Major insurer drops Cassia Regional

Sunday •

April 24, 2016

Hornets Win First Playoff in 14 Years • D3

www.magicvalley.com •

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Blue Shield, Cassia Regional Must Settle Spat • C1

BASQUE SUNSET

As the Magic Valley’s first generation of Basque immigrants disappears, an identity is fading, too. Rupert sheep rancher Henry Etcheverry and the valley’s other second-generation Basques are carrying on some traditions of their mothers and fathers. But they are vestiges of a vanishing culture, a culture once a big part of southern Idaho’s agricultural fabric. See the special report on B1.

DREW NASH, TIMES-NEWS‌

Jim Sievers R.N., speaks with a patient during his shift Monday at Minidoka Memorial Hospital in Rupert.

Major Insurer Drops Cassia Regional Thousands of patients will have to find new doctors, travel for care LAURIE WELCH lwelch@magicvalley.com‌

University’s construction management department and the Friends of Minidoka will be honored for reconstruction of the guard tower at the former internment camp where the U.S. government moved some 13,000 Americans of Japanese descent from their homes on the West Coast during World War II. Seven miles north of Eden, the Minidoka National Historic Site is scattered with remnants of the camp’s buildings.

‌ URLEY • Dan Blauer lives just a few B blocks from Cassia Regional Medical Center, but he can no longer receive care there or choose the doctor he prefers.‌ Regence Blue Shield of Idaho, an insurance company, has failed to negotiate a cost-reimbursement contract with Cassia Regional, meaning that company’s clients will have to go to a different hospital if they need medical care other than emergencies. Regence referred people to Minidoka Memorial Hospital and St. Luke’s Medical Center in Twin Falls, a change that could affect more than 4,300 people in Mini-Cassia, forcing some to drive long distances for routine medical care from new doctors unfamiliar with their health histories.

The insurance company is used by some of the largest employers in Cassia County and Minidoka County to provide health care insurance for employees, including both Mini-Cassia school districts. The failure to settle on a new cost contract has enraged physicians and left patients like Blauer caught in the middle.

“It’s crazy,” Blauer said. “I live four or five blocks from the hospital, but I have to go to another hospital.”

Regence dropped Cassia Regional out of its Idaho network April 1 after negotiations crumbled. Regence said in a letter to its customers that the change will not affect people’s emergency care choices, but if they want to go to Cassia Regional for ongoing care or want to go to a physician employed by the hospital, they will have to pay “significantly” higher costsharing at out-of-network rates.

“It’s wrong that patients are being forced to go elsewhere,” said Rod Barton, Cassia Regional’s administrator. “It’s really been a difficult situation for us.”

The hospital says Regence wanted to cut reimbursements to Cassia Regional by 20 percent, a position Barton said was anything but “reasonable and fair.”

The insurance company says it wants the hospital to move toward a new fee structure increasingly being adopted at hospitals across the country.

Please see PRESERVATION, A3

Please see INSURANCE, A3

STEPHEN REISS, TIMES-NEWS‌

Since 1958, Basques in Minidoka County have put on a big community dinner, bringing immigrants and MiniCassia locals together for meals of lamb. Most of the original cooks are gone, but their children continue the tradition. Here, people dine at the 58th annual St. Nicholas Basque Festival Dinner on March 19 in Rupert.

| See more of the Times-News’ best work at Magicvalley.com/bigstory.

Barn Reporting, 3 Structures Win Historic Preservation Awards cultural history,” Preservation TIMES-NEWS ‌TWIN FALLS • A Times-News Idaho said. It will give out one reporting project on historic Onion this year, to the Jefferson Magic Valley barns, a Kimberly County Courthouse — “for the school gymnasium, an archi- unfortunate demolition of an tecturally significant Bliss home important historic structure and a relic of the Minidoka in Rigby.”

