In the News

Court Ruling a Blow for the Health of Idaho

I am writing to you with surprising and disappointing news. Judge B. Lynn Winmill has ruled in the antitrust litigation, and he has ruled against us and our partners, the Saltzer Medical Group. 

Our leaders, our boards, our employees, and our supporters know that St. Luke’s and Saltzer have been trying to do the right things for the right reasons to bring accountable care to the people of Canyon County. 

The evidence presented by our attorneys told our story well and demonstrated that St. Luke’s was, and is, pursuing innovation and putting the best thinking of providers and public policy experts to use to truly improve health care for the people of Idaho. Even the court acknowledged that it was “convinced” that the transaction would improve health care if left intact, and said St. Luke’s was to be “complimented on their foresight and vision” for its efforts to improve the delivery of health care in the Treasure Valley. 

“The Acquisition was intended by St. Luke’s and Saltzer primarily to improve patient outcomes,” the judge wrote in his decision. “The Court is convinced that it would have that effect if left intact …”

While this news is disappointing, our job and our journey remain the same. We must continue the hard work of changing the way health care is delivered. We know that the people of Idaho want and deserve better health, better coordinated care resulting in better outcomes, and healthcare providers to take accountability for these outcomes, including the cost of the care. 

The court’s decision calls into question whether accountable care can be an option for the people of Idaho, and specifically those who live in towns like Nampa and Caldwell. We must expend the additional effort and resources necessary to ensure that these residents have a choice when it comes to their health care and hospital providers, though it will undoubtedly be more challenging and take us longer to achieve.

Though our job is made more difficult by this decision, and though our competitors have, in the near term, achieved their goal of slowing our progress, our commitment and determination is not diminished. 

Thank you to our board members, who have been steadfastly dedicated to offering the best health care at the lowest cost to our communities. I admire and respect the Saltzer Medical Group for having the courage to stand up and fight for what is right against the significant resources of the federal and state governments, Treasure Valley Hospital, and the Trinity Health System. Thank you to our leadership teams, physician partners, and staff members, who have remained committed to our vision. And a special thanks to all the attorneys who so expertly and ably represented St. Luke’s and Saltzer. 

We will review the judge’s findings and conclusions and anticipate appealing the decision. In the meantime, we will determine how we can work with Saltzer going forward to best serve the people of the Treasure Valley. 

Thank you for all you do for St. Luke’s and our patients, and remain focused on your why. In the long run, winning or losing this case is not the measure of our success; the measure of our success is the extent to which we improve the health of the communities we serve, provide patients with the best possible outcomes and lower the cost of care for the people of Idaho.



  • Dr. Pate,

    I received news of the decision from a coworker moments before reading your blog post. If I wasn’t already sitting down, I’d have had to.

    Since being born here, I have always felt a part of the St. Luke’s family. This familial relationship has only intensified since joining the St. Luke’s team 10 years ago. The news hit me as though it were a personal blow.

    However, I, like you, am undeterred. I believe in St. Luke’s, our mission and our vision. I am committed to even more fully commit myself to changing the healthcare delivery model for the benefit of my community, which includes all those I hold dearest.

    Let’s keep moving forward!

  • I’m interested to see what will happen to Saltzer. From the bits and pieces I read, I understand they did not really have a plan B.

  • I am speechless, but not really surprised. I hope we appeal all the way to the top! How can we achieve the goals of the ACA if the courts prevent us from doing so?

  • Heartsick for our peers at Saltzer and the community we serve.

    At no juncture did I question the value and validity of Saltzer joining with St. Luke’s to improve the health of people in our region. I so appreciate our leaders’ vision and will continue to believe in this and serve here with pride and conviction.

    Thank you as always for your communications.

  • Hi, Janna.

    I can’t imagine that we won’t. We already have our attorneys reviewing the judge’s findings and conclusions for reversible error.

    It is not only a bad decision for Nampa, but for most of the country.

  • Hi, Michael!

    That is exactly the right attitude! I was shocked and dismayed by the judge’s decision, but I believe that there is a chance this will be overturned on appeal. Regardless, we must press ahead.

    This lawsuit only served to bring our employees, physicians, leaders, and boards closer into alignment and commitment to our vision. This is certainly a setback, but even the court acknowledged that we were to be commended for our foresight and vision.

    I know that all of our employees and physicians will rally, and that this will reinvigorate our efforts to provide accountable care to the people of Idaho.

  • Hi, Barbra.

    I have already met with the Saltzer leaders. We are both exploring our options, which will almost certainly include an appeal and a request to the Ninth Circuit to issue a stay on divestiture until such time as the court is able to hear our appeal.

    We are examining options, but this certainly is a huge threat to the Saltzer Medical Group, physicians, employees, patients, and Nampa.

