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Standoff could cut off Blue Cross patients at MCG Hospital and Clinics

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Patients with Blue Cross Blue Shield of Georgia insurance are being told they might not be able to use Medical College of Georgia Hospital and Clinics or its physicians after Aug. 15 because contract talks have broken off.

Negotiations are continuing, and an extension or a deal remains possible even after the deadline, officials said. Each side says the other is not responding to overtures.

Talks about new rates began about 10 months ago because rates have been unchanged since 2003, said Frank Smith, the chief operating officer for the group that represents the health system’s physicians. Blue Cross said in a statement that the health system’s doctors have received “higher than market rates” for more than nine years. MCG health system wants 13 percent, or about 1.4 percent per year over the nine years, Smith said. Blue Cross countered with 3 percent.

“They started the negotiations saying they would offer us 3 percent, and for nine months they’ve been on 3 percent,” he said. After a couple of months, the health system set an initial termination date for the contract in January but has extended it four times in hopes of reaching a deal, Smith said.

“We finally got to the point where we told them we weren’t going to extend any longer,” he said. “They’ve not moved off their initial position in nine months, and we have.”

Blue Cross countered that it has “made multiple proposals that have moved the parties closer together” and that its attempts to reach senior leadership “remain unanswered.”

If the health system does terminate with Blue Cross, it will come at a stiff price. Blue Cross represents about 10 percent of its business, $60 million to $70 million, Smith said.

Both sides said that they are open to more talks and that negotiations will likely continue.

“If they came with something that we thought was a reasonable attempt to try to resolve the differences, we’re certainly open to talking,” Smith said. “I expect we will be talking right up through the deadline of Aug. 15 and even beyond that.”

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onlysane1left
216
Points
onlysane1left 07/26/12 - 02:47 am
5
3
Thats right we don't need the

Thats right we don't need the Supreme Court or Obama to tax us, we'll just let both of these money making machines decide on how much of our money they are going to take without any input from us. No, don't complain, just repeal Obamacare, these two giant will care for all of us nicely. Socialized medicine, nope, not needed at all. Why should other people gain off of our hard earned money?

agustinian
689
Points
agustinian 07/26/12 - 06:12 am
4
2
Reporting

Well, instead of talking about how far apart the parties are, why don't you give an example of how MD's are being compensated by Blue Cross in 2003 versus 2012. The urban CPI has gone up 25% in that period. If Blue Cross is only offering 3% -- most would consider that an insult. In that period, the Federal minimum wage has gone up 40% from $5.15/hr to $7.25/hr. I'm with MCG on this. If that's all they are offering -- walk away.

OhWell
326
Points
OhWell 07/26/12 - 07:17 am
3
0
Why not provide us with the

Why not provide us with the contracted rate for other hospitals in the area and include the allowed amount, the contractual write off (courtesy to the patient) and let us see how those compare. Other hospitals do not seem to be having this problem. I have seen several EOB's from University and Doctor's lately and their contracts seem to be in line for the region.

Riverman1
83791
Points
Riverman1 07/26/12 - 08:34 am
3
0
Blue Cross is the provider

Blue Cross is the provider for state employees. We have a state owned hospital unwilling to provide care for state employees? Why should MCG get any more than other hospitals in the area?

BamaMan
2356
Points
BamaMan 07/26/12 - 08:45 am
3
0
That's

what I was going to say also, Riverman. Aren't there EMPLOYEES of MCG (it will always be MCG) that have BC/BS? Are you kicking your own employees in the rear, or just your patients? 2-3 weeks notice sure isn't much time to notify someone their insurance will soon be not accepted!

HighSociety
1840
Points
HighSociety 07/26/12 - 09:27 am
1
0
BC/BS just went through this

BC/BS just went through this with Doctors Hospital a few months ago. Hopefully the two can resolve the problem and continue to work together.

Fiat_Lux
15420
Points
Fiat_Lux 07/26/12 - 09:35 am
4
1
Boy, Howdy!

This one is an absolute mess. MCG is saying it is getting reimbursed below the rate that other area hospitals and physicians are receiving, and that doctors (at least those that are not on the "incentive" track) haven't had a raise in 9 years.

From the VP of GHSU HR:
"The physicians of GHS Medical Associates have had zero adjustment to how they are paid by BCBS for over nine years. While we have exchanged several proposals with BCBS, the fact remains that we need to bring this contract to market rates. This is critical to retaining the exceptional physicians we have now and for recruiting new physicians to the area. As of now, BCBS has offered an adjustment that is below inflation for this year, but they have failed to address the nine years these physicians' rates have stayed the same. This is simply not acceptable..."

Things have kind of escalated since that memo went out.

