PATIENTS TAKE THE HINDMOST
CHI Memorial and BlueCross BlueShield of Tennessee have said throughout their months-long contract dispute that they nevertheless are putting their patients first.
Today, the hospital and the insurer have about 150,000 patients who might disagree.
On Tuesday, a Memorial hospital spokeswoman said as of July 1 most BlueCross members in the area will no longer have access to the hospital’s services. Meanwhile, BlueCross said it was removing Memorial as a provider in its popular Network S. The insurer said it was adding HCA Parkridge Medical Center to the plan in a three-year agreement.
A BlueCross spokesman said the insurer still hopes to work out an agreement with Memorial for its Network P customers and its Medicare Advantage plan. However, Memorial said it was unlikely to split its physicians and the hospital services.
Tens of thousands of Chattanooga area patients have seen this movie before, most recently in September 2021 when negotiations went down to the wire before the same two combatants signed a three-year agreement that was said to have been in the works for 10 months.
Before that, similar disputes between local hospitals and insurers had worried patients at least a half dozen times over the past two decades.
We said after the fact in 2021 that we hoped both sides more clearly understood the risk and worry of patients potentially having to pay higher, out-of-network charges or find new doctors, and would vow not to allow it to happen again.
So much for that.
As recently as this newspaper’s April 27 edition, when each side offered a commentary on the negotiations, William Warren, managing partner of the Chattanooga Heart Institute, CHI Memorial, said the hospital “puts patient care and community service before profits.” And Scott Pierce, BlueCross executive vice president and chief operating officer, said “we’re committing to doing everything in our power to protect doctor-patient relationships.”
But it seems “patient care” — at least what a patient can count on — and “doctor-patient relationships” — which are at risk for tens of thousands of patients — are exactly what customers won’t be getting come July 1.
The issues in the dispute, in general, were fairly simple. Memorial said its costs had risen more than 30% since the outbreak of COVID-19 and it required larger reimbursements from the insurer, which it claimed has enough cash reserves for the larger reimbursements without raising premiums. BlueCross said it offered competitive increases but noted that what Memorial was asking would force increased health care premiums for employers and workers.
The decisions by the hospital and the insurer now put the onus on employers. Do they look for another insurer that will offer their employees access to Memorial and its doctors or do they stick with BlueCross and its network that includes Erlanger in addition to Parkridge? Do they absorb any of the potential cost increases that may depend on the move they make, do they pass them along to their workers or do they both incur part of the pain?
Parkridge, though the youngest of the three area major hospitals (opened in 1971), is on a growth path with a
$72 million expansion announced in January, a $16 million free-standing emergency department that opened in October near Camp Jordan in East Ridge and a $17 million freestanding emergency room under construction in SoddyDaisy. Meanwhile it offers maternity and behavioral health services Memorial doesn’t have. Also planned is a joint venture with Erlanger hospital for an outpatient surgery center in the former U.S. Xpress building on Jenkins Road.
Still, Memorial has been the choice of so many insured by BlueCross for so long that the changes likely will be painful for thousands.
Indeed, the shakeup, insurance broker Russ Blakely told this newspaper’s Dave Flessner, is likely to be the biggest locally in his 43 years in the business.
And, apparently, it’s somewhat of a trend, according to FTI Consulting, which reported in January that contract disputes across the country between payers and providers reported in the media rose by 69% between 2022 and 2023.
That tells us there’s a whole lot more patients than those in Chattanooga who are told they are being put first but who in reality are getting the tail end of the deal. And, unfortunately, in many cases, they can do little about it except what their employer ultimately decides. We’d like to know what kind of customer service that is.