  • Dr. Pate,
    I was lucky enough to be a part of the Saltzer team. It saddens me that they are losing the ability to offer better health care to an area where it is much needed. Hoping an appeal will bring a turnaround. The impact that this decision has on the Treasure Valley and the people of the valley is truly devastating. Hoping Saltzer can pull through this blow!

  • Hi David:

    Indeed. Of course, some of the plaintiffs really don’t want the goals of the ACA to be achieved. We will remain hopeful about our chances on appeal.

  • I’m an employee at SLHS Boise. I have worked here since 1979. I love my profession. I want to make it very CLEAR, this is a profession, NOT a job!

    I am saddened by the many ways SLHS has changed over the years. I am proud to be a nurse and I give excellent patient care, and patient-centered care. I have had several patients and or their families thank me for the time I spend with them, the dignity, respect, and loving care that I give to them. I have also had patients state that as time has gone by over the years, they feel that they are in a factory, hurried from place to place, and that they are a number, not a person. My neighbor had surgery in the fall of 2013, and she said the nurses on 5E were great but very stressed and overworked.

    I’ve had nurses on several floors, especially 7 East and 3 Tele, say that if you have a family member as a patient on our floor, you better have a family member stay with that patient because it is not safe on those floors due to understaffing and continual code grays.

    I am just saddened, for the reason that we are continually told we need to tighten our budget and tighten the staffing because SLHS is having financial troubles. I want to continue to hold my head high and be proud of working for the BEST hospital in the Northwest.

    I would like to know how much money was spent on attorneys and other costs during this ongoing antitrust litigation?

    Thank you,

  • Hi, Michelle.

    Thanks for your kind note. Yes, St. Luke’s will be fine. My thoughts and prayers are with the Saltzer physicians, employees, and their families.

    During the trial, one of the surgeons who left Saltzer testified that the Saint Alphonsus leadership had told Saltzer, during an earlier attempt to affiliate with Saltzer, that if Saltzer did not affiliate with Saint Al’s, they would drive Saltzer out of business.

    Very sad indeed, but we are not done fighting!

  • This is the right decision. With practices/individuals being ‘owned,’ and choices being eliminated, the price of health care has nowhere to go but up.

  • David, I admire and respect your response to the court’s decision and your resolve to persist in your commitment to those served by St. Luke’s.

    The economics of health care are making the advent of population health management inevitable, and fortunately, it is the right thing to do anyway. Managing the health of a population of people is something that cannot be done by a hospital system acting alone, nor by various groups of independent physicians, irrespective of the quality of the work done by each. It can only be done by a large organization comprised of facilities, infrastructure, technology, people, and healthcare providers acting together in a common commitment to keep people healthy and happy with their health plans, doctors, other providers, and hospitals.

    That is accountable care; it is the right vision and it clearly remains the vision of you and your organization. Best wishes. I am rooting for you!


  • Hi, Brant.

    I certainly understand. We have a number of options we are exploring, so hang in there. I have to believe this will all work out!

  • Hi, Barb.

    Not at all. I suspect it will be years before this is all resolved. This is a time when the community needs to support the Saltzer Medical Group. Please tell all your friends and family to support the Saltzer group so that we can keep this stellar group in Nampa and keep jobs in Nampa!

  • I believe this setback is a chance at achieving something great. If we continue to work hard and believe in our mission, good things will come.

  • Wow, something you feel right in the gut!

    Hard to believe, with accountable care as law, because healthcare as presently defined cannot be sustained. So many, even coworkers, didn’t understand the direction St Luke’s was taking and why. It was hard enough to try to help them understand and explain it when there was hope for this to be in our favor when it was all said and done. I cannot imagine how to continue to try to explain to coworkers now.

    Hoping for the success of the appeal, but more dollars that could have been spent on improving health go up in smoke fighting for what should be everybody’s aim for our community and state and consistent with improving health and reigning in the financial monster that health care currently is and has become.

  • Dear Dr. Pate,

    Throughout the uncertainty, helpless waiting, and worry during and following the trial, your steady faith in the work and vision of St. Luke’s has been an inspiration and encouragement to us all. Now more than ever, we know how crucial it is to uphold this vision in a robust way — a vision that is worth its cost.

    Thank you for your leadership.

    Norman L. Shrumm, BCC
    Manager, Spiritual Care Services
    St. Luke’s

  • Hi Dr. Pate,

    First, let me say how great your blog message is. I applaud your ability to be so eloquent and uplifting in such a frustrating and disheartening situation!

    I am sure there is not much I could say to you right now that would make you feel better, but I can’t tell you how much your inspiring leadership means to all of us.

    We will continue to stand behind you to fight the good fight! Thank you for doing what is right, especially when it is difficult.

