WPAHS makes antitrust charges against UPMC and the Blues

Honnête et Sérieux · Apr 28, 2009

I've worked for both systems at one time or another.

WPAHS needs to realize that it has to compete with quality, not by just suing UPMC every time UPMC expands their market share.

In one of the last lawsuits, WPAHS was able to enlist the assistance of Highmark, a lawsuit that went in UPMC's favor and resulted in UPMC countersuing Highmark for higher reimbursements. Highmark learned their lesson.

The biggest commodity I found at WPAHS was arrogance. People want quality healthcare, not some blue-blooded health system like WPAHS running around criticizing everything that UPMC does instead of looking at their own product.

padrik · May 6, 2009

Honnête et Sérieux,

Take an honest moment and seriously read the complaint filed by WPAHS (http://www.wpahs.org/antitrustfiling.pdf). It is a criticism of predatory practices that have increased health care costs and decreased health care choices in western Pennsylvania.

WPAHS does compete with quality, often at a lower reimbursement rate, and according to a 2007 study on cardiac surgeries in Pittsburgh, with a lower readmission rate.

Read the study and I'm sure you'll find a suitable french translation for "outrage."

Honnête et Sérieux · May 6, 2009

Honnête et Sérieux,
Take an honest moment and seriously read the complaint filed by WPAHS (http://www.wpahs.org/antitrustfiling.pdf). It is a criticism of predatory practices that have increased health care costs and decreased health care choices in western Pennsylvania.
WPAHS does compete with quality, often at a lower reimbursement rate, and according to a 2007 study on cardiac surgeries in Pittsburgh, with a lower readmission rate.
Read the study and I'm sure you'll find a suitable french translation for "outrage."

I read it.

It's a complaint, not a term paper; it's not designed to look favorably upon their competitor, and I think they may have gone over the top with frequent use of the 'conspiracy' word (not to mention the 'bribe' concept, which has no place in a civil complain), and even almost three years separated from the region, I can find errors in the complaint. For example, I think the Butler Hosp and Jefferson Hosp would be insulted to hear that West Penn feels they don't offer "sophisticated tertiary care." Additionally, whether they do or not holds no relevance and didn't need to be included in this report.

Next, West Penn is disingenuous in their description of UPMC's profit in comparison to WPAHS using the sizes of the systems as a benchmark. UPMC has specifically positioned themselves to be a self-sufficient system in markets that have no bearing on West Penn. Examples; they create electronic data systems and sell them. They create entrepreneurial programs outsourcing their talent all over the world in such specialties as emergency medicine, oncology, biomedical research, and transplant medicine. They aggresively pursue and conduct research which has brought us breakthrough pharmaceuticals, biologics, and technologies. Salk and Starzl ring a bell? They take venture capital risks for which they deserve to reap the rewards just as they suffer the consequences of failed venture. I'm not sure why this is so 'criminal.'

Unlike WPAHS, UPMC hasn't just been directing their focus at Pittsburgh, but to the world, and to try and exhibit their revenue stream as a function of their Pittsburgh market share is disingenuous.

Now I don't believe it's a perfect organization, but they've got a model that works. And having worked in both systems, when one of my parents required a CABG, I encouraged him to go to West Penn even though I worked at UPMC (Oakland) at the time. I felt the care was comparable for a relatively lower risk surgery, and the West Penn unit was more aesthetic and capable for what was needed. And UPMC is committed to the region; I've been in the old Children's Hospital; it was a dump. Without UPMC pitching in the money, I wonder who would've gotten Children's into their new building? Is UPMC's scholarship promise irrelevant? Really...a $100 million dollar gift to city students. They really must be evil.

I remember the 2007 cardiac surgery comparison, and that study left out obvious information that I was familiar with first hand having worked in their CTICU. When I was at UPMC, we were caring for the highest-risk cardiac patients in the city. We were doing combination procedures on high-risk patients that no one else wanted to touch (heck, some of them were so sick I was reluctant to touch some of them), but these ended up being patients that opponents were willing to use in a propoganda war against UPMC. I wanted to scream, because I knew that if we restricted ourselves to the lower acuity cardiac patients that everyone else included in the 'study' was doing, they'd look like amateurs in comparison to UPMC's outcomes. Really...more than once we received patients from Butler and Jefferson and Dubois and other cardiac surgery centers, POST OP patients that were an absolute mess...conveniently not referred to WPAHS and were not 'readmitted' to their respective centers, so it would be tough to count them as 'readmissions.'

