ST. FRANCIS, BCBS SPLITTING ; HOSPITAL SAYS IT NEEDS HIGHER REIMBURSEMENTS IN NEW CONTRACT [Topeka Capital Journal (KS)]

Topeka'sSt. Francis Health Center and its affiliated facilities and physicians will no longer be part of the Blue Cross and Blue Shield of Kansas network effective Jan. 1, Blue Cross announced Tuesday on its website.

St. Francis officials have sent a cancellation letter to Blue Cross, said Mary Beth Chambers, manager of corporate communications for Blue Cross. St. Francis and Blue Cross have worked together for many years, she said.

The development includes bringing an end to Blue Cross contracts with Leavenworth'sSt. John Hospital and professional providers associated with St. Francis Clinics and Associates in Family, Blue Cross said.

"We feel we offered St. Francis a contract that is both fair to them and, more important, appropriate for our members," Chambers said. "Our members trust us to keep their health insurance premiums as low as possible. To do this, we sometimes have to draw a line with our providers when they demand higher reimbursements than what we think is appropriate. This is our responsibility to our policyholders and our members."

St. Francis and Blue Cross had been working to try to extend their agreement, which ends Dec. 31.

"Over the last several months, St. Francis Health Center representatives have been negotiating in good faith with Blue Cross and Blue Shield of Kansas to secure a new contract that covers care provided to Blue Cross members," Debbie Welle-Powell, vice president for managed care at St. Francis, said in a statement. "Fair payments from insurance companies like Blue Cross are critical to our ability to continue providing high-quality care to this community. The rates that Blue Cross is negotiating could have a significant impact on our ability to continue providing patients with high-value care. We just can't allow this."

Chambers responded, "We expect all of our contracting partners to provide our members with high-quality care, and that is why we do include a quality incentive program in our contracts based on the metrics we think are important to weigh."

She also said Blue Cross doesn't "characterize our conversations with contracting providers as negotiations. It is up to the provider to decide if they want to accept the contract or not."

Welle-Powell said Blue Cross is justifying its "proposed low payment rates by regrouping St. Francis with other health care facilities that are outside our service area and that provide fewer services."

"By putting us in a tier lower than our quality indicates, Blue Cross is not acknowledging our value and consistency in delivering integrated care, advanced technologies, and services that increase quality outcomes for patients and reduce costs," Welle-Powell said.

Beginning Wednesday, Blue Cross will begin sending out a "significant number" of letters to its members and employee groups in northeast Kansas about the announcement, Chambers said.

"We would very much like to have them," she said about St. Francis. "They are an important provider. But it was their business decision to not accept our contract."

Chambers said Plan 65 Medicare supplement insurance holders won't be affected as long as they go to a Medicare contracting provider. However, Plan 65 Select holders will be affected because members are required to use a Plan 65 Select hospital for preplanned admissions.

"We will do everything we can to work with Blue Cross, and we still have time to reach an agreement," Welle-Powell said. "In order to guarantee our patients have in-network access to our facilities and physicians in 2013 and beyond, we are encouraging patients to consider other insurance options."

Chambers said: "It's their decision. We have their cancellation letter on file. We want them to reconsider their decision to cancel the contract."

Information posted on the Blue Cross website regarding the situation can be found at http://www.bcbsks.com/promo/stfrancis- stjohn/index.htm.

Information posted on the St. Francis website regarding the situation can be found at http://www.stfrancistopeka.org/ bluecrossinformation.