    Best regards,

    Michael Fenello, CEO
    St. Luke’s McCall

  • Dr. Pate,

    I read the ruling memo. I am disappointed as well, but I take great pride in the fact I am part of the St Luke’s family. We can hold our heads up high with pride in the health care we provide and that our motives are honorable. We have not LOST our pride and integrity, and for that I stand proud!!
    I believe in St Luke’s with all my heart and I believe in the leadership. I look forward to continuing my growth as a leader in this truly wonderful organization. WE WILL TAKE CARE FORWARD!

    Tammy Billings LPN
    St Luke’s Clinic Urology

  • Regardless of the love fest going on, the fact is that St. Luke’s violated the law. The facts in presented in court did not support the rhetoric. The facts remain that St. Luke’s attempted something that is not lawful.

    If St. Luke’s is really interested in providing better care at a better price, let’s see it.

  • Dr. Pate,
    You all need to stand your ground and fight back! This situation sounds like something from Atlas Shrugged. You have the foresight to see how the market is changing before the competition and you act on it. The competition gets caught behind the curve and wants the government to protect them from their own slow decisions.
    What is even more unbelievable is the fact the judge admits patient care would be improved if the deal was left as is! And the increased cost … let’s see, you provide a better mouse trap and it is not allowed because it cost more than an inferior product? So much for capitalism.

  • I’m surprised by the decision, but can’t help feeling that if the parties and their attorneys had been more willing to release more of the evidence presented in the case to the press and public, the basis and benefits of the transaction would have been more obvious to the public, who after all should be the real beneficiaries of these efforts.

  • Hi, Richard.

    I cannot tell you how much your kind note means to me. Thank you for taking the time and making the effort to write in and encourage us.

    We do have to find an answer to how to provide care in an integrated delivery system that can deliver on the promises of population health. The plaintiffs seem to think that we can do this just fine in the current structure and environment, but we don’t see it the same way. Ultimately, the law is going to have to be flexible enough to allow for innovation or we will not be able to deliver on the full promise of accountable care.

    Thanks again for your wonderful note. I appreciate our friendship and your support! It means a lot to me!

  • Nicole,

    Thanks for your comment. There is great wisdom in your words. I often think about the fact that things that seem to be significant blows today end up being wonderful opportunities in the future.

    We have to believe that right ultimately will prevail. Thanks for your comment and for following the blog!

  • Hi, Larry.

    Unfortunately, the antitrust law is not that clear-cut, which in part explains why it took 19 days of testimony in a trial after two years of investigation into this matter. We disagree with the opinion and will see what the appeals court thinks.

    But no one here at St. Luke’s is feeling defeated. We are recommitted to our pursuit of better health, better care, and lower cost. And our work toward this Triple Aim continues to pay off. We were recognized among the top hospitals in the nation again this week.

    While this decision means it will take a bit longer to achieve all of our goals, we are undeterred and continuing our pursuit!

    Thanks for your comment and for following the blog; it’s a good way to continue to follow our progress in this journey.

  • Hi, Michael.

    My thoughts exactly! We have known that our competitors have been having difficulty executing and stinging from Saltzer’s choice. The good news is that we will continue on, behind the scenes, transforming health care and getting even further ahead of the competition.

    Thanks for your comment and for following the blog!

  • Hi, Mary.

    You have a valid point. I think that if the public could really understand all the information that could not be presented publicly at trial, they would have had a much better understanding of why health care needs to be transformed, and how St. Luke’s and Saltzer were best positioned to deliver on it.

    Thanks for your comment and for following the blog!

  • Dr. Pate,

    I totally disagree with the decision of the court. I hope you do appeal the decision. I don’t think the “other guys” should start celebrating just yet.

    What happens to Saltzer as a result of this decision?

    Keep up the good fight!

    Joan Simmons
    Medical Records

  • This is hardly surprising news to many of us, albeit underrepresented in this blogosphere. The ends don’t justify the means, and anti-trust laws are generally considered good things.

    Regardless of motives, Uncle Luke crossed the line and broke the law. As we’re already $65 million in the hole and employees across the board are feeling the hurt from that, may I ask that you re-think things before devoting more money to more lawyers to appeal this, money that we need right now to improve the health of people in our region.

    Besides, isn’t there enough room for more than one ACO in the valley.

  • To begin with, let me say I am stunned. This decision clearly isn’t in the best interest of the Treasure Valley.
    I do have a personal concern. My wife started working for Saltzer about 10 weeks ago. She was hired by St. Luke’s for her position. Is she now in danger of losing her job?

  • Hi Dr. Pate,

    While disappointed in the decision, I am even more convinced that we have the correct vision and strategy. I view this as a speed bump on the road to the Triple Aim goals we have.

