1 list:
Allowing one health care provider to maintain higher fees creates an unfair marketplace for providers in the region. The result could be all providers pushing to match higher fees or some providers not being able to compete and survive.
This creates a picture that there had been negotiations and that Holzer had insisted on their rates without any room for compromise. However, I have heard from two credible, independent sources - one from OU and one from Holzer - that the last serious conversations with Holzer about their rates took place in June 2007. Today I learned that only in the past few days, right before the March 15 deadline for making changes with our insurance company Anthem, has OU resumed talks with Holzer. This leaves the impression that time pressure was artificially created and that OU members who happen to get their health care from Holzer are being used as a bargaining chip. I don't think this is ethical.
Moreover, even if this is not your intention, this last minute negotiation after long silence creates the perception that it is in fact OU who is trying to push a high-quality health care provider out of the market. For most OU members, the exclusion of Holzer from the Tier 1 list de facto blocks access to Holzer. Since OU is the largest employer in this area, such a decision could result in an unfair advantage for other health care providers and the financial ruin of the local Holzer branch.
You will understand that I am very upset about a plan that factually blocks access to high-quality medical service, while the alternative medical services in Athens are not too attractive. To be fair, I want to add that a few of the local non-Holzer services are of high quality, but there is no consistent pattern to this. And it is not unlikely that some of the improvements are due to the high-quality competition that Holzer created.
I urge you not to rush things, to keep Holzer in the Tier 1 list and to engage in serious negotiations with Holzer so that a solution can be found for next year.
Bernhard Debatin is a professor in the E.W. Scripps School of Journalism
at Ohio University.
4 Opinion
