Here are 10 hospitals and health systems that recently butted heads with payors over contract negotiations and reimbursement rates.
1. Albany Medical Center and Aetna. Aetna Insurance announced it will drop Albany (N.Y.) Medical Center from its network, affecting 24,000 Aetna customers in the Albany area, according to a CBS report. The decision will go into effect Feb. 5, 2011. According to Aetna, the hospital asked for a 100 percent increase to physician rates and the hospital proposed rates that were more than double the average cost of care of other hospitals in the region. Aetna patients account for about 5,400 annual visits to Albany Med, around 1 percent of the hospital's volume. The insurance company will continue to treat Albany Med as an in-network hospital in case of emergencies.
2. Texas Health Resources and Blue Cross and Blue Shield of Texas. Blue Cross and Blue Shield Texas is in discussions with THS about cost increases over the next three years. The hospital change wants an increase during a period when it expects to provide more than $3 billion in care for Blue Cross patients. The insurer says the desired increases are too high. Texas Health Resources told Dallas News that the health system is only asking for a "modest single-digit increase." Blue Cross is the state of Texas' biggest private insurer, and Dallas and Houston are the insurer's biggest spending metro areas.
3. East Jefferson General Hospital and Blue Cross Blue Shield of Louisiana. East Jefferson General Hospital in Metairie, La., and BSBS of Louisiana recently ended a months-long standoff, spurred by a request from CEO Mark Peters, MD, for an 18 percent reimbursement rate increase for services delivered to Blue Cross policy holders, according to a Times-Picayune report. He argued he was trying to position the hospital alongside its top market competitor, Ochsner Health System. The two parties signed a new, three-year contract on Nov. 22. The agreement affects as many as 140 physicians with admitting privileges at East Jefferson and up to 20,000 Blue Cross policy holders in the area. The details of the contract were not disclosed.
4. George Washington University Hospital and Kaiser Permanente. Beginning in Jan. 2011, George Washington University Hospital in Washington, D.C., will no longer accept Kaiser health insurance. The hospital's announcement follows a similar move by its affiliated physician group, the GW Medical Faculty Associates, which is responsible for around 90 percent of hospital admissions. According to a Washington Business Journal report, the dispute stemmed from what the hospital determined to be inadequate rates, as well as Kaiser's business model. Under Kaiser, insured patients must seek out care from Kaiser's in-house network of clinics and physicians. Patients are only sent outside the closed network when they need hospital admission or specialist care, a model the hospital found frustrating as it tried to shed its traditionally compartmentalized structure.
5. St. Rose Dominican Hospitals and Health Services Coalition. Nearly 30 percent of Las Vegas' workers could be forced out of the St. Rose Dominican Hospitals system in Las Vegas if the system cannot reach an agreement with Health Services Coalition, according to a Las Vegas Sun report. Health Services is threatening to end its contract with St. Rose because it maintains the system charges too much for treatment. While the payor is fighting with other local hospitals over contract negotiations as well, St. Rose is currently the only hospital group it has threatened to drop. The hospital system says Health Services reimbursement rates are well below the cost of care and are not financially feasible, especially in the face of inflation.
6. Exeter Hospital and Anthem Blue Cross/Blue Shield. Anthem declared an impasse on Monday, Dec. 13 over its contract negotiations with Exeter (N.H.) Hospital, informing its customers it will terminate the hospital's contract on Dec. 31, according to a Sea Coast Online report. Exeter Hospital is still hopeful that an agreement can be reached, citing the 22,000 patients that would be impacted if the Anthem contract was ended. The hospital recently offered Anthem a one-year agreement that officials were hoping would act as a short-term solution while negotiations continued. Anthem declined the offer, saying they are seeking a multi-year agreement that would require Exeter to drop its rates gradually over a number of years. Exeter's one-year solution called for an increase in rates.
7. Boone Hospital Center and Anthem Blue Cross/Blue Shield. Anthem Blue Cross/Blue Shield and Boone Hospital Center in Columbia, Mo., have traditionally signed a contract every three years, according to a Columbia Daily Tribune report. This year the two parties collided over reimbursement rates, eventually reaching an agreement on Dec. 15. The hospital wanted more money for the procedures it provides, while Anthem did not want to pay the hospital more. Hospital officials declined to provide details of the new agreement but said policy holders should not see any changes. Anthem sent out a message to policy-holders in early December, notifying them of the issue and warning them that no agreement could result in higher rates.
