Hospitals, Nurses and Fighting for What Matters
Next week we celebrate National Hospital Week and National Nurses Week. I consider hospitals, whether ours or others, to be almost sacred places, where healing occurs and sometimes miracles. I’m so proud of our UMMC hospitals and all the hospitals in Mississippi and what they have accomplished during many decades of service.
But you know hospitals are just places. Rooms and beds and ORs. It’s the people – the doctors, the techs, the housekeeping staff, the lab professionals, the therapists, the administrators, the nurses, and so many more – who make them the very special places that they are.
I’ve written before in VC Notes about how important nurses are to me. Back in the days when I was working full time in the Emergency Department, if you wanted to know what was really going on, you asked the nurse. Then, later in my own experience with family illness, I was reminded what I already knew, that nurses are the caring heart of a hospital.
To be honest, I don’t do a good job of keeping up with all the recognition days, weeks and months. So when I am not immediately aware that it’s your week, or I don’t acknowledge it sufficiently, I apologize in advance. What I am constantly aware of, and what matters most to me, is what all these professional groups bring to us, what they give of themselves to our patients every day, and their passion to make the world better.
And this is why I feel it’s so important that we take a firm stand over our contract with Blue Cross & Blue Shield of Mississippi.
The last thing I want to do is engage in a public confrontation with an insurance company. I hate it for our patients, who may be inconvenienced if we go out of network July 1. And I hate it for our physicians and staff, because it’s a huge distraction from the important work that you do.
But we can’t avoid this any longer. Our base contract with BCBSMS was executed 28 years ago, when I was in medical school. Even for those of you who were not born by 1990, you know that UMMC and health care in general were vastly different then. And Blue Cross was different. That was before they converted from a non-profit organization to a for-profit insurance company.
For the most part, our base contract is just a formal legal document that sets down who the parties are and how they will conduct business. But there’s one clause in it that doesn’t reflect modern reasonable business practices, and Blue Cross has refused to negotiate that clause. It’s the clause that says, as a practical matter, whatever else we may agree to in our contractual relationship, including what they will pay us, Blue Cross can change it at any time to suit them. We are free to take it or leave it. And because Blue Cross controls the lion’s share of the insurance market in Mississippi, we’ve had to take it.
A good example happened four years ago. After another “near termination” experience, Blue Cross said they would give us a rate increase. Both parties signed on. And then they used a series of maneuvers to claw back every bit of that increase and then some.
Why did the leaders of UMMC agree to such an onerous, one-sided contract 28 years ago? I have no idea, but I imagine it was because the relationship between the two parties was much different then. UMMC wasn’t the statewide vital resource it is today. And Blue Cross in all likelihood did not have a business strategy that, in our experience, could be summarized as "3-D" - deny, delay, dictate. They deny claims for the flimsiest technical reasons, delay payment, and dictate to us what, when, how and if we will be paid for our services.
That’s why the contract as it is currently written must change. Any new negotiations must start on a level playing field. The realities of health care delivery have changed tremendously over the last 28 years. We simply cannot tolerate an unfair contract any longer.
Blue Cross is already saying this is all our fault and that we don’t measure up to their standards of quality and cost. These are not valid arguments.
Even though virtually all experts agree that quality ratings skew against academic medical centers, especially those that are also safety net hospitals, our quality scores have constantly improved since 2015. And because there is a time lag in reporting, our current scores are even better than what has been publicly presented. Current metrics are available on our clinical quality website.
Frankly, Blue Cross’s focus on quality is superficial, based entirely on claims data and not clinical outcomes. Their program is limited in scope and lacks a strong evidence basis. Their definition of “hospital-acquired conditions” is a mystery to providers, and seems arbitrarily set to justify payment denial.
Blue Cross also says our costs are not in line with their expectations. But according to the Association of American Medical Colleges, compared to peer academic medical centers and teaching hospitals, our hospitals are among the most cost-efficient in the nation.
Are our costs higher than those of a hospital in a Mississippi community of 50,000 people? Of course. But that hospital is not operating all of the high complexity services around-the-clock that we are. Yet for many services, we are paid the same as a community hospital.
I saw in the news that Blue Cross issued a statement saying UMMC wants to be treated differently than other network hospitals.
Yes, we do. We are different. Is that not self-evident?
Ask yourself the question, “What is the value UMMC brings to Mississippi?”
Now, think about all the students we teach, not just the thousands on our campus but another 1,500 health professions students from schools in Mississippi and across the U.S. Think about our outreach programs that have introduced thousands of underrepresented elementary, junior high, and high school students in Mississippi to the idea that a career in health care or science is within reach. Think about the research we are doing on conditions that matter in Mississippi – from heart disease to Alzheimer’s to obesity and so much more. Think about all the emergency services we coordinate on a daily basis and lead when disaster strikes. Think about how the sickest people in the state – the neonates, the patients needing organ transplants, the critically injured – turn to us for life-saving care. Think about how much we have meant to the families of all the patients we have treated at Batson Children’s Hospital over the years. Think about the outreach we have provided to the under-resourced communities of the Delta and other rural areas through our school nurse programs and our telehealth network (another service Blue Cross doesn’t want to pay for). If this isn’t enough, think about the economic impact all this activity represents, activity that originates at UMMC and has been estimated at nearly $3 billion annually.
Now, it’s only fair to ask, “What is the value Blue Cross & Blue Shield brings to our state?”
I don’t want to fight with Blue Cross & Blue Shield of Mississippi. I know they have many fine employees. They are an important company in this state. I want us to work arm and arm with them to create a healthier population. They say that’s what they want, too.
But if we must fight, we will. Because hospitals matter, nurses matter, patients matter, students matter and academic medical centers all matter. And you matter, because you are doing the work – the real work – to help us reach A Healthier Mississippi.