Doctors scrambling in insurance dispute
By KRIS HUNDLEY, Times Staff Writer
Dr. David McKalip, a St. Petersburg neurosurgeon, was ready to review a surgical patient's X-rays Thursday morning when he learned there weren't any to look at.
The patient, who is insured by BlueCross BlueShield of Florida, was unable to get X-rays at St. Anthony's Hospital because the contract between the insurer and St. Anthony's parent, BayCare Hospital System, was terminated earlier this week.
"Now he's going to have to hustle and find another hospital to do his X-rays," McKalip said of the patient, who is recovering from spine surgery. "It will significantly delay his treatment and my ability to determine whether he's ready to go back to work."
With the state's biggest insurer and the Tampa Bay area's largest hospital system unable to reach agreement, patients and doctors are scrambling to reschedule procedures elsewhere. Competing managed care companies are receiving more inquiries from employers considering a switch. And hospitals that remain in the BlueCross network are preparing for an influx of new patients.
The contract dispute, which resulted in St. Anthony's and six other BayCare hospitals being dropped from the BlueCross network Tuesday, might prove a particular windfall for BayCare's biggest competitor, HCA Inc.
HCA, previously known as Columbia/HCA, has nine area hospitals and will likely reap the most new business as a result of the BayCare vs. Blues deadlock. HCA is involved in its own negotiations with BlueCross; its contracts with the insurer expire Nov. 30.
Dan Miller, president of HCA's West Florida division, declined to comment on negotiations with BlueCross, citing a confidentiality agreement in the contract.
"I can say BlueCross' rates to hospitals are significantly below market," Miller said. "And the numbers BayCare has made public regarding their reimbursement are pretty accurate."
BlueCross spokesman Bruce Middlebrooks said, "We are talking to them right now and have been having some positive negotiations. We hope to reach an agreement."
Don Gaias, an insurance consultant at Towers Perrin in Tampa, said the standoff between BayCare and BlueCross should work to HCA's advantage.
"I think it obviously gives HCA leverage if a deal is not cut with BayCare," Gaias said. "BlueCross had better make a good deal with HCA because they can't afford to lose both" hospital systems.
The BayCare hospitals affected by the contract deadlock are St. Joseph's, St. Joseph's Women's and Tampa Children's in Tampa; South Florida Baptist in Plant City; North Bay Medical Center in New Port Richey; Morton Plant in Clearwater; and St. Anthony's in St. Petersburg.
Members of BlueCross' HMO, PPO and traditional plans continue to have access to 21 area hospitals. Executives at these hospitals say they have not seen a noticeable increase in demand for services. Nor do they foresee serious problems in handling the additional case load.
"We don't expect to see any real changes in our patient volume until the beginning of next week," said Bill Hervey, spokesman for Bayfront Medical Center in St. Petersburg. "We're looking at increasing our staffing and creating more room. And we're communicating with our doctors to let them know we'll be as flexible as possible to accommodate their needs until this dispute gets resolved."
Bayfront's contract with BlueCross runs through October 2003.
Local doctors said there may be some inconveniences ahead.
McKalip, who practices at four St. Petersburg hospitals, said several local operating rooms are already at capacity. "I've had to negotiate blocks of time at hospitals," he said. "If the surgery is short, you'll get in, but if it's for a longer procedure, it might take two to three weeks to get on the schedule. But people's health needs will be met."
Despite the inconvenience, McKalip and other doctors congratulated BayCare for refusing to sign what it considered an unacceptable contract. "BayCare is saying they're not going to take it anymore," McKalip said. "Insurers just move health care dollars from patients to their pockets. And they tell us to take 95 percent of Medicare reimbursement or we'll be dropped."
Gaias, the insurance consultant, said it's possible BayCare will fare better financially outside the BlueCross system, especially with PPO patients. For example, a hospital in the BlueCross network might receive 80 percent of a discounted rate for a PPO member. Out of network, the insurer might only reimburse 60 percent, but of a higher, nondiscounted charge.
(BayCare officials have said they will try to minimize out-of-pocket charges to BlueCross patients, though how they might do so and at what cost to its budget is unclear.)
"If you do the math on the back-end, BayCare may do better on BlueCross' reimbursements now that they're out of network," said Gaias. "I really believe these folks have to come together. But the longer it goes, the less reason there may be to settle."
The longer the stalemate lasts, the more Gaias expects to hear from employers looking for alternatives to BlueCross. "Larger employers, who already have printed enrollment materials for BlueCross really can't make a change until January 2004 at the earliest," he said. "But smaller companies can call another company tomorrow, ask for a quote and offer another option."
In full-page newspaper ads, BayCare has encouraged patients to push for such a switch, even offering phone numbers of competing managed care plans.
Though United Healthcare of Florida said it was too early to see an impact, a spokeswoman for Humana Inc. said its agents have already been giving quotes to employers considering a change.
"And at companies' open enrollment meetings, where BlueCross and Humana are both offered by the employer, we're seeing much greater traffic," said Humana's Pam Gadinsky. "This is affecting us in a positive way."
-- Kris Hundley can be reached at firstname.lastname@example.org or (727)892-2996.
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