ER coverage causing problems

Monroe County employees, as well as others with Blue Cross Blue Shield of Florida health insurance, could be in for a rude awakening the next time they visit a Baptist Health South Florida emergency room at either of Fishermen's Community or Mariners hospitals in the Florida Keys.

The two Baptist hospitals have a new physician group operating their emergency rooms and services, which will affect Monroe County employee health plan participants, according to a recent Monroe County government memo to its employees.

Baptist Health has outsourced the physician group that serves the two hospitals' emergency rooms to a third party, and that group does not accept Blue Cross Blue Shield, County Employee Benefits Administrator Natalie Maddox stated in the Sept. 22 memo.

Blue Cross Blue Shield is the primary health insurance provider for the county government and many county residents.

This change does not apply to Blue Cross Blue Shield's coverage of the emergency room visit itself. It only applies to doctors who treat patients within the emergency room.

The memo also stated that the new physician group is working on establishing a contract with Blue Cross Blue Shield but that the process of doing so could be lengthy.

"Florida Blue has reached out to them to attempt to bring them in network," county spokeswoman Kristen Livengood said.

Also, the memo advised county employees to consider using a primary care physician as an alternative to an emergency room visit if they have a non-life-threatening emergency.

In the interim, Blue Cross Blue Shield policy holders throughout the county are urged to clarify their own coverages before treatment, which could be an afterthought for some patients and family members who are dealing with health-related circumstances associated with an ER visit.

With health insurance options already somewhat limited in the Keys, this change could add out-of-pocket expense to the county employee and resident populations who receive out-of-network care.

Outsourcing of services or general cost cutting is nothing new for the healthcare industry, even before the coronavirus pandemic. For example, many healthcare providers offer telemedicine options, both in the interest of cutting costs as well as maintaining distancing.

According to Leonard L. Berry, senior fellow at the Institute for Healthcare Improvement at Texas A&M University, hospitals have long embraced the practice of outsourcing services to specialized companies for nonclinical tasks such as laundry, information technology and cybersecurity. Outsourcing those types of services can boost a hospital's efficiency and bottom line.

However, over the past few years there has been an upward trend of hospitals outsourcing clinically relevant services - like anesthesiology and emergency medicine - to companies separate from the hospital. When that happens, hospitals relinquish some of the control they have over quality of care. Berry's research focused on four clinically relevant services - emergency care, radiology, laboratory services and environmental services - and found "tangible harm to patients and hospitals" when those were outsourced.

Comments on social media about the local ER change ranged from anger to resigned acceptance. Some, like Jonathan Murphy of Marathon, expressed a disconnect between this emerging drop off in coverage and tax dollars Middle Keys residents have contributed as part of the property taxing district created to help rebuild Fishermen's after Hurricane Irma severely damaged the previous structure in 2017.

Efforts to reach Baptist Health for comment went unanswered before press time.