WPAHS complains when a physician 'goes to the dark side' and works for UPMC, but they revel with delight when a physician crosses the tracks in their direction. West Penn alleges that UPMC falsified an analysis of WPAHS's viability, but the financial picture of WPAHS for the past few years seems to indicate that UPMC was right. WPAHS fails to acknowledge that UPMC allowed WPAHS to have low-cost access to several of their residency and fellowship programs for many years, allowing WPAHS to reduce their own operating costs associated with using these UPMC physicians. Really, how can WPAHS have the AGH system essentially handed to them, then be given almost $170 million in loans by Highmark, and then complain it is everyone else's fault when they sputter as a health system?

As a former long-time resident of the region and a former employee of both systems, here is what I saw; I saw the WPAHS and it's predecessors resting on their laurels, smugly looking about as if they were the consumate 'big dogs' in the region, sitting tight and failing to do what it takes to preserve and capture market share, and then suddenly realizing they were asleep at the wheel as UPMC strove not to just be a powerhouse in Pittsburgh, but in Western PA, and a resource to the world.

And as we see, WPAHS is resorted to 'complaints.'

I'm not disagreeing for the sake of it, I'm calling it as I see it. I left WPAHS because UPMC gave me far more opportunities. They paid for most of my nursing education. They gave me opportunities that WPAHS specifically denied me, and even though I wanted to work at both facilities for personal reasons, it was my supervisors at WPAHS who created incompatible circumstances; UPMC didn't care where I worked when I wasn't there. UPMC knew how to cultivate loyalty; WPAHS failed.

I'd like to think there is a place at the table for WPAHS, but this looks like nothing more than sour grapes.

Honnête et Sérieux · May 6, 2009

All that said, I thank you for sharing.

wonderbee, BSN, RN · May 13, 2009

Without picking the complaint apart line-by-line, and just addressing the spirit of the intent, I applaud WPAHS for addressing the monopoly issue UPMC presents. I doubt they will win but at least they're raising the issue.

Honnête et Sérieux · May 13, 2009

That is undeniably one way to look at it, and I understand why some would view it that way. But having worked for both systems, I don't have much applause for a system that is simply whining because they keep picking fights with UPMC and keep losing.

K98 · May 16, 2009

That is undeniably one way to look at it, and I understand why some would view it that way. But having worked for both systems, I don't have much applause for a system that is simply whining because they keep picking fights with UPMC and keep losing.

Having worked for both systems as well, I'm happy to see that somebody continues to pick fights with the Evil Empire. I'd hardly call it whining. BTW, where can I witness all of this arrogance (and blue blood) at WPAHS?

Honnête et Sérieux · May 17, 2009

Having worked for both systems as well, I'm happy to see that somebody continues to pick fights with the Evil Empire. I'd hardly call it whining. BTW, where can I witness all of this arrogance (and blue blood) at WPAHS?

I experienced it at Alle-Kiski and AGH.

I was a per-diem employee at Alle-Kiski, and was invited to take a partial FTE position with benefits and a seat on a committee. Since it wasn't full-time, I also sought out desirable employment elsewhere to fill out my income, and I obtained a coveted casual position with a UPMC affiliate. As soon as the folks at AGH found out I obtained a casual position at UPMC, they immediately passed word on to my supervisor at Alle-kiski that my offer for a partial FTE position was to be withdrawn. I was permitted to continue working as many hours as I wanted (they did this because I was an eager worker who frequently came in to fill in the gaps), but I was no longer eligible for the benefits that came along with being a partial FTE employee. I was also specifically forbidden to participate in any of the committee functions, and I was no longer allowed to conduct anymore of the training that I had been doing for them (AGH/Alle-Kiski) for the preceding year.

I immediately resigned.

