At the end of next year, the contract between the University of Pittsburgh Medical Center and Highmark Health Plan will expire, and many Western Pennsylvanians are worried about losing access to the doctors and hospitals they have patronized for years.
In October, a pair of Pennsylvania House representatives introduced legislation that would impose new rules on nonprofit integrated delivery networks, like UPMC, which offer both healthcare and health insurance.
House bills 1621 and 1622 are sponsored by Reps. Jim Christiana (R-Beaver) and Dan Frankel (D-Allegheny), and would require IDNs to accept all patients regardless of the insurance they hold.
On Wednesday, the House Health Committee heard from UPMC and Highmark, as well as doctors, patients, nurses, trade groups and many others with a stake in the debate.
Christiana said the legislation would have impacts far beyond Western Pennsylvania, as the IDN model becomes the norm in the healthcare industry.
“It is not simply an isolated, regional fight,” Christiana said. “We need to direct the conversation back to patient care and how to protect patient access. If we want to pursue the best quality, highest value healthcare right now, we must have full patient access and complete competition in the insurance market as well as in the provider market.”
Predictably, Highmark is in favor of the legislation, while UPMC is against it.
Dr. William Winkenwerder, president & CEO of Highmark, said he is concerned about patients losing access to care at UPMC facilities.
“We believe the state lacks clear authority to prevent a large hospital or a doctor affiliated with a large delivery system from denying affordable access to care or refusing to treat long-standing patients, even if the patients are in the middle of treatment,” Winkenwerder said.
But Tom McGough, senior vice president and chief legal officer at UPMC, said that most patients in the region will continue to have access to UPMC.
“By Jan. 1, 2015, every insurable resident of Western Pennsylvania will have the option of access to all UPMC facilities and services, with the vast majority of that access being in network,” he said.
That “vast majority” is made up of patients with coverage through Medicare, Medicaid and CHIP — about 50 percent of the market — as well as all consumers with non-Highmark plans.
A UMPC spokesperson said that more and more companies that currently only offer a Highmark option are beginning to switch to other providers.
But Highmark said it is not just a matter of access, it is a matter of affordable access. They say switching from Highmark plans to UPMC plans is not financially feasible for some people.
And then there are folks like Cathy Doerfler of Pittsburgh, who four years ago was diagnosed with scleroderma, a painful auto-immune disorder that causes the buildup of scar-like tissue on the skin. During the course of her treatment, she switched from UPMC insurance to Highmark’s Community Blue insurance plan, but her doctor assured her that their relationship would not be severed.
“Shortly after the change, I received an alarming letter from UPMC,” Doerfler said. “The letter stated that I had 30 days to find a new physician. I was shocked, I tried everything I could to keep this doctor. UPMC even refused (to let me) pay cash, out of pocket for my treatment.”
Christiana and Frankel both expressed concern that stories like Doerfler’s would become more commonplace, as the consolidation of the healthcare industry continues.
There was considerable disagreement at the hearing about whether the proposed legislation would promote or stymie competition in the market.
Diane Holder, vice president and chief communications officer at UPMC Health Plan, the insurance arm of UPMC, encouraged the committee to “look at what the free hand of competition can do … and not to put a bill into place that tries to freeze Pennsylvania methodology in place, that gets in the way of potential innovation.”
While Frankel said he failed to see how requiring a healthcare provider to accept more insurance plans would negatively affect competition, his motivation for introducing the legislation seemed to be more moral than economic, saying, “It’s unconscionable that a healthcare system would simply refuse to see some patients.”