    In my experience in the technology industry, in my 30 years at HP, entrenched competitors, the courts, and the federal government too often look in the rearview mirror when making policy and defending the status quo. We will find a way, as most successful tech firms have, of keeping our vision looking forward.

    As a mentor and friend at HP, Ray Smelek, often said, “There is a reason the windshield is bigger than the rearview mirror.” Let’s keep looking and moving forward together.

    Rich Raimondi
    President, Bishop Kelly High School
    Director, St. Luke’s Health System

  • Dr. Pate,

    I have worked here at Luke’s for 13 years now and enjoy being a part of the community that helps people fight their illnesses. My wife used to work here at Luke’s but has worked at Saint Al’s Nampa for the past eight years. We were both pulling for this decision to go the way of Luke’s. We thought it would make Saint Al’s step up their health care as well and with us doing our part to make it better and them having to raise their bar as well we would have great health care in the entire valley.

    We have our own aches and pains that we need health care for, and this valley has wonderful services for many treatments and illnesses. By you trying to make health care even better for all of us here, I commend you and encourage you to keep going.

    Bob Bradley

  • Hi, Lisa.

    Thank you for the support and encouragement. I am reasonably certain we will appeal. First of all, we believe the judge applied the wrong standard. Second, this case is of extreme importance nationally, as well as to our dedicated physician partners at Saltzer. It is a significant blow to the patients of Saltzer and the city of Nampa.

    Thanks again, and thanks for following the blog!

  • Hi, Joan.

    Yes, I am hopeful that the Ninth Circuit of Appeals will overturn the judgment. In the meantime, we will ask Judge Winmill to stay his order while we appeal the case. If granted, that would mean we would continue on as we have been for the past year while we go through the appeal process.

    Thanks for your comment and for following the blog!

  • Hi, Forest.

    I was certainly stunned myself. From the comments and questions of the judge throughout the trial, I certainly didn’t see this coming. We are going to do everything we can to support the Saltzer Medical Group.

    Please tell your wife we appreciate all she does for St. Luke’s and our patients. She will be fine, I assure you.

  • Hi, Rich.

    I love your comment and I think that is a great view, for us to keep focused on the future. We are going to do incredible things, and it is because of our dedicated physicians, employees, and board members. Thank you for your leadership on our board!

  • Hi, Bob.

    Thank you for this very encouraging note. We will keep up the fight! The ironic thing was that Saint Al’s used the antitrust laws in an anticompetitive manner. Saint Al’s may have succeeded in slowing us down, but they have not stopped us. Not even close!

  • This judge is setting a bad precedent. The medical industry is not a traditional market. Most of the funding is not coming from private investors; it is coming from the government (Medicare, Medicaid, Tricare), and there is a cap to what they will pay for services.

    Unwinding this merger is like trying to unwind a salsa. The market has already been affected, competition is everywhere, and prices are pretty stable.

    My family are established with Saltzer providers, and I see care going in a positive direction. I hope, despite this ruling Saltzer, will be able to continue at the top of their game!

  • Can you please elaborate on how this decision “calls into question whether accountable care can be an option for the people of Idaho”?

  • I am glad the judge ruled against St. Luke’s. Every time I have had to see a doctor, the price goes up, and the docs are all owned by St. Luke’s. So much for the keeping cost down. Before being bought up by St. Luke’s, my bills were lower. You can’t convince me that you are providing better care at a lower price.

  • I completely and fully agree with the decision. If the judge really felt like St. Luke’s was in the right, he would have ruled that way. Maybe you and others don’t agree with the decision, but that’s why they put it in the judges hands to decide.

  • I am a St. Luke’s employee who lives in Caldwell. Prior to the union of Saltzer and St. Luke’s, there was no “choice” or “selection” in health care. There was only a hospital that changed hands frequently and Saint Al’s-affiliated clinics. I excitedly looked forward to, and now count on, the seamless care provided by the St. Luke’s network of providers for my family. My chart is my chart whereever I go. If I forget about a past illness or medication, they have it.

    Truly, I wish the judge had bothered to ask my family or my neighbors what WE wanted, what we DEPEND on. This union promised us a better, safer quality of care; we didn’t have to come all the way to Meridian or Boise to be seen by OUR provider. In an emergency, we were assured care from our own network. Now? Well, now, we shall see, as the courts determine to remove choice from us in the name of fair trade.

    Appeal, please, please, appeal!

  • Dr. Pate,

    I’m sorry to hear this. However, I believe you and your staff will prevail no matter what! I will send prayers for your success! An appeal definitely seems in order, especially given that “Even the court acknowledged that it was ‘convinced’ that the transaction would improve health care if left intact, and said St. Luke’s was to be ‘complimented on their foresight and vision’ for its efforts to improve the delivery of health care in the Treasure Valley.”

