Jenny Deam Oct.
10, 2019 Updated: Oct. 10, 2019 10:56 p.m.
As many as 100,000
UnitedHealthcare plan members could lose in-network access to all eight Houston
Methodist hospitals and dozens of its out-patient facilities on Dec. 31 after
the insurer announced it was dropping the major hospital system from its network.
The move would affect
anyone with a UnitedHealthcare employer-sponsored plan as well as those covered
under the insurer’s Medicare Advantage program for seniors, both the hospital
and the insurance company confirmed on Thursday. Medicare Advantage enrollment
for 2020 begins next week.
UnitedHealthcare, the
nation’s largest insurer, has also said it would drop roughly 800
Methodist-employed physicians from its network on April 1, 2020.
While the thousands
of physicians affiliated with Houston Methodist would not be affected by the
insurer’s decision at this time, the move could still have sweeping impact if
those doctors send patients to a Methodist hospital or facility, which would be
out-of-network and cost patients substantially more money.
Negotiations are
continuing, but the war of words has escalated in recent days as both sides
accuse the other of bad faith and greed. The increasingly nasty fight also
offers a rare glimpse at just how contentious negotiations between insurers and
providers have become.
On Oct. 2, Dr. Marc
Boom, CEO of Houston Methodist, sent a terse email to doctors and department
heads saying that after a two-decade relationship with UnitedHealthcare, the
insurer “abruptly gave us notice of termination after we refused to accept rate
cuts so deep they would have a negative impact on the way we deliver care to
thousands of patients who rely on us every day.”
Then, Optum, a United
Healthcare sister company, announced that as part of the ongoing dispute, after
Oct. 14 any plan member entering the organ transplant program at Houston
Methodist — considered one of the nation’s best — will be redirected to an
in-network facility to avoid a future out-of-network charge. Existing Methodist
transplant patients will be covered after Jan. 1 to assure continuity of care,
insurance officials said.
“With these moves”
Boom fired back in a second email on Wednesday, “United is not putting the
patient first but looking to use its members as pawns in its negotiations,”
UnitedHealthcare took
its own shot, accusing Houston Methodist of overcharging patients and
being “significantly more expensive than some of the most prestigious hospitals
in the country.” The insurer, in a statement, also contended Houston Methodist
system is the most expensive in Texas, “driving up the cost of health care for
all Texans and the health care system overall.”
“Their costs are not
in line with similar institutions,” said Dave Milich, CEO of UnitedHealthCare
commercial plans for Texas, said in an interview Thursday. “If you’re going to
hold yourself up as one of the top hospitals than we’re going to compare you to
them as far as relevant cost.”
Pick a stat
UnitedHealthcare’s
internal data indicates the cost at Houston Methodist is 49 percent higher than
the average cost at the four other top hospitals in Texas ranked by U.S. News
& World Report, and more than one-third higher than the top five ranked
best in the nation, the company said. Those U.S. top hospitals are Mayo Clinic,
Massachusetts General Hospital in Boston, Johns Hopkins Hospital, Cleveland
Clinic, and New York-Presbyterian Hospital-Columbia and Cornell.
Milich added that
employers who offer his company’s plans have demanded that it do more to bring
down costs for workers.
Stefanie Asin, a
spokeswoman for Houston Methodist, disputed that its health care system was
more costly than other top institutions. She said statistics from the RAND
Corp., a think tank in Santa Monica, Calif., place Houston Methodist’s costs in
the mid-range of health care systems in Texas.
“They’re all about the
numbers,” she said of UnitedHealthcare. “We’re all about the patients.”
Chris Skisak,
executive director of the Houston Business Coalition on Health, a nonprofit
that represents employers purchasing health plans, said Thursday both sets of
data could be correct, depending on which figures are used and how they are
analyzed. Using the RAND study, Methodist’s costs are, indeed, in the mid-range
among health care systems in Texas, he said.
But that study also
showed Texas hospital costs are higher than those in Chicago, Los Angeles and
New York, which suggests that the UnitedHealthcare data is also correct. “The
losers here are the patients,” he said.
On Wednesday,
Methodist sent letters to about 20,000 UnitedHealthcare Medicare Advantage
members urging them to sign up for other insurers’ plans and included a list of
companies and contact information. Enrollment for the program for those over 65
runs from Oct. 15 to Dec. 7.
Working hard
“Be assured that we
have negotiated in good faith with United, but they continue to demand
reductions to our overall contract,” the letter to patients said, “We simply
cannot accept cuts that would negatively impact the way you experience care.”
Milich said his
company is avoiding putting patients in the middle of the fight. While in
contract negotiations with other area health systems in the area, it has only
reached an impasse with Houston Methodist. “We are talking regularly” he
said,“and working hard to come to an agreement.”
jenny.deam@chron.com
twitter.com/jenny_deam
No comments:
Post a Comment