Meanwhile, GHSU employees covered by a BC/BS-managed health care plan are being reassured that nothing will happen to their coverage, presumably to include the level of co-pay. Blue Cross is supposed to send out a letter to GHSU employees stating that, but it hasn't happened yet. [Who to believe, who to believe...]

GHSU is sending out a steady stream of the dire warnings that lately have included the addresses of people to write and chastise for this mess.

I, for one, would love to see a side-by-side comparison of the reimbursement rates, along with a listing of the salaries and bonuses of all the parties involved in the dispute, physicians included. ALL of these people, probably on both sides, and certainly the physicians, get paid buckets of money at a time when the huge numbers of the people having to pay for healthcare coverage are struggling just to make ends meet.

It's a little hard to get excited about paying doctors more money when the difference for most of them is whether they drive a Lexus or a Toyota, or to take one ski or island resort vacation per year or three of them. Enabling that kind of luxury is fine if the people who pay for the policies that reimburse them are doing ok financially, albeit at their own lower standard of living. But we aren't all doing ok, by and large, and this part of the country isn't wealthy even in the best of times.

Demanding luxurious salaries is absurd and probably somewhat on the immoral side of things when the middle class is having so much trouble just keeping up. It's the very thing that widens the gap between the 'haves' and the 'have-nots', and it breeds resentment. And societal resentment results in very. bad. things.

You haven't lived until you realize you're going to have to take your desperately ill child to Atlanta every week because BC/BS won't pay but half the cost of their treatment at GHSU. This little stand-off is what forces people to choose government control of this industry.

There is plenty of blame to go around.

JRC2024
8854
Points
JRC2024 07/26/12 - 10:07 am
3
0
I just took my mother to

I just took my mother to Doctors Hospital for backpains which turned out to be blood clots. They put her in the system as uninsured and the bill at the ER was $1840.00+ but reduced to $482.00 because they thought she did not have insurance. The reduction tells me that she was over billed on the insurance side. How can a reasonable bill be reduced that much? I know I could not do that in my business.

kkirk007
19
Points
kkirk007 07/26/12 - 12:05 pm
1
4
Lux, are you saying that a

Lux, are you saying that a doctor -- who busted his butt for several years in school, then doing residencies, and took out a couple hundred thousand in student loans -- should be driving the same crappy Toyota as a Kinko's assistant manager? A doctor asking for a six-figure salary is NOT unreasonable. After all the work getting there, that's the reward. It's not "immoral". If they didn't get to drive nice cars and have nice houses, then what's the incentive of studying for 10 years and starting out $200K+ in debt?

kiwiinamerica
942
Points
kiwiinamerica 07/26/12 - 12:26 pm
0
0
@Fiat Lux
Unpublished

Freezing doctors' salaries at MCG will solve nothing and can't be seen in isolation from market forces. The market always wins. All this will do is stimulate a rush for the exit turnstiles. Doctors who are not satisfied with their compensation will simply move to where they can demand a better salary.

I believe that Georgia has a shortage of physicians. IOW, they are in demand and the law of supply and demand says that when something is in short supply, its price usually rises.

Fiat_Lux
15420
Points
Fiat_Lux 07/26/12 - 01:56 pm
4
0
Well, no, KKirk, it's not

what I'm saying at all. You kind of went way out with that. But you know what? The doctor who lives across from me drives a very nice Toyota and his wife and children also have--wait for it-- Toyotas! Of course, he also gives away a huge amount of the money he brings home and spends tons more on college tuition for several of his numerous children. And he had student loans too.

There's nothing wrong with expecting a 6-figure salary today, especially with all that it takes to become a doctor, or with wanting to drive a nice car either. However, salaries that run up to and well over a quarter of a million dollars DO, in fact, seem a bit excessive when compared to the salaries of most of the people who make it possible for doctors to live that way, and all the while act as though they are worthy of worship.

Nobody begrudges you or your significant other for having as your goal a much higher standard of living than the average for Americans, although most of your patients would hope you went into medicine because you wanted to help sick people more than you wanted to separate them from big chunks of their money. But what you wrote makes you seem merely crass and greedy, and nobody wants to be going to a doctor like that, if you are a doctor.

You should think about how it looks (and you sound) to the people who pay those insurance premiums when they are forced to live on even less just so they can keep getting the essential medical care their families need. That's who will end up paying for these raises for doctors.

And a lot of us busted our butts for many years and ended up with lots of debt, and will never, ever get paid anything approaching what the lowest paid doctor at MCG makes. And a lot of us put up with utter crap from those doctors, mainly because we mainly care about what we are doing. My sympathies, therefore, tend to be on the waning side.

Sweet son
10391
Points
Sweet son 07/26/12 - 01:59 pm
0
0
Riverman: I think!

I think United Health care handles State Employees and BC/BS handles MCG and maybe other University Sytem institutions. Correct me if I am wrong.