    Dr. Pate, you and St. Luke’s do the right things for the right reasons – “improving the health of the communities we serve, providing patients with the best possible outcomes and lowering the cost of care for the people of Idaho.”


    Lisa Przybysz

  • Sorry to barge in on the St. Luke’s love fest here, but the facts may be getting a little muddled. Providing quality health care in the Treasure Valley is not in question, but violating antitrust laws is probably never a good idea. For being as savvy a healthcare system as I have always known you to be, shame on you, St. Luke’s, for not looking out for the interests of the community in a more positive way. You and you alone have jeopardized quality health care for those patients wishing to align with Saltzer providers.

  • As a physician at St. Luke’s, I would like to ask Dr. Pate and the board if this failed legal effort has been a factor in the multi-million dollar loss which has affected our salaries and our lowered retirement contributions.

    Who is accountable for this failure? If we as a physicians make a major error in judgement, we are accountable to patients, the government, and insurance companies.

    To whom are administrators accountable, and what consequences do they have when their decisions affect the lives of employees? Do they take salary reductions as we physicians must?

  • Hilking,
    When the Marine Corps moved my family to Idaho in 2002, my daughter broke her foot. We could not find one physician to care for her that accepted our military insurance. Now we have access to many different specialties. St. Luke’s does not jeopardize quality health care; they have expanded it to provide high-quality coverage to a larger population. I would say that is looking out for our entire community in a very positive way.

  • Dr. Pate,

    I think it is vitally important for everyone to remember that the court case considered a point of law, potential anti-trust violation, and was not a verdict on the goals of the St. Luke’s system in general, one way or the other. The judge’s comments clearly show that.

    The vision you have for health care is not a new one, as you know. The “HMO” systems 20-plus years ago were also attempts to reform health care, by having the corporate entities/hospitals rewarded for keeping people well, not just treating them when they got sick.

    They didn’t execute this plan well enough to survive, in general. Kaiser Permanente in California is one of those that has survived and done a pretty good job by most accounts, but many went under. If St. Luke’s truly shares this vision and is on target with it, I think Luke’s can and should put it into place, and it will naturally grow and expand if it proves its worth. Don’t propose it. Do it and prove it.

    If a corporation/hospital must have a virtual monopoly to make this work, then the laws will have to be adjusted, and the healthcare system handled more like utilities, which also enjoy near-monopolies but are heavily regulated as they do so, and are not tax-exempt. Benevolent monopolies are wonderful concepts, but quite rare in the real world.

    There will also have to be some consideration on if and how independent physicians like me, a vanishing breed these days, can be a part of such a vision without necessarily having to be owned. Wouldn’t that allow the Saltzer group to help Luke’s vision?

    The Stark laws, for example, have unnecessary and unintended consequences that affect me negatively and benefit hospitals greatly. I still have my own vision about how to practice and continue to do so under the existing laws; I have no choice. Neither does Luke’s.

    I assume that Luke’s will continue forward despite this ruling, to prove in the real world that this vision works, and if it does, then perhaps the laws and the regulatory systems can be adjusted appropriately to help facilitate such a system in the future. Do you have a choice?

    So in short, maybe this makes the task more difficult, or more difficult in some local communities, but put the process in motion and prove it’s right.

  • This is very disappointing to see. As everything else around us changes, so does health care. When it comes to the Saltzer Medical Group, they are part of Idaho, part of our community, and to provide much better health care to our family and friends, it seems only logical for them to unite with St. Luke’s.

    I have to say that the judge did not do his homework very well, because if he did, he would have learned that St. Luke’s represents the future of health care. We will provide the way for better health care not only in Idaho, but for the entire nation.

    I know that there are a lot of people out there with a lot of questions about us and that don’t agree with what St. Luke stands for, but they are not very well-informed or not willing to learn about us.

    The day that the judge ruled against the acquisition was a truly sad day for the entire state of Idaho and the future of our health care.

  • Hi, Liquidchicken (There’s a story there, no doubt :)!).

    You raise many valid points. No matter what this case ultimately means for us, we will continue to find ways to work with Saltzer and for us together to continue our journey towards better health, better care, and lower costs.

    Thanks for your comment and for following the blog!

  • Hi, Kevin.

    Yes, leading experts believe that accountable care, where there is true accountability for patient outcomes as well as overall responsibility for the costs of that care, can only be delivered by integrated delivery systems. There are a limited number of providers who would have the capability of dong this in Idaho, and some competitors have said they have no interest in wading into accountable care for the Medicare program.

    Even if others were pursuing the same vision, there are no areas of Idaho where there are more than two health systems competing. This will create more problems of the nature presented by this case, and ironically will mean that competitors will be vulnerable to the same antitrust challenges.

