Health plans threaten to terminate contract with hospital group

If negotiations over a contract between Health Services Coalition, a group of 24 self-funded insurance plans, and St. Rose Dominican Hospitals break down, nearly 30 percent of Las Vegas workers could be forced out of the St. Rose system, the Las Vegas Sun reports.

That means, patients would have to find hospitals outside St. Rose, which operates three hospitals and two surgery centers, or pay for services out of pocket.

Health Services is threatening to end their contract because it maintains that St. Rose charges too much for treatment--and is the most expensive provider in its network--without delivering care that justifies the high rates.

If quality measures showed that St. Rose hospitals were much better than all the others, the higher rates might make sense, Leslie Johnstone, the coalition's executive director, said. "But we do not see any hospital standing out in its quality."

St. Rose's Siena and San Martin hospitals are among local facilities that see the highest number of patient readmissions, according to a Health Services study.

St. Rose spokesman Andy North objected, noting that the system ranks above the national average on CMS heart attack and pneumonia quality indicators. Health Services reimbursement rates are well below the cost of care, he said, as the coalition pays less than half the national average; it proposed to pay even less next year. St. Rose wants to an increase to cover inflation.
Neither side would reveal the prices under discussion, the Sun reports.

Health Services is fighting with other valley hospitals as well, but St. Rose is the only hospital group that it has said it might drop so far. But the coalition is playing hardball. "It is not a foregone conclusion that we will settle with the other hospitals," Johnstone said.

To learn more:
- read the Las Vegas Sun article

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