Japanese internment camp won Four Orchid winners are from state awards from Preserva- south-central Idaho: tion Idaho.‌ Cultural Heritage PresThe Boise-based nonprofit, ervation: For “Those Big Old dedicated to the protection of Barns,” a special reporting Idaho heritage, will honor 10 project published in the Times“Orchid” winners at its News on Nov. 15 and 39th Annual Orchids Nov. 22, reporter Mychel & Onions Awards CerMatthews researched the emony and luncheon history and condition of at 11:30 a.m. May 21 at more than a dozen old the historic Ada County dairy and livestock barns Courthouse on Jefferson — many threatened by Street in downtown Boise. weather and neglect.

Tickets are $20 for mem- Matthews The project’s first installment featured a bers and $25 for others.

Beforehand, the organization will Twin Falls man’s effort to prelead a walking tour of the histori- serve a significant 1914 Buhl cal neighborhood at 10:30 a.m.; barn. The second part of Mattickets are an additional $5. thews’ project was presented as The Orchids celebrate con- an easy driving tour of 13 barns tributions to historic preserva- from Buhl to Murtaugh, in varytion in Idaho. The Onions point ing states of repair or disrepair. out projects “that have shown Some are on the National Reginsensitivity to the state’s ister of Historic Places; others

I‌ f You Do One Thing: Wood River Orchestra presents its spring concert at 4 p.m. in the Wood River High School Performing Arts Theatre at Community Campus, 1050 Fox Acres Road, Hailey. Free.

have been altered beyond recognition. Some are still in use; others have been repurposed.

The digital package at Magicvalley.com, created by Enterprise Editor Virginia Hutchins, deepened the experience for readers with interactive features. Photographers for the project were Stephen Reiss and Drew Nash.

Contribution to Historic Preservation: Scott Roberts of CTA Group and Luke Schroeder, superintendent of the Kimberly School District, will be honored for renovation of the 1940s L.A. Thomas Gymnasium. A $1.5 million renovation started in 2014 — 70 years after Kimberly residents finished building the large concrete gymnasium.

“We have modernized it, but we’re leaving the integrity of the building,” Schroeder said at the time. It’s still the district’s most utilized multipurpose space, with a stage, basketball court and bleachers.

Cultural Heritage Prese r v a t i o n : Stan Cole at Cole Architects, Boise State

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Sunday, April 24, 2016 • A3

Tea Party Candidates Vie for Seats in Idaho Primary Election KIMBERLEE KRUESI Associated Press‌

‌ OISE • The struggle inside the B Republican establishment is once again raising its head in the battle over Idaho’s most competitive legislative races in the May 17 primary election.‌ Far-right candidates have lodged aggressive campaigns against some of the Legislature’s key incumbents, arguing that the establishment has strayed from conservative values. Yet tea party incumbents are also facing opponents, who are discontent with how the far right has represented legislative districts.

The GOP primary is often considered the most competitive leg of the

election because Republican candidates rarely face a strong Democratic challenger in November. Furthermore, only a handful of Democratic candidates are facing primary challengers.

A look at some of the key races: ••• Republican Sen. Shawn Keough, of Sandpoint, faces Glen Rohrer, a businessman from Priest River.

Keough is the longest-serving senator in the Idaho Legislature and is hoping to secure an 11th term.

Rohrer hopes to win his first political office.

Keough, who recently became co-chairwoman of the power Joint Finance Appropriation budget committee, has faced criticism for having

a voting record that strays from her fellow northern Idaho legislators. For example, northern Idaho lawmakers tend to vote nay on most budget related proposals, unlike Keough.

••• In north-central Idaho, incumbent Republican Rep. Shannon McMillan, of Silverton, will face off against Priscilla Giddings, a member of the Air Force Reserves from White Bird.

McMillan, who is seeking a fourth term, rarely introduces bills or debates legislation, but almost always votes against public school funding bills, refusing to explain why when asked by reporters.

This will be Giddings first attempt at seeking office. However, her

political background includes serving as a legislative aid during the 2015 Legislature and working as an Idaho field director for U.S. Sen. Mike Crapo’s 2016 re-election campaign.

