Provider Perspective

March 13, 2024

Interview with Dr. Nick Kashey

Clinical VP, Population Health and primary care provider

Merrin Permut As a provider and health care advocate in this community, what are your concerns about the ongoing negotiations between Legacy Health and Regence?

I worry about access for patients. If Regence decides to drop Legacy from its network, there are so many patients that will have to find new primary care providers, and even without this change, it can take many months for a patient to get an appointment with a new primary care provider. I work in a rural community, and patients have very few options already. Limiting these even further would be untenable. 
It’s not just primary care access – patients are having a hard time getting specialist visits as well as procedures scheduled, and with fewer options, Regence patients will have to wait even longer.  Legacy is a high-quality provider organization, and keeping patients from accessing those services would be a huge loss for the patients. 

If an agreement is not reached, how will this affect Legacy patients who are Regence members? How will it impact you as a provider?

Patients will be stuck in a tough position of having to choose between changing providers (and there may not be other options within a reasonable timeframe) or paying higher out-of-pocket costs to continue with their existing provider.  That financial burden could be disastrous for patients.  Medical debt is one of the leading causes of personal bankruptcy. 

As a provider, I’m terrified that a patient would wind up making financial decisions that increase the burden on them out of loyalty or lack of options.  If a patient makes the choice to continue care with me at out-of-network cost, that will take away resources from the patient that should be used in better ways.  That weighs on my conscience.  As much as I want to keep my relationship with my patients, I don’t want to be the cause of their financial strain. 

 What are you telling patients who have questions about this situation? 

I tell them the truth – that Legacy’s costs of maintaining the excellent care we deliver have gone up, mostly to provide our 14,000 workers who live in Oregon and Washington an appropriate wage, and that we can’t sustain delivering care on the rates that Regence is offering us.  None of us want to see healthcare costs increase, yet we must remain fiscally solvent to be here to provide the care that we do. 

How are contract disputes like this impacting health care throughout this country? 

Our country has yet to codify access to healthcare as a human right, and the health of our patients and our health systems is suffering because of it.  We need to make fundamental changes to the way healthcare is paid for that promotes true well-being and protects patients from these kinds of situations. 
This is unfortunately not a unique situation – healthcare providers across the country are facing increased costs as their workforces struggle with inflation, housing costs, and general cost of living. This is a national trend, and similar challenges are felt in many different states. 

If you could tell the head of Regence one thing, what would it be? 

Please recognize that we need to be reimbursed appropriately for the care we deliver for your members, so that we can continue to be a high-quality provider to the patients of Oregon and Washington.  Non-profit health systems are not the primary drivers of growing medical cost, and by undervaluing the work we do it only puts patients at risk. 

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