    If the decision were to become precedent in Idaho, the development of accountable care to the extent that providers could actually take on financial responsibility for the outcomes of health and care of a population will be severely limited.

    Great question! Thanks for following the blog!

  • Hi Linda:

    I understand why you feel the way you do. Just a few observations from me.

    First of all, we have only just begun our journey. The American healthcare system is very broken, and it didn’t get that way overnight. It will take a while to fix, and we are trying. How many other physicians or hospitals have you heard commit publicly that they are trying to find ways to lower healthcare costs?

    I understand that you have seen increasing costs. Are you aware of any friends or family members who have told you that their healthcare costs have already gone down? I believe you would still have seen increased costs even if you weren’t seeing St. Luke’s physicians, based simply on economic factors and costs rising throughout our economy and across all areas of activity.

    However, we are doing things that we have profiled on my blog as programs to help reduce healthcare spending for many patients. And we have a lot more work to do.

    I understand that you are happy about the verdict. Unfortunately, the judge’s decision will actually slow down our efforts to reduce healthcare costs.

    Thank you for being part of the conversation and for writing in with your thoughts.

  • Hi to N/A.

    And that is also why there are courts of appeal, as a means of ensuring justice. We’ll keep everyone posted on how we proceed, and I know you’ll be following along. Thank you for getting involved in the conversation.

  • Marie,

    Thank you so much for your wonderful comment. That is exactly what we are trying to achieve.

    I wish that everyone would read your comment to see what our work means to the people who actually live in those communities and are affected by what we are trying to do and what the implications of the judge’s opinion will be.

    Thanks for your comment and for following the blog!

  • Hi, Hilking.

    Just a few facts to consider.

    We responded to an invitation from Saltzer to affiliate after they made a lengthy consideration of options and determined that an affiliation with St. Luke’s was the best and only way for them to deliver accountable care to the people they serve. This is a fact that can easily be checked with the Saltzer physicians and leadership.

    And it’s worth noting that the judge applauded our “foresight and vision,” and was convinced that if left to stand, our affiliation with Saltzer would have improved care for patients.

    We can certainly have differences of opinion about the judge’s decision, but not about the facts.

  • Hi, Dr. Patterson.

    The antitrust laws are indeed good things, but they are extremely complicated. Most of the information used by economists to determine what the market was and what the market concentrations were was only available through subpoena and was not available to St. Luke’s leaders prior to this transaction, during the investigation, during the trial, or even now.

    It is worth noting that Saint Alphonsus attempted to acquire Saltzer. They have the only hospital in that market, and I don’t believe they thought what they were doing was illegal or violated the antitrust laws.

    So while this outcome may not have been a surprise to you, it was to all of our very well-informed leaders, and it was very surprising to our antitrust experts.

    You are correct. Motives are irrelevant in an antitrust action, and the district court judge has determined that we broke the law. That determination will not be final until this case runs its course.

    It is incorrect to say that we are $65 million in the hole. We are reducing $65 million from our cost structure so that we can make the investments we need to make to ensure the preferred-provider level of care Idaho’s communities have come to expect from St. Luke’s.

    In terms of rethinking things, I assure you we are taking your advice, and giving our response considerable thought and review.

    I think it’s important to note that we did not start this. Suit was filed against us.

    And there is certainly room for more than one ACO in the valley. Competitors have had the same opportunity to become a federally-designated ACO as we have, but have chosen not to do so.

    We believe that the people of Canyon County should also be able to have accountable care, and if the antitrust laws continue to be applied in a rigid fashion and do not evolve with the evolving landscape of health care, then people in small to mid-size communities will not have the same opportunity to have accountable care and risk-based insurance products available to them that are available in large urban and metropolitan areas.

  • Hi, Dr. Cohen.

    Thank you for your question. No, the antitrust case has nothing to do with St. Luke’s finances. It has neither caused nor contributed to our financial circumstances.

    Almost all health systems across the country have experienced pressure in recent months on their financial performance. Many health systems have responded by laying off employees. St. Luke’s instead has responded by trimming our cost structure. I’m not aware of any reductions such as you have referenced in your note, but would be happy to look into information that relates to your particular case if you’d like.

    As for accountability, our leadership team engaged leading antitrust counsel and we carefully reviewed the situation. We presented all of the facts and legal advice to our boards and together, we all decided on our legal course. If you ask me, I would tell you I am accountable; if you asked our boards, I think they would say they are accountable, because we all made the best decision we could based on the information available. No major error in judgment was made.

    I still think we made the right decision. We stood up for our principles and we kept a commitment that we had made to physicians, physicians who had no other choice if we decided to take the easy way out and abandon our relationship.