••• In the Treasure Valley, incumbent Republican Rep. Pat McDonald, of Boise, will stand off against tea party favorite Rod Beck, also from Boise.

McDonald was appointed to the Legislature in 2014 following the resignation of Mark Patterson, who stepped down after his criminal record was revealed.

Beck was a former Senate majority leader while serving in the Statehouse between 1985 and 1990, and briefly in 1995. He has since unsuccessfully attempted three times to

Early Voting for May Elections Starts Monday

Insurance Continued from A1

Either way, the failure to reach a deal has left Cassia Regional “dismayed that we couldn’t continue our relationship,” Barton said, a partnership that’s lasted for 20 years. And it could have major implications for health care systems across the Magic Valley, as MiniCassia patients search for new doctors and physicians apply for privileges at hospitals that accept Regence Blue Shield patients.

Details of the Deal Regence Blue Shield says the company and Cassia Regional may not be as far apart.

“We don’t feel at all like it is at an irreconcilable place,” said Lou Riepl, a Regence spokesman. “We are still having conversations with them.”

Cassia Regional is the only hospital out of 44 in the state that is out of network with Regence, Riepl said.

The sticking point in the talks was over how the insurance company would reimburse the hospital for its clients’ care. Traditionally, insurance companies have paid a percentage of the total bill. But the insurance industry is increasingly moving toward a new model that emphasizes fixed costs for procedures and medical care, a model insurance companies say brings more predictability.

In the past century, health care providers have been paid for the volume of services or procedures they perform. Value-based reimbursement takes into consideration how good the services are and if it takes care of the problem, instead of volume.

Barton, the hospital CEO, said the new proposal was “complicated” and the hospital was unsure what the bottom line would look like.

Riepl said while using the percentage-of-costsbilled payment method, Cassia Regional had the

TIMES-NEWS ‌TWIN FALLS • Early voting for the May 17 elections starts Monday and runs until May 13. Registered voters can also request mail-in absentee ballots by mail, fax, or email, or pick up applications at

their county clerk’s office.

And, people can register to vote at early voting or on Election Day with proof of residence and photo identification.‌ Contact your county clerk’s office for early voting times.

DREW NASH, TIMES-NEWS‌

Pharmacist Preston Maxwell makes a call concerning insurance Monday, April 18, 2016, at Minidoka Memorial Hospital in Rupert.

Are You Covered?

Patients should call the 800 number on the back of their insurance card if they are unsure whether services are covered innetwork at any facility.

See a gallery of photos of employees at work at Minidoka Memorial Hospital online at Magicvalley.com. “distinction” of being most expensive hospital in the state for Regence members.

“We weren’t saying even the rates out,” he said, “just make progress on the rate of parity in the state.”

But Idaho and Utah, where Cassia Regional’s parent company is based, are recognized for having some of the lowest cost health care in the nation, Barton said. “In the big picture we were already running really lean,” he said. “It’s part of our big focus.”

Hospital contracts with Regence vary across the

state, but the company says it’s had good responses from hospitals moving toward fixed-cost systems. It’s trying to move all hospitals toward multi-year agreements and value-based reimbursement.

Michelle Bartlome, a spokeswoman for St. Luke’s in Twin Falls, said St. Luke’s renegotiated its contract with Regence in the past year. Under the deal, Regence reimburses the hospital on set fees, meaning the hospital gets paid a certain amount for every diagnosis, regardless of how much it costs the hospital to treat.

The hospital declined to provide further information on its contract. “We don’t discuss contract details,” Bartlome said.

What’s Next?‌

Losing the Blue Shield patients will be a huge setback for Cassia Regional, the hospital said, but not enough to make it insolvent.

Patients who have out-ofstate Regence Blue Shield or Blue Cross are not affected by the change, and the hospital has been in contact with officials at both school

districts and is encouraging them to look for other payers. Some exceptions apply for school district retirees.

Still, community members are holding out hope the hospital and insurance company will reach a deal that could keep local people at their community hospital.

“As board members we are frustrated by it,” said Clay Handy, chairman of Cassia Regional’s board.

