Patient access to care in jeopardy
St. Paul, MN – The Minnesota Hospital Association (MHA) is
opposing a payment change plan by Blue Cross and Blue Shield of Minnesota
(BCBS) scheduled to take effect May 1 that will slash payments to hospitals and
have a particularly devastating effect on rural health care.
MHA President and CEO Lawrence Massa described the payment change
as converting BCBS payments from a negotiated discount from a hospital's
charges — a payment methodology that has been used for small hospitals for
decades — to a below-cost or marginally above-cost rate unilaterally set by
BCBS.
MHA has heard from dozens of hospitals scheduled to have their
payments cut on May 1 that the impacts will be “in the hundreds of thousands to
millions of dollars.” Massa said that for many of these small hospitals in
rural communities, the payment cuts will “put them into deep, deep red ink.”
“To dramatically disrupt long-standing reimbursements to hospitals
will, if implemented, jeopardize patients' access to care, especially in rural
communities served by smaller hospitals, such as ours,” said Kimber Wraalstad,
administrator of the Cook County North Shore Hospital in Grand Marais, a
critical access hospital. “Because of Blue Cross’ unilateral change to the
reimbursement methodology and rates, we may have no choice but to terminate our
contract with Blue Cross.”
“As a result of the Blues’ plan, we are looking for what changes
we need to make to absorb the unexpected and significant cuts from the largest
insurer in the state,” said Joel Beiswenger, president and CEO of Tri-County
Health Care in Wadena, also a critical access hospital.
Massa said that BCBS began contacting a portion of hospitals
earlier this year about the payment changes. “Instead of contacting all
hospitals and warning them about this change at once,” Massa said, “Blue Cross
is communicating with only 25 or 30 percent of hospitals at a time, perhaps to
avoid the inevitable statewide backlash that would be unleashed.”
Minnesota hospitals are attempting to individually contact Blue
Cross to negotiate a revised payment methodology or reimbursement rates that
are less devastating. In addition, some hospitals are seeking a delay in the
implementation.
Anecdotally, Massa said he has heard of hospitals deciding to
eliminate services such as home health care, which provides vulnerable and
elderly patients with care in their home so they do not have to travel to
appointments at greater cost and with more risk of exacerbating their health
conditions.
Massa said that he heard of one hospital where the employees
collectively chose to forego a portion of their retirement benefits to help
salvage access to needed care for patients. “It’s very frustrating to our
members that the people who provide direct patient care are faced with the
unthinkable choice between cutting off services to their patients or losing
some of their retirement benefits. I don't believe for a second that Blue Cross
considered such alternatives before deciding to move forward with these huge
cuts.”
MHA is also concerned that patients and communities will attribute
the loss of services and access to health care reform initiatives. “The timing
of this is extra troubling,” Massa said, “because some people will mistakenly
conclude that they lost access to care or hospitals closed because of federal
or state health care reforms when, in reality, these are decisions by a single,
dominant insurer that decided to pay wholesale rates rather than discounted
retail rates.”
The Minnesota
Hospital Association helps 144 hospitals and health systems provide quality
care for their patients and communities.