They're are showing a little more humility these days since they've been shown they are no longer the big dog.

K98 · May 17, 2009

I experienced it at Alle-Kiski and AGH.
I was a per-diem employee at Alle-Kiski, and was invited to take a partial FTE position with benefits and a seat on a committee. Since it wasn't full-time, I also sought out desirable employment elsewhere to fill out my income, and I obtained a coveted casual position with a UPMC affiliate. As soon as the folks at AGH found out I obtained a casual position at UPMC, they immediately passed word on to my supervisor at Alle-kiski that my offer for a partial FTE position was to be withdrawn. I was permitted to continue working as many hours as I wanted (they did this because I was an eager worker who frequently came in to fill in the gaps), but I was no longer eligible for the benefits that came along with being a partial FTE employee. I was also specifically forbidden to participate in any of the committee functions, and I was no longer allowed to conduct anymore of the training that I had been doing for them (AGH/Alle-Kiski) for the preceding year.
I immediately resigned.
They're are showing a little more humility these days since they've been shown they are no longer the big dog.

I agree that you were poorly treated, but that seems to be the rule rather than the exception in nursing. Bankruptcy and reorganization can certainly change a lot of attitudes in management, as can the presence of a union (not that I would call the SEIU a union). All that said, your situation hardly points to systemwide arrogance. By that yardstick, you won't find a system that isn't arrogant. There is/are always an employee/employees that feel they are being mistreated. From my position in the trenches, I see little difference between the systems, other than the assignments are safer for the most part at WPAHS (AGH specifically) since nurse/patient ratios are subject to contractual agreement.

Honnête et Sérieux · May 17, 2009

I agree that you were poorly treated, but that seems to be the rule rather than the exception in nursing. Bankruptcy and reorganization can certainly change a lot of attitudes in management, as can the presence of a union (not that I would call the SEIU a union). All that said, your situation hardly points to systemwide arrogance. By that yardstick, you won't find a system that isn't arrogant. There is/are always an employee/employees that feel they are being mistreated. From my position in the trenches, I see little difference between the systems, other than the assignments are safer for the most part at WPAHS (AGH specifically) since nurse/patient ratios are subject to contractual agreement.

You asked where you could "witness" the arrogance, so I shared an example. Since I worked for the organization long before they offered me the partial FTE, I had a strong grip on the "mood" of the organization.

This general attitude is of which I speak, not just this one incident. I shared it out of your inquiry, but this mentality is what was commonly displayed. I frequently heard language that matched this behavior.

You then tried to generalize this toward all systems, but I never experienced this as a UPMC employee...I worked in several departments, some of which shared competitive markets with AGH. I never experienced this same attitude as a UPMC employee. WPAHS was free to behave as they wished, and free to choose whatever style of competition they wanted to use. UPMC did not care if I was a part-time employee with the AGH system.

I worked in both system, I don't know how you can try to explain away my personal experiences and observation.

And I don't know why WPAHS doesn't understand why they are losing market share.

K98 · May 18, 2009

You asked where you could "witness" the arrogance, so I shared an example. Since I worked for the organization long before they offered me the partial FTE, I had a strong grip on the "mood" of the organization.
This general attitude is of which I speak, not just this one incident. I shared it out of your inquiry, but this mentality is what was commonly displayed. I frequently heard language that matched this behavior.
You then tried to generalize this toward all systems, but I never experienced this as a UPMC employee...I worked in several departments, some of which shared competitive markets with AGH. I never experienced this same attitude as a UPMC employee. WPAHS was free to behave as they wished, and free to choose whatever style of competition they wanted to use. UPMC did not care if I was a part-time employee with the AGH system.
I worked in both system, I don't know how you can try to explain away my personal experiences and observation.
And I don't know why WPAHS doesn't understand why they are losing market share.

I'm not trying to explain anything away, just pointing out that your point of view is your opinion. Your opinion is not necessarily fact. I think that WPAHS understands the dynamics of the western Pennsylvania market very well. I hope that both health systems survive, as I have family working at both. Competition is a good thing, and as the late Allegheny-Singer Health Corporation demonstrated a few years back, you can never get too big to fail.