    We lost this case in district court. It is not over yet, so we don’t know the ultimate outcome. And it is worth keeping in mind that even after 19 days of trial testimony, the judge indicated that while he usually knows how he will rule by that point in the trial, he honestly did not know how he was going to rule in this one.

    At the end of the day, we are accountable to the government if the case is not overturned on appeal, and we will meet all of our responsibilities to the government. My accountability and that of our community boards’ also is to the communities we serve. Idahoans are looking to us to make our communities healthier, healthcare better and safer, and healthcare more affordable. That is what our ultimate accountability is. That is what we are trying to achieve and what we must continue to try to achieve, despite this setback.

  • Hi, Meredith.

    Thank you for sharing your experience. I hear similar stories from others who are grateful for the access to St. Luke’s and our outstanding physicians.

    That was another big advantage to our affiliation with Saltzer. Saltzer physicians testified about how great it was to be able to open up their schedules to see more Medicaid and uninsured patients. They also testified that if the transaction was ordered to be unwound, they believed they would need to limit the number of such patients they could see. I think with time, there would be ripple effects around unwinding this transaction.

  • Hi, Dr. Womack.

    Yes, the judge was very complimentary of our vision and efforts. The judge clearly believed plaintiffs’ claims that all of the objectives of healthcare systems can be achieved without employing physicians and ruled, essentially, that if there is any way to accomplish the objectives without employing physicians, that must be the approach. The U.S. healthcare delivery system, including plaintiffs, have big problems if that is the law, which as of this writing places Idaho at a disadvantage relative to the rest of the country.

    St. Luke’s has taken the position that we need both employed and independent physicians. Interestingly, during the trial Advocate was named as an example of how health systems can provide accountable care without employing physicians, even though Advocate has more than 950 employed physicians!

    We remain committed to our vision and our strategy. It will now take longer to achieve, but we remain steadfast in our determination and efforts.

    We also are working with independent physicians. My opinion is that this decision is bad for independent physicians. I believe independent physicians should have the opportunity to remain independent as long as they wish and can, but based on my own experience as a physician, everything I read, and everything I hear from other physicians and experts, it will be increasingly difficult to remain in independent practice. This decision makes it more difficult for systems to hire independent physicians if they make that decision.

    Thanks for your comment, and thank you for all you do for the patients you serve.

  • Hi Omer!

    Well said! I totally agree.

    Thanks for your comment, and for being a regular participant in our conversation here on the blog!

  • Dr. Pate,

    Certainly this ruling is disappointing. How frustrating to have an initiative set forth by the PPACA with a legal framework that doesn’t support the strategy necessary to transform health care.

    I found Lawrence Wasden’s remarks in response to the ruling very revealing. He valued the protection of competition and business that this ruling ensured. Although important, the transformation of health care requires a discussion more fundamental than the protection of the marketplace. A serious discussion of health care as a fundamental right of our citizens, and the steps required to do so at a reasonable cost to our society, is the level of debate necessary to transform health care.

    Hopefully the appeals prcoess will frame the debate such that the true issues of health care can be discussed. I trust that St. Luke’s resolve will continue to be strong in their efforts to champion the strategies necessary to bring affordable health care to all!

    Brian Sawyer

  • Hi Brian:

    Yes, it is frustrating. Perpetuating fee-for-service competition is not going to be in the best interests of the citizens of Idaho. It hasn’t worked in the past and I don’t know what magical thinking it takes to believe that if St. Luke’s cannot offer the people of Canyon County new care models and insurance products, that somehow competition will fluorish in Nampa.

    The judge did point out that the American healthcare delivery system is broken, but the status quo was protected. Leaders of St. Luke’s came to the realization almost four years ago that the status quo is not doing enough to improve health, is not safe enough, is not high quality enough, and is unaffordable for far too many. Until people come to the realization that the current system is unsustainable, it will be hard to effect change.

    Thanks for your comment, Brian, and thanks for following the blog!

  • Dr. Pate,

    Sorry to be a pest, but in Dr. Peter Cohen’s post, which captures the sentiment of many, he referenced recent reductions in retirement benefits and salary. In your response you stated, “I’m not aware of any reductions such as you have referenced in your note.”

    You might like to know that ALL employess recently had their annual contribution account funding cut significantly. This was a retirement benefit we valued.

    Furthermore, on the hospital side of things, there has been a hiring freeze, lost shift differential pay for nursing, and cuts to CME and training benefits for both doctors and nurses. Among the internal medicine hospitalists, I’ve been told we cannot hire up to the staffing we feel we need, thus stretching our stretched resources. Meanwhile, the outpatient internists have recently received new contracts which, from what I am hearing, have left them feeling pinched. In a nutshell, that’s some of what Dr. Cohen was referencing.

