Blue Cross Responds to Tufts: Deal or No Deal?

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Tufts Medical Center’s CEO Ellen Zane took a big gamble a few weeks ago when she decided to play hardball with Blue Cross/Blue Shield by announcing that Tufts would no longer accept Blue Cross HMO patients beginning in February.

While the official word was that Tufts and BCBS couldn’t come to agreement after 11 months of negotiation, it was widely recognized that Zane’s position was aimed at leveling the playing field in hospital reimbursement, as well as addressing “unsustainably low” payment rates for Tufts.

And now word comes that an agreement has been reached.

Tufts and its affiliated doctors said they will join Blue Cross’s “alternative quality contract,” which the insurer has been pushing as a way to slow the spiraling cost of healthcare while improving treatment. Under the deal, Tufts and its doctors will get a raise with the potential to earn even more money if they reduce the costs of treatment and reach ambitious quality goals.

Tufts doctors announced the settlement, which covers both Tufts doctors and the hospital itself, in an e-mail to employees, patients, and supporters late last night. “Our physicians and Blue Cross Blue Shield are extremely glad that patients no longer have to worry about this situation and can continue to count on the caregivers they know and trust,” read the joint statement issued by doctors at the Chinatown hospital as well as community physicians affiliated with Tufts.

– Boston.com

According to a report in the Boston Globe, “Blue Cross has been pushing an alternative contract that gives hospitals and doctors a budget for each patient, allowing them to make more money if they can reduce the overall cost of providing care while still meeting quality goals. ”  BCBS has spent the better part of a year trying to get this concept to fly with Boston’s major health care providers.

And reportedly, the original agreement BCBS offered Tufts was in fact,that if the hospital signed the alternative quality contract which bases a portion of reimbursement on “performance quality and not just fee for service,” Blue Cross would pay Tufts more.

And because Tufts refused to sign this agreement, negotiations broke down.

But in a move hailed by both Tufts and BCBS, as “win/win,” Tufts has indeed agreed to come on board the alternative contract plan.

Both Tufts and Blue Cross have agreed not to discuss the specific terms of the agreement and  will not be taking media interviews.

Why?

Well, as previously noted,  it seems the crux of the alternative quality contract calls for physicians and hospitals to be given a “budget” for each patient.  If the doctors and hospital can reduce the “overall cost of providing care while still meeting quality goals,” they stand to make more money.

Blue Cross has been working for years on having more control over patient care as a means of cost reduction.

So what happens if the medical care needed by a patient goes over their “allotted budget?”

And how much more time will physicians have to spend fighting over prescribed patient care with Blue Cross?

And doesn’t a contract that calls for making more money if you provide less” patient care, for surely if the plan results in a reduction in overall costs than that is the intended result, potentially  reduce the medical treatment a specific patient may require?

Has a health care system once based on “fee for service” now become “fees for no/less service?”

Or raises for “less” service?

And doesn’t an agreement that calls for no further details or answers to questions from the media, make you concerned about who, the doctor or the “for profit” insurer, will be ultimately making the decisions about YOUR medical care?

And by the way, how much did your BCBS rates go up for 2009?  And will your increased rates ultimately result in less health care services for you?

So shouldn’t both parties, Tufts and BCBS both be willing to explain the specifics,  and give media interviews, so as to answer these sorts of questions?

Related:

Tufts Medical Center & BCBSMA Reach Agreement

Blue Cross, Tufts break fee deadlock

Tufts Medical Center to Deny Blue Cross HMO Patients

JOHN PRESCOTT

BostonKayakGuy

Top Real Estate Agent for more than 14 years, serving the real estate needs of Wellesley, South Natick, Weston, Needham, Wayland, Newton, Framingham and other MetWest communities. www.johnprescott.net

JOHN PRESCOTT

Vice President

Century 21 Commonwealth

508-523-9252

BostonKayakGuy…The MetWest Scene



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