Fiat_Lux
15420
Points
Fiat_Lux 07/26/12 - 02:44 pm
2
1
One last comment on this

Just to set the record straight: GHSU has some amazing and wonderful physicians on staff, and it is quite true that many of the best have left for greener pastures because of the pay scale and frustrations of this old institution. It makes so many of those who choose to stay all the more commendable and valuable. Even with all the hassles and annoyances, I would hate to have to go some place else. It really is probably the best care available in our area, and for some specialty areas, it is the only place where care can be gotten in our area.

It's worth remembering that GHSU has the only Level 1 trauma center within 75 miles.

Riverman1
83791
Points
Riverman1 07/26/12 - 04:15 pm
2
0
Sweetson, you are correct. I

Sweetson, you are correct. I just checked a state employee's insurance card.

Fiat, don't even get me started about trauma centers. Local hospitals have had their names removed from the list voluntarily although they have the same services of trauma centers. The reason hospitals have asked to be taken off is because of payment-insurance issues with those type patients.

Fiat_Lux
15420
Points
Fiat_Lux 07/26/12 - 04:49 pm
2
0
Riverman...

Sad but too true.

K.M.L
5
Points
K.M.L 07/26/12 - 09:11 pm
1
0
All patients?

Does anyone know if this applies to ALL Blue Cross and Blue Shield patients are just Blue Cross and Blue Shield of Georgia patients?

MD2013
101
Points
MD2013 07/26/12 - 09:22 pm
1
1
Sigh

Fiat,

Physicians should be making $250,000+/year. There aren't many fields in the world that require as much training, dedication, sacrifice, effort, and hours that a doctor has to do. I for one can tell you that unless you've been through it or been married to someone who was going through it you really have little insight into the process of becoming a physician.
What's even more disgusting though is the notion that this generation of doctors should expect a lot less income, while simultaneously graduating with 10x the debt that the current practicing physicians did when they were in school. Our tuition+ fees at GHSU's SOM have climbed from 13k/year to 30k/year in just the last 4 years. That's just tuition and fees! Our "projected cost of attendance" is between $55,000 and $60,000 a year for the current 2012/2013 academic year. The incoming class of 2017 should expect > $250,000 in debt to simply attending medical school, where their degree offers them no job and no earning potential. They will have to sit on the debt through a residency and continue to accrue interest on their enormous student loan debts.

$100,000/year may seem like a very large amount of income, but see how far that goes when you have $300,000 of student loan debt at the end of your training and are trying to purchase a home, a practice site, medical equipment, staff, etc...

er911
3
Points
er911 07/26/12 - 10:18 pm
1
0
Support GHSU

It seems to me that many of you feel that GHSU and its physicians are the bad guys in all this. Wake up folks..BC/BS is a business too and if you don't think they are making a killing off the common folks you are wrong. I would like to see the incomes of the BC/BS executives. They are probably making much more than our local doctors. GHSU (MCG) is the best medical facility in the area. It is on the cutting edge of technology and doing research in areas that may lead to saving countless lives. It is bringing in top notch doctors from all over the world. These endeavors cost a little money and GHSU has to remain competitive in the salary dept as well. These physicians deserve every penny they earn for their expertise. If all the working folks out there had not received a raise in 9 years you would be raising hell or looking for a new job. Support GHSU on this issue and let's keep the best docs in town here in Augusta.

MD2013
101
Points
MD2013 07/26/12 - 10:25 pm
0
1
ER911

ER911,

There are executives at BCBS of Georgia that make more money than the entire executive cabinet at GHSU combined. For the majority of the time in question (2003-present) MCG operated in the red due to poor reimbursement and a growing population of patients that cannot pay for any of their care. I'd like to see BCBS's bottom line.. lol

okletssee
34
Points
okletssee 07/27/12 - 05:59 am
0
0
Bottom line...... BCBS is

Bottom line...... BCBS is lining their pockets at patients expense... Increasing premiums every year but not increasing payments on the hospital or physician side. Its not about greed on physicians or MCG. WAKE UP.....ITS ABOUT KEEPING HOSPITAL DOORS OPEN AND RETAINING COMPETENT PHYSICIANS!!! Simple... Black and white... After 30 years in healthcare at area hospitals... TRUST ME... I KNOW!!

okletssee
34
Points
okletssee 07/27/12 - 06:09 am
0
0
ALSO .......GHSU(MCG)

ALSO .......GHSU(MCG) provides plenty of free service to noninsured " self pay" patients! Also I know for a fact many physicians at MCG who express concern for patients and their families... The caring component like in the old days....AND have treated and operated FOR FREE... goes on EVERYDAY. EVERY HOUR! Im pretty critical usually but GHSU/MCG IS THE HOSPITAL/UNIVERSITY Way out in the front of compassion and cutting edge technology. SUPPORT THEM!

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