Monday, August 02, 2010

FROM THE HUDSON INDEPENDENT--UPDATE RE: EMPIRE AND STELLARIS HEALTH NETWORK CONTRACT DISPUTE

Feiner Steps In To End Impasse Between Insurer and Hospitals
Village Workforces Affected By Stalemate
by Robert Kimmel | July 29 2010Greenburgh Town Supervisor Paul Feiner is interceding in the unsuccessful negotiations between the health insurer for hundreds of town and other municipal employees, and the network of local hospitals, where, he says, the town’s employees now have only “limited access.”

Mark Wager, president of Empire Blue Cross Blue Shield, has agreed to Feiner’s request to meet with him and other municipal leaders at Greenburgh Town Hall on August 11.

“I’m pleased that he has agreed to meet because a lot of people are hurting because of this stalemate,” Feiner said. He added he hopes that Wager’s meeting with elected officials can help get the contract talks moving.

Empire Blue Shield has not been able to reach agreement for many months with the Stellaris Health Networks, operator of four area hospitals, including Phelps Memorial, White Plains Hospital, Northern Westchester and Lawrence Hospital Center. Approximately one third of Westchester County residents are reportedly out of the hospitals’ network of care because of the impasse.

The workforces of Tarrytown, Irvington and Sleepy Hollow’s are covered by Empire Blue Cross.

“It has been a major inconvenience for our employees, most of whom would prefer to go to Phelps for their needs,” Sleepy Hollow Administrator Anthony Giaccio said.

The breakdown in talks has also affected the access to the four hospitals for thousands of others with individual and group health policies with Empire BlueCross. In a statement released this past week, Feiner stated, “Employees can’t get the surgeries they paid for at the hospitals of their choice even though we are paying for the insurance.”

The insurance company, however, cannot restrict emergency care access at the hospitals, nor does it in any way affect persons with other coverage, such as Medicare. Phelps Hospital, in a letter to patients, stated, “ as a courtesy, we will continue to submit a claim in your behalf to them,” (Empire Blue Cross). The hospital asks that any such payments be forwarded to it.

In a letter to Wager from Feiner, the supervisor noted that “representatives of the majority of towns and municipalities throughout Westchester County recently hosted a meeting with representatives from Stellaris and the network’s hospitals. Those in attendance now have a better understanding of the issues that challenge the hospitals and why they cannot accept inadequate rates of reimbursement.”

He also said he plans to call another meeting of mayors and other municipal officials and that he “hopes pressure from elected officials will lead to the conclusion of negotiations and the resumption of service.” In order to bolster his pursuit of a settlement, Feiner also is asking town employees to provide him with stories of hardship caused by the contract’s termination, so that he can present them to the insurance company.

According to Stellaris Health, publicly available data shows that its hospitals “are paid less by Empire compared to similar hospitals in the state and across the nation. The non-profit health care operator goes on to state, that, “All we are asking for is that Empire Blue Cross pay us rates that are similar to what they are paying comparable hospitals in our state and around the country. Our need for adequate payment comes after years of underpayments from Empire, and we need to fix this contract now.”

The Hospital network said it operates at a one percent operating margin, as compared to what it claims is the $1 billion in profits that Empire Bloue Cross has “amassed” over the last three years in the New York region. A letter signed by representatives of the four hospitals, notes that, “our hospitals are required to provide care to anyone in our communities who needs our services. regardless of ability to pay. “Over the past two years, we have provided over $22 million in uncompensated charity care.”

Empire Blue Cross points out that it did not cancel its contract with Stellaris but the health systems operator, “allowed its contract to expire when they refused to accept a generous offer from Empire, (20 percent over three years), to increase their rates in an amount that would more than cover cost increases,” and “...keep health care affordable.” The insurer, in a statement released late in July, said that it “gave them an opportunity to earn additional reimbursement for quality improvements.

Instead, Stellaris is demanding new reimbursement rates that would increase the amount you pay for services at their hospitals by over 40 percent in three years,” the statement continued. Empire Blue Cross said it wants “ to ensure that there is a rational connection between what we pay to Stellaris and the value Stellaris delivers.” And it claims that Stellaris receives rates from Empire, “comparable to what Empire pays other community hospitals.”

Knowledgeable observers point out that Feiner apparently has to see the two sides considerably narrow their positions on the thorny issues separating them before negotiations can lead to a positive contract settlement