Antitrust case unintentionally highlights information blocking

A year and a half ago, a federal judge invalidated the purchase of Nampa, Idaho-based Saltzer Medical Group by St. Luke’s Health System in nearby Boise, on antitrust grounds. A new review of documents from that case by the Idaho Statesman newspaper revealed a fine example of what Congress and the Department of Health and Human Services have dubbed “information blocking”:

The documents, which were part of the antitrust lawsuit that St. Luke’s lost last year, show that St. Luke’s tracks its doctors’ referrals and has used technology to make it more of a hassle for doctors to refer outside of St. Luke’s. They also show that [competitor] Saint Alphonsus [Health System] tracks its doctors’ referrals and in 2010 began requiring its employed doctors to refer patients to other Saint Alphonsus providers, with exceptions for insurance coverage, patient preference or quality concerns.

Some of the documents, which media outlets had to sue to gain access to, were pretty blunt. One was an e-mail from a Saltzer physician, written three years before the 2012 buyout, saying that some doctors in the practice “need to do a better job of keeping referrals in house.”

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Another was a notice posted at a St. Luke’s primary care clinic advising patients that read:

If you need emergency care … Please use the Emergency Department at St. Luke’s in Boise or Meridian. St. Luke’s Internal Medicine doctors admit patients only [emphasis in original] to St. Luke’s facilities. Therefore, if your treatment requires hospitalization, we can manage your care more efficiently and effectively if you have received your emergency care at St. Luke’s.

While there was a disclaimer about calling 911 in “life-threatening” cases, the implication seemed clear.

For its part, the information release also did not reflect kindly upon Saint Alphonsus, which was a plaintiff in the antitrust suit. One document revealed the existence of an IT system to track physician referrals. Another indicated that the health system’s “goal is to maximize alignment (prevent leakage) with employed physicians,” according to the Statesman.

When the Boise newspaper approached the two competing health systems, executives at least paid lip service to doing the right thing. For example, St. Luke’s COO Chris Roth is quoted as saying that “knowing someone has already had an MRI and doesn’t need another one” is a major benefit of a single patient record.

However, that’s also a primary benefit of health information exchange.

Another plaintiff, the independent Treasure Valley Hospital in Boise, reported seeing referrals drop off since the St. Luke’s-Saltzer merger and again since the judge invalidated the deal. Dr. Jeffrey Hessing, a orthopedic surgeon who is a Treasure Valley shareholder, put some of the blame on EMRs. According to the Statesman:

When doctors join a big system like St. Luke’s or Saint Alphonsus, they start using electronic medical records technologies that make intrasystem referrals “very streamlined for the physicians. It’s easy. It’s quick.”

Those technologies don’t always interact well with others, so doctors prefer the ease of referring within their own systems, Hessing said.

In other words, lack of interoperability between EMRs seems to be as much of a problem as intentional steering of referrals.

Photo: Flickr user toban black