Johns Hopkins, CareFirst reach agreement to keep doctors ‘in network’ [Baltimore Sun]

Johns Hopkins Medicine will continue to accept CareFirst BlueCross BlueShield insurance, ending a stalemate that threatened to cut off coverage for thousands of patients from some of the region’s most-sought-after medical providers.

Hopkins and CareFirst, the state’s dominant insurer, said in a statement Wednesday morning that they had reached a multiyear contract that will ensure patients will remain “in network” when they see a Hopkins doctor.

“We are pleased to announce that we have reached an agreement with CareFirst to keep our doctors, nurses and other caregivers in CareFirst’s network,” said Dr. Theodore L. DeWeese, interim dean of the medical faculty and CEO of Johns Hopkins Medicine, in a statement. “Our goal was to reach a resolution before our patients had to make changes to their care or their coverage, and we appreciate CareFirst’s collaboration to make that happen.”

The deal surely will relieve angst as many people are in their open enrollment period for health insurance or soon will be, and faced the decision without knowing whether visits to their doctors would go fully or partially without reimbursement.

The current deal was scheduled to expire in December, and Hopkins officials had alerted CareFirst in September that the system would cut ties. At issue was CareFirst’s rate of reimbursement, which Hopkins officials said was far lower than that of other insurers and not keeping pace with rising costs.

For its part, CareFirst said Hopkins was seeking reimbursements exceeding the rate of inflation. Also, as a statewide provider, its costs exceeded those of major for-profit, out-of-state insurers that were choosier about the scope of service they provide in Maryland.

The terms of the new deal were not disclosed.

“Together, CareFirst and Johns Hopkins Medicine are poised to continue providing high-quality health care and maintain our focus on the people who matter most: members and patients,” said Brian D. Pieninck, president and CEO of CareFirst, in a statement. “The impact of our partnership remains tied to advancing health outcomes in the community, and this new agreement provides the structure necessary to organize our efforts and deliver on that shared goal.”

The insurance coverage at issue applied only to medical providers in the Hopkins system, not the hospitals themselves, including Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center in Baltimore and Howard County General Hospital in Columbia. Under an agreement with the federal government, the hospitals do not negotiate rates. Each insurer pays the same rate at each hospital in the state.

Associated labs performed in hospitals and facility fees also likely would remain covered. Care from doctors in the emergency room would have remained covered under the rules in Maryland.

The new deal’s scope largely affects providers that bill patients separately, whether they see patients in the hospital or in a community physicians’ office or outpatient surgery center. Costs of some labs and other services performed outside the hospitals could have been affected.

When it looked as though a deal wasn’t going to be reached, Hopkins sent letters and emails to about 350,000 regular and recent patients last month alerting them to the possible change, though it could have affected anyone with CareFirst insurance.

Hopkins officials said they understood the burden it could place on patients, but called the arrangement unsustainable because the cost of providing health care rose 21% over the past decade but the CareFirst rate increase was only 10%.

That brought criticism of both sides from some patients, who wrote letters to The Baltimore Sun, about the nonprofit hospital system and the insurer.

One defended the Hopkins medical system as deserving of suitable compensation after seeing a personal bill for specialty services reimbursed by CareFirst at one-third the billed rate.

“Such payments are insulting to the doctors and dangerous for the thousands of patients who stand to lose access to them,” the letter said. “Hopkins doctors provide some of the most highly specialized care in the area, and in some cases may be the only option. CareFirst’s lukewarm suggestion that it could help members find other providers ignores both this fact and the sheer number of patients involved.”

But Susan A. Taylor, a Greenbelt psychotherapist, said she never doubted there would be an agreement between her insurer and the medical system, where she sees doctors. She “was really disgusted by this ploy that placed vulnerable patients in between what is clearly enormously profit-driven corporations.”

She said medical providers ought to be thinking of the long-term doctor-patient relationships they jeopardized, particularly those who are really sick.

“CareFirst isn’t blameless,” she said. “But the Hopkins corporation reached out to all of its patients, and what they wanted was clearly to upset people so they would put pressure on CareFirst. All they did was rile up a lot of people who may be very ill and completely dependent on this.”

Anna Palmisano, director of Marylanders for Patient Rights, said she felt the public negotiation held patients “hostage” and that Hopkins claiming “patients are our top priority” was disingenuous.

“While I don’t know the details of the recent agreement, I recommend that in the future these issues be resolved without threatening patients with loss of care by their Johns Hopkins doctors,” said Palmisano, who also is a CareFirst beneficiary.

Both Hopkins and CareFirst officials had said they had hoped to reach a deal ahead of the Dec. 5 contract expiration. Hopkins officials had said they alerted CareFirst by law of the potential to end the contract, and they alerted patients who would need to plan in the event an agreement wasn’t reached.

The prospect of such a major split didn’t just draw attention from patients, it led to pleas from Gov. Larry Hogan and members of the state’s congressional delegation to get to the negotiating table before open enrollment ended for many. The sign-up period for those buying coverage on the state’s health exchange is set to begin Tuesday.

After the announcement of a deal, U.S. Sens. Chris Van Hollen and Ben Cardin of Maryland, both Democrats, and the state’s seven Democratic congressmen released a statement welcoming the contract.

“Marylanders can now breathe a sigh of relief knowing that they won’t experience disruptions to their health care coverage during this year’s open enrollment period,” the lawmakers wrote. “We’re glad to see Hopkins and CareFirst heed our calls to reach an agreement and urge the strengthening of their partnership to promote access to high-quality, affordable health care to Marylanders.”

Collectively, Johns Hopkins Medicine has more than 2.4 million patients and 280,000 emergency room visits a year, according to its website.

CareFirst reports that it has 3.5 million members in the mid-Atlantic region and access to 1.7 million providers.

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