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Insurers and hospitals fight while patients suffer

December 27, 2019

Topics: Quote of the Day

California Medical Association, December 23, 2019

Cottage Hospital System has initiated a contract termination with Anthem Blue Cross that affects three hospitals in the central Santa Barbara area. If the two parties fail to come to an agreement by the end of the year, the contract will terminate effective January 1, 2020.

The California Medical Association (CMA) is very concerned that if the termination becomes effective, Anthem may not be meeting geographic access standards and patients will be forced to travel long distances to receive services at in-network facilities. CMA has asked the Department of Managed Health Care (DMHC) to closely monitor the situation, given the potential disruption to patient care.

As a result of the pending termination, Anthem is requiring its contracted physicians who only have privileges at Cottage hospitals to obtain privileges other in-network facilities. Physicians who do not do so will have their Anthem contracts terminated, which will further impact access to care in the Santa Barbara area.

Based on the list of alternative hospitals Anthem listed in its notice to physicians, it appears that most patients will not have access to an in-network Anthem facility within DMHC’s geographic access standards… There is a high probability that many of Anthem’s contracted physicians will not be able to travel the distance to treat Anthem patients.

CMA is also concerned that this termination is happening after the Covered California enrollment period just closed. Unless Anthem was proactively disclosing to prospective enrollees that these three facilities would not be in-network, patients who enrolled with the plan expecting the Cottage Hospital System to be available in their network will be blindsided.

It remains to be seen whether the two parties will come to terms before the contract termination becomes effective. CMA will provide additional information on this situation as it becomes available.

https://www.cmadocs.org…


Comment:

By Don McCanne, M.D.

The Partnership for America’s Health Care Future was formed to oppose Medicare for All. Amongst its members are America’s Health Insurance Plans, representing the insurers, and the American Hospital Association, representing the hospitals. The American Medical Association was a member but dropped out after its own members demonstrated shifting support towards Medicare for All. Patients are not represented.

Not surprising, this dispute is between insurers and hospitals, both opposed to Medicare for All. The dispute places at risk care of the patients and the ability of physicians to provide that care.

The conclusion is obvious: Let’s dump our current system that allows insurers and hospitals to negatively impact patient care because of a dispute over money, and replace it with a system that ensures care will always be there when needed: a single payer model of Medicare for All. Above all, that benefits patients; the physicians are becoming ever more supportive; the hospitals will do fine after they replace their administrators who may not be dedicated to public service; and the insurers… we’ll find them jobs that will benefit society instead of harming us.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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