    By the way, the reason for these cutbacks that is cited repeatedly by our leadership is, “We are $65M in the hole.” You corrected me when I quoted that, telling me we are not “in the hole,” but instead are “reducing $65M from our cost structure.” I’m not sure I feel the difference. What I can feel is a groundswell of discontent among the hospital staff.


  • I was very disappointed in this ruling. One of my reasons for only applying at St. Luke’s when we had to relocate to Boise was because I felt like, finally, a healthcare organization that gets it!

    With that said, I hope that we pursue any and all avenues to appeal or restructure as we need to so that we can continue with our mission to care for our community in its entirety, not just those needing an acute-care facility.

    Never lose faith when you are fighting and advocating for what’s best for our patients!

  • The comment posted on 1/24/2014 by Rich Raimondi reflected his own personal opinion and is not the position of Bishop Kelly High School, the Catholic Schools Department, the Roman Catholic Diocese of Boise, their staffs, or Bishop Michael P. Driscoll.

    Michael Brown
    Communications Director
    Roman Catholic Diocese of Boise

  • Hi, Kim.

    Thanks so much for your support and encouragement! We are pursuing our options, and I can promise you this. We will succeed at our mission and vision. We are focused on our patients and helping them be as healthy as can be, get the best possible care when needed, and reduce their healthcare costs.

    Thanks so much for your comment and for following the blog!

  • Hi, Sue.

    Health care is going through tremendous change, and many nurses and doctors long for the way things used to be and regret the changes that we are going through. I definitely get that. But I also know that we have to deal with the realities Health care is too expensive, and unless we providers fix it, the government will. I am sure we all would fear that more.

    The financial challenges we are facing are not unique to St. Luke’s and not due to the litigation expenses. We, like other hospitals and health systems across the country, were experiencing pressure on our margins prior to incurring litigation expense, and most of those costs have been covered by insurance.

    I don’t expect the financial pressures to let up, even with the court challenge behind us. We have experienced government cuts that look like they will be extended for another two years under the budget discussions. And people are moving to high-deductible plans, which is likely to discourage their use of healthcare services and make it harder for them to pay for the services they do use.

    All of this would be depressing if it were not for the huge opportunity before us. This is our chance to step up and find new and better ways to make our care even safer, make our quality even better, make our patient experience even better, coordinate care better, manage transitions of care better, and at the same time lower the costs of health care.

    We are on our way, and once we see the difference we have made, I don’t think any of us will want to go back to the old days!

    Thanks for being a part of the improvements we are trying to make and for all you do for St. Luke’s and our patients. St. Luke’s nurses are the best!

  • Hi, Dr. Patterson.

    You are not a pest. Dialogue is important in any time of change.

    You are absolutely right that we did reduce the annual contribution funding this year due to our financial circumstances. But let’s be clear. First of all, that is only one of the retirement accounts. We did not touch the 403(b) match plan. The account you are referring to is in essence a profit-sharing plan. That funding is always discetionary and based on the financial performance of the organization. Employees have come to rely on it because we have always hit our plan. Last year, we did not. There are implications for everyone when we don’t perform as well as an organization. We all need to own the performance of the organization.

    This also was not a salary reduction. Our goal was to find ways to reduce expenses without laying off employees or reducing salaries. The annual contribution is an add-on at the end of the year to people’s retirement contributions, and yes, it was reduced for everyone over what it would have been had we made our budget, but no one experienced a salary reduction or money taken out of their retirement account.

    I understand the frustration. We are between a rock and a hard place, and we are all frustrated. However, we felt that if we had to reduce costs through layoffs and actual salary reductions, the discontent would be even greater. Something had to be done or we would face layoffs, and impact people’s lives in much worse ways than any physician has been impacted. We solicited ideas and help from employees, leaders, and physicians.

    We are still asking for physicians and employees to help us solve these problems. As an example, we believe we can save tens of millions of dollars if physicians come together to help us reduce supply costs. Surely it’s sensible and sound to eliminate some choice when it comes to certain high-cost supplies.

    I know many St. Luke’s physicians are beginning to ask themselves the thoughtful questions about whether a patient needs to be left in the hospital any longer, whether tests are of low value and not likely to impact the patient’s outcome, whether it’s the right thing to do to prescribe more expensive medications when there are less costly alternatives. We will not be successful in the long run unless everyone contributes to the solutions.

    Thanks for your comment, Dr. Patterson. I understand your frustration. This is a difficult time and a time of significant change, and I think that the frustration often is shared by our patients. Many struggle with unemployment, inabiliy to pay their bills, inability to afford health insurance, and challenges in meeting basic needs. I think it is very difficult to face what many do on a daily basis.

    Thanks for all you do for St. Luke’s and our patients.

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