AMCs React to Being Shut Out of Some Exchange Plans
At 958-bed Cedars-Sinai Hospital in Los Angeles, president and CEO Thomas M. Priselac has similar concerns because only one health plan, HealthNet, has plans that include contracts with Cedars-Sinai physicians.
Those who buy plans through Blue Cross, Blue Shield, Aetna, and Cigna will go elsewhere under in-network pricing because, he says, "though we talked with all of them… at the end of the day we were not able to reach agreement on a price that was sustainable."
Priselac says that the scenario the AAMC's Conroy suggests, where health plans were offering rates 30% lower than what they pay for non-exchange commercial plans for care at that hospital, "is not atypical" of what happened at Cedars-Sinai.
He emphasizes that health plans are not seeing the academic medical center in the right context. Rather than excluding Cedars-Sinai because of its high costs, Priselac says, health plans should understand that academic medical centers like his are community resources that "provide a significant volume of treatment for the most advanced care medicine can provide," with large research and teaching programs, "that location is more expensive, but the system overall saves money because it's cheaper to have those costly services in one area so you don't duplicate the people and the equipment."
Where insurance companies get it wrong, he says, is that they make judgments based on cost comparisons in a narrow geographic area.
In time, when the population within the exchanges becomes clearer and patients realize what they have bought, Conroy hopes "clearer heads will prevail. We all want the exchanges to work. We just have to figure out how. And we can't anticipate all the bumps in the road that we'll have to work through to get there."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- CEO Exchange: Preparing for Population Health
- Advocate, NorthShore Deal Would Create 16-Hospital System
- EHR Systems 'Immature, Costly,' AMA Says
- Better HCAHPS Scores Protect Revenue
- Narrow Networks Cut Costs, Not Quality, Economists Say
- 3 Strategies for Retaining Millennial Employees
- 'Early Offer' Malpractice Programs May Spur Reform
- Power of price: In South FL and the nation, healthcare costs often are shrouded in secrecy
- Hospital mergers may lead to higher prices