It has come to my attention that you have received an email from Educators Mutual Insurance, a company that acts as a third-party administrator for the Utah Public School system (a “self-funded program” supported by all of our tax dollars). I understand this email has advised you to start looking for another orthopaedic surgeon. They have apparently informed you that I will no longer be contracting with them as a physician effective August 5th this year.

This is not a decision I have taken lightly because I highly value all of you as my patients. However, because I care about you as my patients, I can no longer allow EMI to take advantage of all of you by continuing to force you to use ONLY Intermountain Cedar City Hospital (or more exactly, any Intermountain hospital) as the facility where you have your surgical procedures performed, especially when I know that you stand to benefit financially by using Cedar Orthopaedic Surgery Center if you so choose.

It is time for me to tell you about the history of events taking place that have centered largely around Cedar Orthopaedic Surgery Center.

Beginning in 2004, my surgery center enjoyed a contract with EMI that provided you, my patients, with the advantages of surgery at COSC if you so chose. For those of you who did get a chance to enjoy those advantages, you know that my pricing is a fraction of the charges that you would have to pay at Intermountain Cedar City Hospital, or any other hospital for that matter. Consequently, your out-of-pocket expenses would clearly be less as well.

However, in early 2013, COSC was faced with the specter of losing our contract with EMI, which administers your insurance coverage. Despite a conference phone call with EMI administrators at that time, EMI went ahead and made the decision to cancel their contract with COSC, NOT because of any problem it had with COSC, but because of a larger across-the-board discount for medical and surgical services that Intermountain Healthcare offered EMI on the condition that they did not contract with COSC (or any other non-Intermountain facility).

This is a bold-faced case of one business basically bribing another business to not use a certain other business! I did not like it at the time, but I still wanted to offer my excellent services to all of you even though your choice of facilities for services became very limited. I found that even with me as a provider, you still had no choice of surgical facility. For me, this is not acceptable to endorse any longer. I have held out hope that I could prevail upon EMI to “see the light” and re-contract with COSC again. Yet despite my best efforts to help EMI understand the benefits of choice in surgical facilities that I offer to my patients, they remain stubbornly entrenched in their stance of wanting to keep their seemingly across-the-board discounts on services that may or may not be actual discounts because hospital charges generally start out as outlandish and get negotiated down to something slightly less outlandish.

Basically, it simply does come down to “choice”.  With me as a contracted provider, I must maintain that having “choice” of surgical facilities (especially when savings could be so significant) is of supreme importance at this time. Without me as a contracted provider, you simply have “no choice”.

I want you to know that I value you as a patient, and although I will be an out-of-network physician as of next month, you can certainly still use my services. When I am not a contracted provider, I am not restrained by any insurance company requirements. I believe that you will still benefit from continuing with me as your orthopaedic physician both with excellent care and transparent cash surgical pricing as well, especially if you have a high deductible, which is quite common these days. Many of my surgical prices are well below some of the standard deductibles, and that is one thing Intermountain finds to be a threat to them. Additionally, if you find yourself injured and in the emergency room, you are quite welcome to request me as your orthopaedic physician. I will ALWAYS be able to care for you in an emergency situation regardless of in-panel or out-of-panel status – (435) DEL-CORE. For more information regarding COSC transparent cash options, you may go to delcore.org.

If you find this issue to be rather irrelevant, I apologize for beating my drum and feeling the need to explain my side of the story. However, if you are outraged at the way you are being treated by your third-party administrator and do not want your choice of where you receive surgical treatment controlled by Intermountain’s collusion with EMI, I invite you to contact both the Human Resources officer for your school district or college and the EMI representative Emily Harenberg at (801) 270-2951 or (800) 662-5850, Ext. 2951, eharenberg@emihealth.com.

My best regards,

Randy G. Delcore, M.D., Medical Director

Cedar Orthopaedic Surgery Specialty Clinic

Cedar Orthopaedic Surgery Center

www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws

How much does the average knee replacement surgery cost – $16,000, $31,000, $90,000? In some markets, it can be all of these. Thanks to medical monopolies across the country, merging hospitals have banded together in order to SUPPOSEDLY bring better care to their patients.

However, these mergers have resulted in skyrocketing health costs, and the quality may be no higher. The more hospitals merge, the less competition in a given area there is. With less and less competition, health care providers can charge insurers anything they want, which in turn, only hurts the patient. Instead of paying more for quality health care, patients and insurance companies pay for larger hospital systems.

The northern Utah market alone sees a cost variation between $5,500 and $11,000 dollars for knee surgery alone. Nearby states like Arizona has a varied market with differences in the Phoenix market over $18,000 while the Tucson market sits under a $5,500 difference. Las Vegas may also see a $5,000 to $11,000 difference in prices for the same surgery.

Additionally, the state of Utah has a very powerful “health care” system that has its own insurance company which does not contract with unaffiliated facilities — that often offer much better pricing. This health system also uses large across-the-board discounts on medical and surgical services to entice other insurers and third-party administrators to avoid contracting with providers that are not affiliated with that system.

There are a number of factors that come into play when you need surgery, including what your own insurance carrier is expected to pay at the local hospital (especially with deductibles being so high these days),  prices at competing facilities, quality comparisons between facilities, and others such as facility location. One essential principle to remember is that high cost does not mean high quality.

Here is a short video that illustrates this very well.

Medibid Explains- The Cost-Quality Paradox in Healthcare from MediBid on Vimeo.

Stand-alone Surgical Centers & Affordable Care

More and more, surgical facilities are making their prices for procedures easier to find. If you know where the cheapest gasoline in town is, why can’t you have the same information for something as important as orthopaedic surgery?

Thankfully there are options in the Southern Utah market for those in Utah, Arizona, California and Nevada for affordable, flat rate orthopaedic surgical treatment. Cedar Orthopaedic Surgery Center isn’t part of a medical monopoly. We publish our flat rates, so you know exactly what you’re paying for your next surgical treatment.

With a fully licensed staff and two state-of-the-art operating rooms, you don’t have to play medical monopoly with hospitals in your area and risk landing on Boardwalk. Our cash prices include everything from surgeon’s fee, facility fee, total joint implants, anesthesia fee and same-day physical therapy. With the state of medicine today, the highest prices certainly don’t mean the best care.