Thursday, October 30, 2014

SD's Initiated Measure 17 (The "Any Willing Provider" Initiative): Not So Much About "Patient Choice" As It Is About "Choice Patients"

     This is my column that ran in the Rapid City Journal yesterday, 10/29:

     "The more I look at Initiated Measure 17 the more I think it’s less about “patient choice” and more about some doctors wanting to take the “choice patients,” namely those who now can afford fairly comprehensive insurance coverage that can be extended to even the most expensive caregivers.  That changes if the measure passes, because then everybody effectively becomes a “choice patient.” Health insurers in South Dakota would have to drop their “preferred provider”  lists of physicians and hospitals and include “any willing provider” of medical services among their participating doctors. 
     The problem with upending the status quo is that by spreading the pool of insured South Dakotans out over a broader field of physicians, care is likely to get costlier just because economies of scale will be lost to existing preferred providers.  They’re likely to lose a significant number of patients who will migrate to any number of newly participating providers.  That means less revenue to cover fixed costs, which will result in their raising fees to insurers in order to remain in the black.  I’ve seen enough academic studies (from universities including George Mason, Minnesota, and Southern Cal, among others)  to regard this as a valid contention, one which is also supported by the fact that the SD Chamber of Commerce and Industry opposes IM 17, mainly because it will likely result in a jump in employer insurance costs as fees from providers across the board increase and the higher costs are passed on to customers. 
      But compelling as the pro-con arguments are when they’re focused on costs to both consumers and physicians, I’m more concerned about the effect of IM 17’s passage on care to the poor given by non-profit healthcare facilities like Rapid City Regional Hospital, which provided me with data from the Center For Medicare and Medicaid Services (  According to the Center, South Dakota’s non-profit hospitals provided $36 million in charity care in 2011, a figure over and above Medicaid reimbursements.  At the same time, the report notes that South Dakota’s specialty hospitals wrote off just $196 thousand.  Considering that much of that care is effectively subsidized by fees received from insurance companies for other services, a drop in the revenues created by RCRH’s insured patients would strain the hospital’s ability to provide charity care.  As to those specialty hospitals?  I doubt they’ll use their windfall of newly generated fees from insured customers to begin serving the neediest members of our community with charity care.  The fact of the matter is that patients can already choose to go to specialty care centers if they’re willing to pay more for coverage that would include those higher cost services.
     As things will stand if IM 17 passes, choices are eliminated because everybody will have to pay more for a high-end policy that covers fees from a broader network of providers ultimately charging more money." 


  1. Mr. Tristian,

    Thank you for offering clarity on this. I was thinking that it could be classified as "If you want to keep your patient, you can keep your patient. If you don't want to keep your patient you don't have to keep your patient."

    I forwarded your thoughts to my family (8 voting Children) my e mail list.

    Thank you!

    Clark Sowers

    1. Good one, Mr. Sowers. Appreciate the comment.