Thursday, April 23, 2009

Doctoring For Dollars: West Penn Health Aims Blockbuster Claims At UPMC, Highmark

Among the quirks of the Pittsburgh region are the lack of taxis, the belief that a hamburger can properly be labeled a cheesesteak, and the strange domination of the University of Pittsburgh Medical Center over the region's health care industry, the local economy and even the university from which it took (literally) its name.

While the national chatter addresses the issue of "too big to fail," in Pittsburgh the issue has been settled for several years: UPMC is Too Big To Criticize. Politicians fear, serve and are funded by UPMC. Publishers and broadcasters are far too busy cashing checks for UPMC "image" advertisements (left) to spend any time questioning anything about UPMC's rise and reign. The University of Pittsburgh has been UPMC's plaything for many years. Large employers might chafe against UPMC's charges but enthusastically refrain from offending the only entity that rivals the Rooneys among Pittsburgh's royalty. (In legal and medical circles, some mumble about the openness of UPMC's conduct, and the legal issues associated with it, but only after checking the room to ensure that no one who might call Mr. Romoff is able to hear.) Highmark, ostensibly a competitor, has been UPMC's bitch for years.

Which makes the West Penn Allegheny Health System's recent filing of a major-league antitrust complaint against UPMC and Highmark fascinating. The details -- a claim that Highmark's chair acknowledged that UPMC-Highmark collaboration has been "probably illegal," a depiction of UPMC declaring an intent to turn Allegheny General Hospital (right) into a "parking lot," an allegation that an internal UPMC analysis showed that some of UPMC's conduct made no business sense outside the context of eliminating competition -- can be viewed as scattered points over a number of years, but most of them strike me as amply believable, and they might provide enough radioactive material for a legal detonation.

Perhaps there are explanations (other than a UPMC-Highmark conspiracy plausibly pinpointed in 2002) for Highmark's treatment of West Penn, for the inability of other health insurers to find traction in Western Pennsylvania, for the seemingly inexplicable attempt to raid every anaesthesiologist employed by West Penn.

This complaint might make Pitt chancellor Mark Nordenberg uncomfortable, however, and perhaps even cause him to rethink the Pitt-UPMC relationship (which appears decidedly slanted toward UPMC's favor). This complaint should cause the region's decision-makers to wonder whether UPMC is good or bad for the region. Those responsible for monitoring qualification for tax-exempt status could reasonably wonder whether UPMC operates "for the public good."

Nothing has been proven. So far, we have a one-sided argument (that seems congruent with years of whispering about town) that is entirely untested. But people should watch this one develop, and many familiar with the underlying circumstances will need no encouragement to do so.

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