“We are still hoping that they will sit down and come to an agreement. I’ve seen this happen before where they came to a stand-off but never to the point of sending out letters.”

Regence says it’s already sent letters to 4,300 clients to say Cassia Regional is no longer in its network.

That includes Blauer, who lives close to Cassia Regional but now has to find a new doctor. He has Regence Blue Shield of Idaho insurance through his wife’s employer, Gossner Foods.

“Now, I can’t go see Dr. (Wayne) Bauer because he’s employed by Cassia Regional — unless I pay more,” Blauer said. “People said they would figure it out, but I guess they didn’t.”

An Influx of Patients at Minidoka Memorial Patients at Cassia Regional Medical Center dropped by Regence Blue Shield of Idaho are surging to Minidoka Memorial Hospital. And more doctors are applying for privileges at the hospital.

“We have also had more interest from physicians who want to do more business here and to make sure they can take care of their patients,” said Tom Murphy, CEO at Minidoka Memorial.

Doctors have to fill out an application to receive privileges at a hospital, and there is a screening process.

“Over the long term,” Murphy said, “it may shift more business to us.”

The hospital offers full radiology, lab, emergency, surgery and in-patient services along with swing bed, where patients stay for ongoing services like physical or occupational therapy.

But, the hospital quit delivering

babies several years ago so new obstetric patients with Regence insurance will have to travel to Twin Falls to St. Luke’s Medical Center or Pocatello.

“I am sympathetic to the patients who will have to go to Twin Falls or Pocatello to deliver their babies,” Murphy said. Blue Shield says patients who were receiving prenatal care prior to the change fall under a clause in the contract and will be able to use Cassia Regional as in-network for their delivery. Other expecting mothers, though, will have to make different arrangements.

“Right now people are frustrated with Intermountain (Cassia Regional’s parent company) and with Regence,” Murphy said.

“And patients and physicians are caught in the middle.”

Minidoka Memorial is under an “evergreen” contract with Regence and has not been asked to change its payment method.

“We would have to analyze any offer,” Murphy said about whether the hospital would be receptive to changes. He said fee-schedule reimbursement is “fairly common,” but typically it works better at larger hospitals that have enough business to capture economy-of-scale savings.

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PHOTOS COURTESY OF PRESERVATION IDAHO‌

The L.A. Thomas Gymnasium in Kimberly.

Teater’s Knoll, designed by Frank Lloyd Wright.

The Minidoka internment camp entry.

Preservation Continued from A1

Whiting, who lives and works there now, restored and updated the studio and wrote a book chronicling its design and history.

For tickets to the award ceremony, contact Preservation Idaho at 208-4245111 or info@preservationidaho.org.

Heritage Stewardship: Henry Whiting will be honored for careful caretaking of Idaho’s only Frank Lloyd Wright building. Known as Teater’s Knoll, the artist studio and home is above the Snake River between Hagerman and Bliss; designed in 1952, it was Dr. Marjorie A. Brockman built for western artist R.N., B.S.N., D.C. Archie Boyd Teater and “A Positive Approach To Wellness” 445 Idaho St., Gooding • 934-5000 his wife, Patricia.

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“The scary part is how to change the methodology and stay viable,” he said.

Murphy said the hospital has every intention to work through any issues that come up with Regence. “We want to avoid one of these lose-lose situations.”

And, he said, he remains hopeful Cassia Regional can mend its relationship with Regence Blue Shield so both hospitals remain viable.

“I want Cassia Regional to be successful because they offer some services that we don’t,” Murphy said. “We need both hospitals in the area.”

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••• Over on the eastern side of the state, incumbent Republican Rep. Ron Nate, of Rexburg, is being challenged by Doug Ricks, the son of Lt. Gov. Mark Ricks, also a longtime state senator.

In his short one-term tenure as a lawmaker, Nate has gained a reputation of siding with the far right. He was ranked as one of the most conservative lawmakers during the 2016 legislative session by Idaho Freedom Foundation, a free market think tank.

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