8. Kent Hospitals and UnitedHealthcare of New England. Patients from Kent Hospitals in Warwick, R.I., recently received letters warning that the hospital may drop out of the UnitedHealthcare network because of a contract dispute, according to a WBRU report. Talks between the two parties continue, but the contract expires on Dec. 31. Top executives of the hospital and the insurer said in early December they fully expect to resolve the conflict, which arose over a disagreement of how much the insurer should pay for Kent Hospitals' procedures.
9. NorthBay Healthcare and Anthem Blue Cross. NorthBay Healthcare in Fairfield, Calif., and the insurer butted heads over contract prices in December, a disagreement that would have potentially affected northern Solano County residents who would have to travel elsewhere for medical treatment if the contract was terminated, according to a Contra Costa Times report. In November, NorthBay CEO Gary Passama sent a letter to 5,000 Blue Cross patients, informing them they could lose Blue Cross coverage at NorthBay Medical Center in Fairfield or VacaValley Hospital in Vacaville if the two sides cannot agree on a contract by Dec. 31. The issue was apparently related to reimbursement rates. The two parties agreed on a new contract for hospital services on Dec. 8.
10. MedCentral Health System and Anthem Blue Cross of Cincinnati. MedCentral Health System in Ohio approved a contract with Anthem Blue Cross in early September, following a July formal letter of intent to cancel its contract with the health insurance company, according to Mansfield News Journal. The letter stated the contract would be canceled effective Jan. 1, 2011, after Anthem offered no increase in cost reimbursements during negotiations for the coming year. MedCentral officials said the hospital was in a financial squeeze between rising costs and lower reimbursements from the federal government and insurance companies.
Read more on payor-hospital relationships:
-10 Key Requirements Health Insurers Want CMS to Put on ACOs
-Health Insurers Respond to Rising Costs With Higher Premiums
-7 Best Practices for Co-Pay Collection
1. Albany Medical Center and Aetna. Aetna Insurance announced it will drop Albany (N.Y.) Medical Center from its network, affecting 24,000 Aetna customers in the Albany area, according to a CBS report. The decision will go into effect Feb. 5, 2011. According to Aetna, the hospital asked for a 100 percent increase to physician rates and the hospital proposed rates that were more than double the average cost of care of other hospitals in the region. Aetna patients account for about 5,400 annual visits to Albany Med, around 1 percent of the hospital's volume. The insurance company will continue to treat Albany Med as an in-network hospital in case of emergencies.
2. Texas Health Resources and Blue Cross and Blue Shield of Texas. Blue Cross and Blue Shield Texas is in discussions with THS about cost increases over the next three years. The hospital change wants an increase during a period when it expects to provide more than $3 billion in care for Blue Cross patients. The insurer says the desired increases are too high. Texas Health Resources told Dallas News that the health system is only asking for a "modest single-digit increase." Blue Cross is the state of Texas' biggest private insurer, and Dallas and Houston are the insurer's biggest spending metro areas.
3. East Jefferson General Hospital and Blue Cross Blue Shield of Louisiana. East Jefferson General Hospital in Metairie, La., and BSBS of Louisiana recently ended a months-long standoff, spurred by a request from CEO Mark Peters, MD, for an 18 percent reimbursement rate increase for services delivered to Blue Cross policy holders, according to a Times-Picayune report. He argued he was trying to position the hospital alongside its top market competitor, Ochsner Health System. The two parties signed a new, three-year contract on Nov. 22. The agreement affects as many as 140 physicians with admitting privileges at East Jefferson and up to 20,000 Blue Cross policy holders in the area. The details of the contract were not disclosed.
