By Robert Weisman and Liz Kowalczyk
The Boston Globe, November 16, 2011
Tufts Medical Center and its doctors group say they will stop doing business with Blue Cross Blue Shield of Massachusetts on Jan. 17 because the two sides canāt agree on a new contract. The move could force tens of thousands of Blue Cross members to change doctors and compel employers across Massachusetts to consider switching to another insurer.
Blue Cross disclosed the termination notice yesterday as it prepared to send letters to about 55,000 employers and other customers alerting them to the Tufts threat, which came as increasingly tense contract negotiations stalled Monday night.
“This is confusing and disruptive,” said Amy Whitcomb Slemmer, executive director of Health Care for All, a Boston advocacy group. “We have essentially a train wreck that has nothing to do with the quality of health care, but is all about escalating costs. In their failure to reach agreement, Tufts and Blue Cross are affecting peopleās care.”
Nancy Turnbull, associate dean at the Harvard School of Public Health, said Tuftsā request for 3 percent increases seems “very much in line” with what other providers such as Partners HealthCare System and Childrenās Hospital have received in recent contracts. And she noted that those providers already were getting higher reimbursements than Tufts.
Turnbull said the dispute underscores why the government needs to get more involved in setting payment rates.
And…
Blue Cross, Fallon post big earnings
By Robert Weisman
The Boston Globe, November 16, 2011
The stateās largest commercial health insurance companies, citing seasonal improvements in their business and a decline in medical claims tied to the sluggish economy, yesterday posted robust financial results for the three months ending Sept. 30.
Blue Cross Blue Shield of Massachusetts, the stateās largest health plan, led the pack in the most recent quarter, ringing up net income of $78.9 million compared with the $75.8 million it earned a year ago.
Comment:
By Don McCanne, MD
By reading the first article in full (available at the link), you can learn some of the details behind the contract dispute between Tufts Medical Center and Blue Cross Blue Shield of Massachusetts. But that isn’t the important issue. What is important is that a very profitable, “non-profit” private insurer, that is able to restrict patient choices in health care providers, is using the threat of disrupting patients’ care as leverage in negotiations over health care payment rates.
Tufts Medical Center is also a party in this dispute. They are also in a position to make a decision that can be very disruptive to the care of their patients.
The problem is in the way we finance health care. We continue to perpetuate a system in which we grant the power to control health care dollars to private financial intermediaries that must consider their own interests first. Health care providers are then placed in a position that a decision must be made on whether or not to participate in the proposed contract with the intermediary.
Contrast that with a single payer system in which the government sets payment rates based on legitimate costs of providing health care. The government pays enough to maintain the operations of the providers, along with separate disbursements for appropriate capital improvements. The providers are not faced with a decision on whether or not to accept the government contract. The only decision they might consider would be whether or not they would want to shut down operations. The government single payer would not allow that to happen merely because of an actual shortage of funds for necessary expenses, as long as essential services were being provided.
It really is time to get the private intermediaries out of our health care. They cost too much, and they take away our choices. An improved version of our own Medicare program would provide the necessary administrative services for us far more efficiently and at a considerably lower cost.