BCBSMS status: What does it mean for you?

Good morning.

Tomorrow is the final day of this fiscal year, and as I look back on the last 12 months, I’m amazed at all that has transpired.  It would take more than the space in this column to go through it all, because it is such an expansive list.  And, importantly, it looks like we will finish the year with a strong financial picture.  That’s good, considering the revenue cuts we experienced the previous fiscal year and the tough actions we had to take in response. 

Two of the biggest news items of this fiscal year are actually happening in its final week. 

One was announced Tuesday when Oktibbeha County Hospital Regional Medical Center in Starkville revealed UMMC as its choice as an affiliate partner.  The goal is to work with OCH leadership and medical staff to help bolster and grow an already vibrant medical community.  We take our role as the state’s leading medical services provider seriously.  This is a testament to the work each of you are doing and it shows how strong the Medical Center’s reputation is statewide.  Thanks to all who worked on this.

The other item has been at the forefront of many of your thoughts and all over the news for the last two months – our contract dispute with Blue Cross & Blue Shield of Mississippi.  If a new contract agreement isn’t reached by tomorrow, there will be questions about what happens if we go out of network with the state’s largest insurer.  This is a complicated matter, so it’s no surprise there’s some misunderstanding out there.

This week, Blue Cross joined us in accepting the state Insurance Commissioner’s offer to facilitate a mediation process to bring the contract dispute to a resolution.  This was encouraging news, but certainly not an assurance that this will be resolved before July 1.  We announced our intent to terminate the contract two months ago, but as expected, they have waited until the last possible moment to begin meaningful conversations.  Even so, we are hopeful this will lead to an agreeable contract.  We are trying to do the best thing for our patients.  Things are beginning to move quickly but as of the time this column is being delivered to your inbox Blue Cross has yet to agree to a date to begin mediation.  Without that commitment, we still plan to officially go out of network with BCBSMS beginning this Sunday.

That brings me to today’s questions, focused on what happens in an out-of-network scenario, that I’ve heard many people ask in different ways.  These weren’t directly submitted to me, but they certainly touch on topics many of you are wondering about.

Now, on to the questions.

Q:  Going out of network may be a major disruption to our clinical operations and could possibly cost us patients and money. Why are we going through all of this trouble?

A:  This will almost certainly be a new challenge - on top of all the other health care challenges that we will overcome.  We really dislike this, and we apologize for the inconvenience, hardship and expense this may lay at the feet – and pocketbooks – of our patients.  But we feel we must do this, especially for our patients.  We are a vastly different institution than we were in 1990.  That was a long time ago!  The World Wide Web had just been invented.  We’ve changed, the national health care landscape has changed, and BCBSMS itself has changed.  It’s time for a new, viable, fair contract.  We are only asking for a reasonable business relationship.  To date, Blue Cross has not agreed to it.  We must go into this resolved to do what we need to do to continue to provide services to patients all over the state, but we also need to think about our ability to grow and transform in ways that the market demands and that Mississippians need.  We need a better contract, with fair rates, in which one side isn’t able to adjust the terms without the consent of the other party.  That’s a simple – and sensible – request.  Unfortunately, Blue Cross has repeatedly shown they don’t consider us partners in improving Mississippi’s health future and is forcing us to take this unwanted step.

Q:  Don’t UMMC providers have their own individual contracts with Blue Cross? Are these also affected?

A:  Unlike other insurers we contract with, Blue Cross does require all billing providers to contract with them separately.  However, since the consolidation of University Physicians with UMMC, all of our employed providers have delivered care and billed under the Medical Center’s tax ID number.  When we sent BCBSMS a notice of termination letter in late April, its language made it clear that all billing being done under UMMC tax ID numbers were affected, including provider billing.  So, yes, UMMC providers would also be out of network along with the facility.

Q:  Does this affect me and my family if we want to keep seeing our UMMC doctors?

A:  Simple answer: no, if you (and any state employee) and your dependents are enrolled in the State and School Employees Health Insurance Plan. Insurance coverage for that group is managed under a different contract that BCBSMS manages but does not own.  However, if you work here but are covered under the workplace or private insurance of your spouse or other family member that is not the State Health Plan, or if you have a Blue Cross plan obtained directly through them, then UMMC will be out of network under those plans. Nevertheless, UMMC and our providers will continue to see BCBSMS patients, it just may be in an out-of-network scenario.

Q:  With all the news coverage about the possibility of us going out of network, we’ve already had some patients cancel appointments. What do we tell our current patients?

A:  Assure them that if they want you to be their care provider, there doesn’t have to be a disruption to your current relationship.  We will not stop seeing patients with Blue Cross insurance if we go out of network with them.  But we must be transparent and tell patients their out-of-pocket costs could very likely go up – in some cases, a good bit – and we are sorry for that.  Additionally, their normal procedures for paying their bills may be disrupted.  For established patients who are undergoing a treatment plan, it’s possible they will not be affected.  If you need help determining which patients would fall under the continuity of care provision, please contact your department leader. And, as always, our Emergency Departments are open to all patients, regardless of insurance status.  Our registration and scheduling staff have a long list of additional talking points to help each and every patient make the best decision for him or her.  We hope all of our patients and any who are considering us for their care will not have a change of heart based on this contract dispute, but the reality is that many will, and we must be understanding of that.  What’s best for patients is always our top priority, and in some cases, that may mean accommodating them if they choose to receive services elsewhere.  Let’s be helpful, and then we’ll have an easier road to winning them back later.

Q:  Only five years ago we threatened to go out of network with Blue Cross, but it all worked out. What happened?

A:  We are right back where we were in 2013, sort of.  Then, like we did two months ago, we announced our intent to terminate our BCBSMS contract -- but our main point during that contract dispute was the rates.  We felt we were not being paid fair reimbursement rates for services provided to Blue Cross patients.  In that case, a resolution was reached and we accepted the rate increases they offered us.  We thought we accomplished what we set out to do.  But through some crafty policy changes and rate manipulation, BCBSMS made what seemed like increases in rates turn into a net loss.  This was in the background, without us agreeing to the changes. Fast forward five years later, and the current relationship and contract terms are no longer tenable.  That’s why, this time, we are focusing less on rates and more on the contract.  We must have a contract that does not allow Blue Cross to change our reimbursements without our consent.  We must have a contract that recognizes us for the special services we provide to the state.

Q:  I’ve read that Blue Cross says we want to be treated differently than other hospitals. Is that really what we expect?

A:  Absolutely.  As the state’s only academic medical center and leading health provider, we offer many advanced services not available at other facilities.  You’ve heard this list before: we have the state’s only Level I trauma center, the only children’s hospital and the only organ and bone marrow transplant programs; we are the state’s safety net hospital; we are the leading medical response agency in times of crisis; and of course, we graduate nearly 1,000 health science professionals every year who fan out across Mississippi.  These are just a few examples of the unique and vital role we play, and they should be looked upon by the state’s largest insurer as such.  Major teaching hospitals like us are treated as special by insurers across the country, but BCBSMS has said UMMC is no different than any other hospital.  To that, we just cannot agree.  For UMMC to continue to offer advanced services and plan long term for Mississippi’s health care landscape of the future, it’s important that our insurance partners recognize our uniqueness and pay us accordingly under a contract that is fair to both sides.

To reiterate, this action is not one that was decided lightly.  Many people have spent long hours evaluating what it means for us and our patients.  We simply cannot sit back and accept the status quo.