Tuesday, November 15, 2011

Blinked last time, but hammering this time

CommonHealth reports that contract renewal talks between Tufts Medical Center and Blue Cross Blue Shield of Massachusetts have broken down.  This "could leave at least 88,000 patients in search of a new primary care doctor, reports WBUR’s Martha Bebinger. Blue Cross is alerting employers (whose employees have Blue Cross health plans) in letters today that they may no longer be able to go to Tufts."

This contract negotiation tactic by BCBS with the relatively small Tufts system practically demands a contrast with the give-away the company agreed to with the region's dominant provider group just a few weeks ago.  What a warm set of press releases were issued back then, as both sides presented their deal as reducing health care costs, when it actually augmented the excessive differential in rates that had been awarded to that provider group for years.

This time, the press releases are a lot less friendly, and the parties seem far apart.  Maybe the explanation is that there was just no money left after that other contract was signed.


Dave W. said...

After watching the strong-arming and disproportionate "negotiating" that BC of MA has done with providers over many years combined with misteps such as the Golden Parachute they provided Mr. Killingsworth, I for one am happy to see Tufts throw down the gauntlet instead of raising the white flag. I'm a BCBS (out of State) member who lives here in the Metrowest area and I applaud what Tufts is doing.

Anonymous said...

Ellen Zane succeeded with this tactic a few years ago, I don't think BCBS will back down this time around if for no other reason than to not show weakness. This is quite a few patients for Tufts to loose especially with Cerberus courting people right and left.

Barry Carol said...

While I obviously don’t know the details of the Tufts – BCBSMA negotiation, I would like to offer a couple of thoughts. I was at a healthcare conference for investors over the last two days and heard presentations by three for profit hospitals companies located mainly in the southern and western regions. All three told us they expect rate increases from commercial payers to average 5%-7% per year over the next several years while their costs per adjusted admission are probably rising at about 3% and Medicare and Medicaid rates are increasing less than that amount and, in some states, Medicaid rates are declining. The cost shifting continues.

If I were an insurer, I think I would be willing to support disclosure of actual contract reimbursement rates. I would tell the providers that are paid less that some are paid more for because of their market power bur we’ve placed them in the non-preferred tier and we’re doing everything we can to steer patients away from them, especially for the routine care and services that everyone can do competently. Reasonable rates and good quality will be rewarded with more patients. Expensive providers will lose patients over time.