Carondelet-BlueCross dispute could leave patients in the lurch
The hospital system, which recently went from a nonprofit to a for-profit company, will terminate its contract with the state's largest health insurer unless the two parties can agree on reimbursement rates by the end of the year.
Negotiations to determine how much the private insurer will pay the hospital system for providing care to its members have stalled.
The contract dispute could potentially lead to a "crisis in access to care," said
"BlueCross continues to undervalue the care we provide to its members," Benz said. "Their refusal to negotiate fair and sustainable payments is hurting our network and jeopardizing its members' health choices."
Carondelet executives say BlueCross pays the Catholic hospital chain less than other private insurers pay, and they also claim BlueCross pays Carondelet less than it pays other
BLUECROSS RESPONSE
BlueCross senior vice president of strategy, sales and marketing
"Our main goal is to make sure our members have rates that can be affordable and part of that is making sure we're paying hospitals systems like Carondelet appropriately," he said.
The dispute comes as Carondelet announced the layoffs of 100 staff members last week and continues to operate in the red. Carondelet facilities have experienced net losses of more than
Stelnik of BlueCross said the hospital is seeking to balance its budget by aggressively pursuing higher payments.
"I think the quick-fix idea on their end is to increase reimbursement, despite the fact that they're already being competitively paid," he said.
Dr.
"There's no amount of cost-cutting or efficiency that we can put in place to fully address financial challenges, unless our payers actually do their part in paying us fairly for the care we provide," she said. "The time is absolutely now for BlueCross BlueShield to come to the table and negotiate with us."
Beiter said the contract dispute is a long-simmering "local issue" unrelated to Tenet's recent acquisition of the heath system.
'GAME OF CHICKEN'
Conflicts like this between insurers and health care providers often involve hard-line "posturing" but typically, the insurer and hospital will reach an agreement at the last minute, said
"It's a game of chicken sometimes," he said. "Neither party wants to lose the other party. For Carondelet, it's important because they'll lose (patient) volume if they don't sign a contract. For BlueCross, it's important because now they won't have as attractive a network" without Carondelet.
Negotiations between hospitals and insurers take place under a veil of secrecy, since insurers don't reveal what they pay to other hospitals, and hospitals can't share those figures with one another. But each side is vying for leverage in the negotiation, as the resulting multi-year payment agreement has long-lasting consequences, said
Taking the behind-the-scenes fight to the media is one way to pressure the other party to cave in, he said.
"You get into this PR battle," he said.
In negotiating payment rates with commercial insurers, hospitals strive to recoup some of their losses from treating uninsured patients and those covered by government payers
Hospitals don't have to go to the negotiating table completely blind. Like Carondelet, TMC has commissioned third-party analyses to see how its reimbursements compare to its competitors', Bush said. Those reports compare aggregate reimbursement levels, as opposed to payments to particular providers. And they can't account for the differences in the level of services hospitals provide. For instance,
While hospitals can't share reimbursement rates with one another, Carondelet's new parent company Tenet runs health care facilities in
PATIENT IMPACT
Aggressive negotiating tactics can cause upheaval for patients caught in the middle. If an 11th-hour agreement doesn't happen, it can take time for another contract to come together. In the meantime, affected patients have to change providers or face higher costs.
This summer,
"Obstetrix physicians have continued to provide fundamental access to care to pregnant women and/or their babies facing complicated health conditions without certainty of reimbursement by UnitedHealthcare," Dr.
UHC's
Some BlueCross plans include an out-of-network benefit option, which would still allow customers to go to Carondelet providers and face higher deductibles and coinsurance. But the insurer's
Patients would be billed as if they were uninsured if they sought care at a Carondelet facility, which would be cost-prohibitive for most people, he said.
"I really don't think it's being expressed quite strongly enough the impact this is going to have on BlueCross individual plans, as well as the
BlueCross spokeswoman
Those clients must decide by Monday, when
"It's so mysterious how they make these arrangements for paying the doctors and hospitals. Who is at fault here? Who is the greedy one?" Early said. "I just feel bad I'm forced to say to people, 'Decide between your health plan and your doctors, and decide now.' "
Contact reporter
@EmilyBregel
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