Blue Cross Blue Shield reimbursement rates threaten access to local hospitals

Sep 16, 2019

To the Editor:

Why does healthcare continually rank as a top concern among Americans? Because at some point we all get sick.

Whether you’ve sprained your ankle and gone to an urgent care center or are seeking support for a loved one with a potentially life-threatening illness, you deserve to receive exceptional care in your community. And you shouldn’t have to worry about your insurance coverage in your moment of need.

When the time comes that you or someone in your family needs care, many of you will turn to Southcoast Health. As a community health system, we’ve invested time and time again to strengthen and expand our services, enabling patients to receive world-class care close to home. Some of our most recent investments include the Lash Heart and Vascular Center at Charlton Memorial, a Rapid Assessment Zone at the St. Luke’s Emergency Department, seven Urgent Care centers that include “get in line online” technology to reduce wait times, two cancer centers and a full renovation of our Stoico/FIRSTFED Maternity Center at St. Luke’s.

At present, Southcoast Health has more than 700 care providers and 75 locations in its affiliated network, providing care and service to hundreds of thousands of southeastern Massachusetts and Rhode Island residents.

Every day we work to fulfill our promise to you, to our patients and to their families, that you do not have to travel out of the South Coast region for sophisticated and innovative procedures. In acknowledgement of the world-class care we deliver in your backyard, Southcoast was the only community and non-teaching hospital in Massachusetts named to Newsweek’s inaugural list of the World’s Best Hospitals 2019.

Our care teams live, work and raise families here, and our roots run deep in the neighborhoods we serve. You may know a newly graduated nurse whom we hired for his or her first clinical job. Maybe the Southcoast Center for Weight Loss provided your neighbor with a personalized plan for a healthier lifestyle. Or perhaps someone you know works as a radiologic technician or
primary care physician at Southcoast.

We pride ourselves on being more than medicine. To us, that means everything from volunteering in our communities to improving access to care to redefining what a “community” hospital is, and should be, by bringing the most advanced care to the region. We are here for you in sickness and in health.

To do this we need our insurance partners to reimburse us fairly in the marketplace. Our community and clinical investments more than justify that we be reimbursed equitably with comparable community health systems in the Commonwealth. Equal, and in many cases superior, quality and service should merit equitable compensation.

As every healthcare organization is required to do with its insurance partners, we are in the process of renegotiating our reimbursement rates with Blue Cross Blue Shield of Massachusetts (BCBSMA). It is a complicated but necessary process that may be one of the most challenging aspects of the financial side of healthcare. Southcoast is committed to negotiating in good faith with BCBSMA, on behalf of our patients, in the hopes of signing a new contract later this year. Our ask of BCBSMA is simple: to be treated fairly and equitably so that we may continue to invest in the superior care and service you want and need locally.

Unfortunately, our concern at this time is that BCBSMA seems to be putting their revenues before our patients — before you, before Southcoast Health and the South Coast region.

If an agreement is not reached, starting January 1 BCBSMA will no longer provide in-network coverage for healthcare provided by Southcoast providers to individuals and families with BCBSMA insurance coverage; this includes care provided in our physician offices and hospitals, our Visiting Nurse Association and our urgent care facilities, with only limited exceptions such as emergency department visits.

For employers who use BCBSMA for their insurance plans, your employees will have to travel farther, often taking more time off from work, to receive care. In addition, that out-of-region care may be even more costly. The alternative would be for individuals to pay increased out-of-pocket costs to continue seeing their existing Southcoast providers.

The 7,500 individuals who work at Southcoast Health are proud to serve the hundreds of thousands of residents of the South Coast. You are our family members, our friends, our neighbors and our colleagues. We are committed to continuing to provide this exceptional care experience and we will continue to advocate for you throughout this process.

We have listened to what many of our patients – and our community – have told us: residents of the South Coast don’t want to travel to receive the same quality care you could access close to home. To ensure that you don’t have to, insurance companies need to reimburse community hospitals fairly. We need BCBSMA to engage in meaningful negotiations that result in a timely, fair and equitable solution. Our patients and our South Coast region deserve nothing less.

Keith A. Hovan
President of Southcoast Health System and Southcoast Hospitals Group