Persistence may pay off for Bo Watson on insuror/provider contract bill

March 11--NASHVILLE -- About this time last year, state Sen. Bo Watson's bill making insurers let health providers know up front about contract changes was poised for passage in the Tennessee General Assembly.

At the last minute, though, it died, for the third straight year.

Cause of death? Fierce opposition from insurers.

But hope springs eternal, and when combined with persistence it sometimes pays off.

Watson's Provider Stability Act is scheduled for final Senate floor consideration Monday. It's widely expected to pass there and later in the House, where Health Committee Chairman Cameron Sexton, R-Crossville, is sponsoring the companion bill.

Watson said the bill is intended to address long-standing gripes among physicians and other providers about abrupt changes by insurance companies regarding fee and payment schedules for treating patients.

Doctors are especially aggrieved because their operations are smaller than hospitals and other provider groups. Last year, physician groups' office managers testified to their frustration, saying it was difficult for them to keep up with the changes.

But insurers like Chattanooga- based BlueCross BlueShield of Tennessee and Cigna, which has a large Chattanooga presence, said multiyear contracts with providers require them to adapt quickly to changes such as new and improved treatments.

They argued changes are far from arbitrary and ultimately benefit their customers because they help keep costs low.

Watson, who could not be reached Friday, earlier credited insurers' willingness to work on the issue for the bill.

Changes won't apply to various state and federal government health care programs.

The prospect of passage at last makes doctors happy.

"The Healthcare Provider Stability Act will level the playing field between providers and insurers," said Dave Chaney, a vice president with the Tennessee Medical Association, whose members are physicians.

Chaney said limiting fee schedule changes to once a year and requiring more transparency from payers will give doctors and other health care providers more financial predictability and stability in their businesses.

"In every other industry, a contract is a contract. It should be the same in health care," Chaney said.

Mary Danielson, a BlueCross BlueShield spokeswoman, said the company appreciates Watson's efforts "to find a mutual compromise that addresses our ongoing efforts to support the health care cost and quality needs of our members."

Speaking before the Senate Commerce and Labor Committee last week, Watson said that when insurers make changes now, providers have only 30 days to respond.

"Either they accepted it or moved on and could be moved out of the [insurers'] network. This remedies that problem," he said.

The bill says insurers must give at least 60 days' notice before making any material change in their provider manuals for a reimbursement rule or policy.

A 90-day notice is required in changes to fee schedules, which list reimbursement amounts for specific therapies, procedures and other services.

"That's an important detail, particularly for the providers, and I want to thank the insurance industry for working with me on that," Watson later told the Senate Commerce and Labor Committee.

Another provision requires the insurer, upon written request, to send the fee schedule list to the provider's email free of charge within 10 business days. Watson called it a "big ask" of the insurance industry.

The proposed law would take effect Jan. 1, 2019.

Contact Andy Sher at [email protected] or 616-255-0550. Follow on Twitter @AndySher1.

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