[JHeath]

There has been a rumor of SSFHS and Anthem terminating their network agreements, but...let's not jump the gun. Between the two of them, they make up a large part of the healthcare insurance and professional providers in NW Indiana. There's too much money to be lost by both were this to occur.


http://www.post-trib.com/news/1221823,anthem.article

Experts: Anthem, hospital will reach deal
October 15, 2008

By Mark Taylor Post-Tribune correspondent

Local health care experts predict that the Sisters of St. Francis Healthcare Services and Anthem Blue Cross and Blue Shield will most likely kiss and make up before Nov. 2.
That's when St. Francis, Indiana's largest Catholic hospital chain, would withdraw from its contract with Anthem, the state's largest private insurer.

In the interim, however, babies are scheduled for delivery, surgeries are set and tens of thousands of Northwest Indiana residents insured through large employers like NIPSCO and various school corporations are feeling the jitters.

St. Francis said Anthem has failed to pay its member claims promptly and is seeking higher reimbursement rates. Anthem said the 13-hospital system is seeking unreasonably high rate increases that will raise the cost of health care to employers and employees alike.

Gene Diamond, chief executive officer of the Northern Indiana Region of St. Francis, said that Anthem's business within his system represents thousands of patients and tens of millions of dollars.

The Mishawaka-based health system that operates hospitals in Crown Point, Dyer, Hammond, Michigan City and Munster,

"This would mean dislocating physicians, patients and companies we work with at the end of the year and beyond if we cannot reach an accord with Anthem," Diamond said.

Both sides understand the risks involved. Anthem knows that if large employers' employees lack access to hospitals in their area, they might switch to another insurer.

And St. Francis' termination announcement puts employers on notice at the same time of the year when insurance contracts typically end. St. Francis also knows that Anthem insures a sizable number of its patients, who could panic and schedule their deliveries and surgeries at other hospitals.

Anthem spokesman Tony Felts said St. Francis and his company have engaged in contract talks for more than one year. "Anthem is negotiating to keep health care costs affordable, while the Sisters of St. Francis are seeking a 50 rate rate increase over the next 39 months. When you consider that the cost of medical inflation is between 5 percent and 7 percent, this far outstrips those costs," Felts said.

"In this challenging economic time a 50 percent rate increase over a three-year period is not acceptable and we know it will have a negative impact on the cost of health care for our customers."

Felts conceded that Anthem's new software billing system has delayed payments to St. Francis and other health-care providers. The company covers 2.5 million Hoosiers.

Greg Yust, St. Francis vice president of managed care contracting, denied that St. Francis is seeking a 50 percent rate increase.

"We would agree that both sides need each other," Yust said. "SSFHS has been successful in securing long term agreements with Aetna, Humana and Sagamore in the past year and we hope to do the same with Anthem."

Nadine Derek, an independent health-care consultant from Lakes of the Four Seasons, said the complaints from both sides sound eerily familiar. "We've been through this before," said Derek, recalling other highly publicized contract negotiations between large insurers and big hospital systems, most recently in Chicago. "They're trying to push each other into a corner and see who'll cry uncle first. Neither can afford to ignore the other. What we usually end up seeing is midnight resolution. But in the meantime, patients are the victims in this brawl."

Merrillville insurance broker Carla Cohen of the Braman Insurance Agency agreed, saying the imbroglio is stirring unnecessary chaos and panic.

"In places like Crown Point and Michigan City where SSFHS has the only hospital, people are worried. But this tactic is very common. If they fail to come to an agreement it could get pretty serious. I expect they will, but it could come down to the last hour.

Cohen said. "It will cost patients more money to go out of network and the doctors and hospitals will lose patients and money if they don't settle."

But Cohen advised calm. "I'd say stay tuned. A lot can change between now and Nov. 2. I wouldn't advise anyone to jump the gun yet."

[Roger Kaputnik]

This is where we will find out why monopolies are usually not good for normal, tennis-shoe-wearing folks.

[stop 39]

This is where we will find out why monopolies are usually not good for normal, tennis-shoe-wearing folks.

This is actually more of an ologoply, we have options with other healthcare providers as well as other insurance carriers.

[Roger Kaputnik]

Did someone sneak in another hospital into MC?





