Published February 2003

Health-care Briefs

Everett Clinic to cut care
for Basic Health Plan patients
The Everett Clinic says it will no longer care for about 1,100 low-income Basic Health Plan patients, following Regence BlueShield’s decision to cut payments for patient care by 15 percent to 50 percent for office visits, specialty care and procedures.

Under the Basic Health Plan, working poor residents have most of their health insurance paid for by the state, with patients paying the remainder. At The Everett Clinic, Basic Health Plan patients had health insurance through Regence BlueShield. More than half of those patients are at or below federal poverty levels, said Jodi Coffey, a Regence spokeswoman.

The change means that 1,100 Basic Health Plan patients of The Everett Clinic must either switch to the Community Health Center of Snohomish County or Group Health to get their medical care, Coffey said.

Although the change went into effect Jan. 1, patients who have a continuing medical problem will be allowed to finish medical treatment before they have to switch, said Rick Cooper, chief executive of The Everett Clinic.

Cooper said the decision to no longer accept Basic Health Plan patients was made after estimating the organization would lose $350,000 this year caring for them.

Coffey said that Regence had to cut the amount of money it paid doctors to care for Basic Health Plan patients because its rates were 20 percent to 30 percent more than competitors’ costs.

Regence now pays doctors who care for Basic Health Plan patients slightly more than what they’re paid for taking care of Medicaid patients, who typically are disabled, on welfare or very poor, she said.

Many physicians in Snohomish County have refused to accept new Medicaid patients because state payment rates are so low they lose money on every patient. Recently, The Everett Clinic said it would only accept new Medicare patients if they join a Medicare health maintenance organization.

Valley General, community work
to keep Sultan clinic open
The last chapter on Sultan's only medical clinic, threatened with closure on March 31, may not have been written yet.

In late January, officials of Medalia Medical Group and its parent organization, Providence Everett Medical Center, announced it would close the clinic, citing mounting financial losses at both its Monroe and Sultan clinics. Together, the losses were estimated at between $600,000 and $700,000 this year.

On Jan. 29, the board of Monroe's Valley General Hospital approved a financial analysis and in-depth study of keeping the doors open at Medalia's Sultan medical clinic, one of several steps under way to keep the clinic from closing..

Mark Judy, chief executive of the Monroe hospital, said the Sultan Fire District is asking for a grant of up to $15,000 from the Washington Health Foundation to help map out strategies for keeping the clinic open. Last year, the estimated losses at the Sultan clinic were $155,000, he said.

Judy said the Monroe hospital could step in for the short-term to help keep the clinic open until a permanent solution, such as establishing a nonprofit corporation to operate the clinic, could be found.

Lawsuit filed to keep
Premera Blue Cross a nonprofit
The Washington State Hospital Association, the Association of Washington Public Hospital Districts and two hospitals recently filed a lawsuit in King County Superior Court in an attempt to keep Premera Blue Cross from converting to a for-profit corporation.

The group argues that the company’s plan is illegal and would harm the health insurer’s subscribers. If the for-profit conversion is allowed, however, the hospitals contend they have a claim to some of the company’s assets.

Premera spokesman Scott Forslund called the lawsuit “disappointing,” adding that the hospitals’ demand for some of the company’s assets is not valid.

In May, Premera announced it wanted to become a publicly held, for-profit firm after 58 years as a nonprofit. With nearly 900,000 subscribers, it is the state’s largest health insurer.

Premera officials have said the conversion would help the company raise money to invest in technology and patient services and would not affect the insurer’s rates or the fees paid to doctors and medical providers.

Forslund said many of the issues raised in the lawsuit will be addressed by the Washington insurance commissioner’s review and subsequent ruling on the proposed conversion.

Related: Providence left reeling from health inspection

Related: Providence to lay off 350

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