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Health-care dispute could cost businesses

December 27, 2001

Health-care dispute could cost businesses



A month ago I wrote a column about the impending departure of Dr. Stephen Lippman, the region's only endocrinologist, specializing in, among other things, the treatment of diabetes.

Everyone I've spoken to about Dr. Lippman - his patients, other doctors and James Hamill, CEO of Washington County Health Systems, Inc., says that he's a dedicated professional who's improved the quality of life for many patients. Nor do hospital officials dispute Lippman's contention that his programs have saved millions in inpatient charges.

The problem is that although Lippman does a great job, he does a lot of his work with patients on the phone - and insurance companies are prohibited by law, according to Hamill, from paying for phone consultations.

Without those reimbursements, the practice, which is owned by the health system, runs a deficit Lippman estimates at $300,000 a year. The system asked Lippman to change the way he practices medicine, but he's refused. Barring some last-minute agreement, he will leave Nov. 7.

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In my first column on this subject, I suggested one possible solution. Since Baltimore City recently got some of the non-profits there to voluntarily contribute cash by threatening to enact a tax on them, why not use the threat of possible legislation to persuade insurers to share some of the money Lippman's saving them?

It seems like a fair deal: If I save you a couple million per year, you share a couple hundred thousand with me. And in addition, you get some good p.r. (which insurance companies need) when you hand over the check.

Anything's possible, said John Donoghue, a local state lawmakers who chairs the health care subcommittee of the House Economic Matters Committee.

"Legislation is always up for discussion," Donoghue said, adding that "we're constantly fighting with insurance companies on the level of reimbursement."

Donoghue said he'd had calls from many patients and with Lippman himself, but because Lippman and the health system have a contract, doesn't feel he can interfere. He's confident, he said, that the system is actively recruiting a replacement.

Some letter-writers have cast the Washington County Health System as the villain, but not even Lippman is doing that. Dr. Dan McDougal, medical director of Antietam Health Services, told me that over the years the system has subsidized the practice in the amount of $2 million.

Now, Dr. McDougal said, the insurance companies have tightened down considerably on what they'll pay for certain procedures and the system is not as profitable as it was. And so, he said, the subsidy is no longer affordable.

Did anybody ever talk to the insurance companies about doing things a different way? In fact, a source within the health system told me that three years ago, an outside consultant recommended approaching insurers about a "capitation agreement."

In such a system, insurers would pay so much per month to the health system to keep every diabetic patient well, and guarantee that insurers' costs wouldn't increase.

So what happened to that idea? Citing the fact that it contains proprietary information, the health system won't share the full report, or portions of it or details of any talks that may have been held.

As I said in my Sept. 30 column, the whole matter has an Alice in Wonderland quality to it. Dr. Lippman was hired to improve the community's health and did so, but in a way that doesn't produce enough revenue.

It's situations like this which will increase the pressure for a single-payer health-care system, because the current system penalizes doctors like Lippman, who keep patients out of the hospital, out of doctors' officies - and healthy.

Unfortunately, one single state can't set up such a system, even though there's a group in Maryland pushing for one. My fear is that if only Maryland has such a system, everyone with a chronic condition and inadequate insurance will try to establish residence here, causing costs to mushroom.

More likely will be some stop-gap measure until everyone has forgotten Hillary Rodham Clinton's failed attempt and the feds are ready to try again.

My suggestion to the business community here is to pay close attention. With health-care costs slated to go up 13 percent this year (according to USA Today), the area is about to lose someone who significantly cut such costs. It may look like a difference of opinion between a doctor and his employer, but over time what it might be is a significant reduction in many firms' profits.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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