UPMC flexes muscles, unfairly

COMMENTARY

BY Dr. Angela Rowe

The physicians and staff of The Advanced Center for Surgery thank state Sen. John H. Eichelberger Jr., state Rep. Judy Ward and state Rep. John McGinnis for ensuring patient choice in the Greater Altoona healthcare market and for attempting to secure high quality, low-cost healthcare services for all in our community.

Sadly, their tremendous efforts seem to be for naught.

UPMC bought the struggling Altoona Hospital to gain a foothold in our community some six years ago.

Soon thereafter, UPMC Health Plan entered the insurance market and immediately began to direct patient care to their hospital.

The two entities are supposed to be separate, and there is to be no collusion between the provider side of UPMC and the insurance side.

As many of you have experienced, patient choice of independent physicians and facilities has greatly diminished in Greater Altoona.

Make no mistake, our long-time patients can no longer seek care at our physician-owned facility despite the fact that we provide high quality care at a low cost.

UPMC Altoona Hospital’s and UPMC Health Plan’s referral and networking practices are so pervasive and egregious that many of our patients have filed complaints with the Pennsylvania Office of Attorney General.

They are awaiting the outcome of those investigations.

Seemingly in vain, our legislators prevailed upon UPMC Health Plan to review their network practices and consider adding the Advanced Center for Surgery to their Medicare, Medicaid and commercial products.

As of this writing, UPMC Health Plan’s response is a resounding no.

The Advanced Center for Surgery is the first Pennsylvania ambulatory surgery center deemed qualified to perform outpatient Total Joint Replacements.

Our patients can undergo hip, knee and shoulder replacements and be back in their homes within six hours. We also have the region’s lowest infection rate.

Right now, UPMC Health Plan patients must have replacements at the much higher costing UPMC Altoona and recover with a sicker patient population surrounding them.

This is a misguided attempt to drive The Advanced Center for Surgery and its practices out of business, even though our surgeons are assigned more than 60 percent of the uncompensated emergency room call at UPMC Altoona.

This is not fair or sustainable for our community.

Ironically, The Advanced Center for Surgery’s physicians are included in UPMC Health Plan’s provider networks. They obviously believe we are qualified to serve patients they insure, but our surgery center competes with UPMC Altoona, so it is excluded.

Our State College surgery center is also within UPMC Health Plan’s provider networks, because they own no State College hospital. State College UPMC Health Plan patients can receive high quality, low cost care, but Altoona UPMC Health Plan patients cannot.

The facts are clear.

Patient choice drives healthcare competition, increasing quality and reducing costs.

Market domination by a healthcare provider that is also an insurer stifles patient choice and leads to lower quality and higher costs.

Unfortunately, the Greater Altoona community is now subjected to market domination and is experiencing these adverse outcomes.

With great regret, our physicians need to consider if we will continue to cover emergency department call at UPMC Altoona.

The UPMC Health Plan refuses to contract with us, and UPMC Altoona redirects patients to their practices even if we are the requested physicians.

Our practice can no longer financially support entities that are devoted to our destruction.

We welcome all patients to our practices. Please be persistent if you are requesting us from the UPMC emergency room or UPMC-owned practices.

And ask your UPMC physicians where they would send their own family.

Rowe is the only female board certified orthopedic surgeon in Blair County. She is the first vice president of the Pennsylvania Orthopedic Society and is the Medical Director at The Advanced Center for Surgery in Altoona.