4. George Washington University Hospital and Kaiser Permanente. Beginning in Jan. 2011, George Washington University Hospital in Washington, D.C., will no longer accept Kaiser health insurance. The hospital's announcement follows a similar move by its affiliated physician group, the GW Medical Faculty Associates, which is responsible for around 90 percent of hospital admissions. According to a Washington Business Journal report, the dispute stemmed from what the hospital determined to be inadequate rates, as well as Kaiser's business model. Under Kaiser, insured patients must seek out care from Kaiser's in-house network of clinics and physicians. Patients are only sent outside the closed network when they need hospital admission or specialist care, a model the hospital found frustrating as it tried to shed its traditionally compartmentalized structure.
5. St. Rose Dominican Hospitals and Health Services Coalition. Nearly 30 percent of Las Vegas' workers could be forced out of the St. Rose Dominican Hospitals system in Las Vegas if the system cannot reach an agreement with Health Services Coalition, according to a Las Vegas Sun report. Health Services is threatening to end its contract with St. Rose because it maintains the system charges too much for treatment. While the payor is fighting with other local hospitals over contract negotiations as well, St. Rose is currently the only hospital group it has threatened to drop. The hospital system says Health Services reimbursement rates are well below the cost of care and are not financially feasible, especially in the face of inflation.
6. Exeter Hospital and Anthem Blue Cross/Blue Shield. Anthem declared an impasse on Monday, Dec. 13 over its contract negotiations with Exeter (N.H.) Hospital, informing its customers it will terminate the hospital's contract on Dec. 31, according to a Sea Coast Online report. Exeter Hospital is still hopeful that an agreement can be reached, citing the 22,000 patients that would be impacted if the Anthem contract was ended. The hospital recently offered Anthem a one-year agreement that officials were hoping would act as a short-term solution while negotiations continued. Anthem declined the offer, saying they are seeking a multi-year agreement that would require Exeter to drop its rates gradually over a number of years. Exeter's one-year solution called for an increase in rates.
7. Boone Hospital Center and Anthem Blue Cross/Blue Shield. Anthem Blue Cross/Blue Shield and Boone Hospital Center in Columbia, Mo., have traditionally signed a contract every three years, according to a Columbia Daily Tribune report. This year the two parties collided over reimbursement rates, eventually reaching an agreement on Dec. 15. The hospital wanted more money for the procedures it provides, while Anthem did not want to pay the hospital more. Hospital officials declined to provide details of the new agreement but said policy holders should not see any changes. Anthem sent out a message to policy-holders in early December, notifying them of the issue and warning them that no agreement could result in higher rates.
8. Kent Hospitals and UnitedHealthcare of New England. Patients from Kent Hospitals in Warwick, R.I., recently received letters warning that the hospital may drop out of the UnitedHealthcare network because of a contract dispute, according to a WBRU report. Talks between the two parties continue, but the contract expires on Dec. 31. Top executives of the hospital and the insurer said in early December they fully expect to resolve the conflict, which arose over a disagreement of how much the insurer should pay for Kent Hospitals' procedures.
9. NorthBay Healthcare and Anthem Blue Cross. NorthBay Healthcare in Fairfield, Calif., and the insurer butted heads over contract prices in December, a disagreement that would have potentially affected northern Solano County residents who would have to travel elsewhere for medical treatment if the contract was terminated, according to a Contra Costa Times report. In November, NorthBay CEO Gary Passama sent a letter to 5,000 Blue Cross patients, informing them they could lose Blue Cross coverage at NorthBay Medical Center in Fairfield or VacaValley Hospital in Vacaville if the two sides cannot agree on a contract by Dec. 31. The issue was apparently related to reimbursement rates. The two parties agreed on a new contract for hospital services on Dec. 8.
10. MedCentral Health System and Anthem Blue Cross of Cincinnati. MedCentral Health System in Ohio approved a contract with Anthem Blue Cross in early September, following a July formal letter of intent to cancel its contract with the health insurance company, according to Mansfield News Journal. The letter stated the contract would be canceled effective Jan. 1, 2011, after Anthem offered no increase in cost reimbursements during negotiations for the coming year. MedCentral officials said the hospital was in a financial squeeze between rising costs and lower reimbursements from the federal government and insurance companies.
Read more on payor-hospital relationships:
-10 Key Requirements Health Insurers Want CMS to Put on ACOs
-Health Insurers Respond to Rising Costs With Higher Premiums
-7 Best Practices for Co-Pay Collection