Independence Blue Cross of Philadelphia suing local community hospital.

[NRSKarenRN, BSN, RN]

Grand View Hospital publishes ads backing its stand in Blue Cross flap

Public relations blitz asks insurer to be 'fair' to the West Rockhill institution in contract negotiations. Newspaper notices include signatures of thousands of supporters.

07/19/01

By LISA KOZLESKI And JOE McDONALD

Of The Morning Call

http://www.mcall.com/html/news/quaktwn/b_pg001_e2b1_2grandview.htm

The battle over medical reimbursements between Grand View Hospital and Independence Blue Cross is moving to the public relations arena.

Full-page advertisements proclaiming community support for the hospital began appearing today in The Morning Call, The Philadelphia Inquirer, The Intelligencer in Doylestown and The Reporter in Lansdale, said hospital spokeswoman Anita Fordyce.

"Our community stands behind Grand View,'' the ad says. In the background are thousands of names -- 4,129 in all, the ad says, "and growing.''

The signatures were collected over 72 hours on cards distributed in the West Rockhill Township hospital's lobby and doctor's offices and at local employers, Fordyce said.

The ad also contains a letter, addressed to G. Fred DiBona Jr., chief executive officer of Independence Blue Cross (IBC) in Philadelphia. It was paid for by the hospital.

It urges DiBona to negotiate a contract with Grand View that is "fair and reasonable to the hospital.''

Negotiations for a new contract remained at a stalemate on Wednesday, although both sides have stated their interest in another meeting.

According to Grand View Hospital Chief Executive Officer Stuart Fine, the latest direct contact between the hospital and officials at the largest health insurance provider in southeastern Pennsylvania was on Monday, when Grand View and Fine were sued by Blue Cross for libel, slander and bargaining in bad faith.

Fine and attorneys for Grand View called the lawsuit a "heavy-handed negotiating tactic." Fine said Wednesday that attorneys for the hospital have filed arguments asking that the suit be dismissed. A spokesman for Blue Cross could not be reached for comment Wednesday evening.

At issue in the contract dispute is the amount of money Independence Blue Cross will reimburse Grand View for the treatments and services it provides Blue Cross patients.

Earlier this week, Fine said the Bucks County hospital loses millions of dollars each year because Independence Blue Cross does not reimburse Grand View for the entire cost of its care of Blue Cross patients. Fine estimated that Grand View probably would lose $5 million in the next 12 months if it continues to be reimbursed under the terms of the existing contract, which will expire July 31.

The two sides have offered proposals and counterproposals but have not been able to reach a compromise.

At the request of Fine, U.S. Rep. Jim Greenwood, a Republican from Bucks County's 8th District, called DiBona earlier this week.

According to Fine, Greenwood said DiBona "indicated they [blue Cross] were willing to meet," Fine said. "We sent another note yesterday [Tuesday] asking to please let us know when. Congressman Greenwood said he asked Mr. DiBona how the hospital can meet with Blue Cross when we were just hit with a lawsuit. Mr. DiBona said something to the effect that that issue is one of the first things we will discuss."

If the dispute is not resolved by the end of the month, those with Blue Cross insurance still would be able to go to Grand View for emergency care but would have to go to other hospitals for nonemergency treatments.

Grand View is the third hospital that IBC has sued over the past 1 1/2 year. Prior was Children's Hospital of Philadelphia and Thomas Jefferson Health network. This is being done in the name of "COST CONTAINMENT" as insurers don't want to pay for full cost of services, and expect discounted rates. Now when they can't agree with facility over the discounted cost, they are starting to take facilities to court over "bad faith bargaining".

Facilities can only discount costs so far--usually 10-15% off of UCR (usual and customary rates). Hospitals are losing ton's money as only two dominate insurers: IBC and AETNA are in the Philadelphia region. Monopolistic practices by these insurers have occured for years. Hospitals are only now realizing they can't continue to operate in the red due to too deeply discounted prices; accepting the cuts for fear patients would go to competitor's facilities. They have begun to realize that they have power too.

Insurance companies have an obligation to have enough facilities/providers in their network that can provide the services their insurred customers need. AND the insurred customer is telling the insurance company who THEY want as provider of services.

This has lead to the meaga mergers of the past few years as facilities mearged to cut cost, get services/supplies at cheapest prices "buying power". However, consumers didn't want to have to go 10-20 miles down the road to see the only specialist/surgeon/hospital that their plan wound cover, so in some areas they switched insurances, accepted out of pocket expenses to keep long term provider or if provider changed location (due to practice bought out) they follwed provider to new location.

All this MONEY being spent on NON-Essential services, marketing/PR, name changes, "build it better and larger, they shall come" while eliminating long term employees who kept the practices/facilites running ....and now LAWSUITS! My 2 cents. Karen

[fiestynurse]

I applaud Grand View Hospital for standing-up to Blue Cross. Our local hospital here recently did the same thing, with positive results. However, it's a risky, "boston tea party," kind of move for a hospital. I have to say that the ad in the paper was a bad move on the hospital's part. They should have trusted the local community to support them, without resorting to these tactics.

I wish them luck in battling this lawsuit by Blue Cross.