An oligopoly is a market form in which a market or industry is dominated by a small number of sellers (oligopolists). The word is derived from the Greek for few (entities with the right to) sell. Because there are few participants in this type of market, each oligopolist is aware of the actions of the others. The decisions of one firm influence, and are influenced by the decisions of other firms. Strategic planning by oligopolists always involves taking into account the likely responses of the other market participants. This causes oligopolistic markets and industries to be at the highest risk for collusion. [http://en.wikipedia.org/wiki/Oligopoly]



Because I am familiar with Anthem, I can see something else going on. As the Gentle Reader will doubtless know, many health care providers contract with insurance companies to reduce the fees charged to patients. This usually is quite a large reduction, maybe to 40%. Claiming that Anthem is defaulting on the contract is a way to stop charging those reduced fees. My concern is that fees are about to take a big upward hike. This would affect all the hundreds of physicians employed by the Sisters, too, not just the hospital charges.

I hope that this is just a negotiating tactic by the Sisters when the new contract comes up with Anthem.

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...amp;TM=50104.84

Regional hospitals may refuse Anthem insurance holders

Deborah Sederberg
The News-Dispatch

Thousands could face out-of-pocket fees if deal isn't reached by Nov. 2.

MICHIGAN CITY - On Nov. 2, the Anthem Blue Cross/Blue Shield contract with the Sisters of St. Francis Health Services might terminate.

If that happens, it could affect tens of thousands of Anthem insurance customers in Indiana, including several thousands in La Porte County.

All La Porte County employees are covered by Anthem, as are employees of La Porte Community Schools, and ArcelorMittal Steel Co.

"SSFHS has tried to remain a good partner with Anthem through their claims payment problems that have been ongoing for almost a year," the sisters said in a letter to officials who buy insurance for employees and sell insurance to individuals. "We continue to receive feedback that other hospitals and physician groups have encountered similar issues.

"Because claims problems continue, SSFHS has provided notice that the contract with Anthem will terminate Nov. 2, 2008, due to lack of timely claims payment."

Gene Diamond, regional CEO of the Northern Indiana region for the Sisters of St. Francis Health Services, said he isn't ready to allow his organization to take the blame for contract termination.

"We believe Anthem breached the contract (by failing to pay in a timely manner) and there are provisions in the contract for dealing with that," he said.

Among the hospitals owned by the Sisters of St. Francis Health Services is St. Anthony Memorial here, as well as hospitals in Indianapolis, Beech Grove, Mooresville, Lafayette, Crawfordsville, Crown Point, Hammond, Dyer and Munster. Also affected are some 300 employed physicians in more than 60 professional practices, among them Health Partners Medical Group and Working Well in Michigan City.

Tony Felts, communication director for Anthem Blue Cross/Blue Shield of Indiana, said the disagreement is not about payment issues, but rather about rates. He claims SSFHS is asking for a 50 percent hike within 39 months after a contract is signed. "We have been negotiating for about a year now," Felts said. "The contract negotiations predate service-related concerns." Anthem insures about 2.5 million people in Indiana. His company is mandated to keep health care costs down, Felts said.

"We have offered Anthem competitive rates if they are able to resolve their operational issues," said Greg Yust, vice president, managed care contracting for SSFHS.

"SSFHS has recently completed long-term contracts with Aetna, Humana, CIGNA and Sagamore," he added.

Yust said the sisters also offered to bring in a third-party negotiator.

Thousands of patients insured by Anthem are served by SSFHS, Diamond noted, "and the last thing we want to do is to dislocate all those patients or their employers."

Diamond is hopeful an agreement can be reached within the next couple of weeks. Felts and Yust expressed similar hopes.

Anthem patients who do not have access to an insurance plan within the SSFHS network will be treated as out-of-network clients at SSFHS facilities, Yust said. That would mean paying higher out-of-pocket fees, depending on the services required.



Contact Deborah Sederberg at dsederberg@thenewsdispatch.com.

[Southsider2k12]

A couple of tidbits that came out before the meeting last night regarding the insurance issue. St Anthony's has had problems receiving timely payments from Anthem, including some taking as long as a year or more. The other issue is that the hospital received significantly less reimbursement for certain procedures than do other area hospitals.

[southyards]

I’ve heard from my insurance representative that the St. Anthony/Anthem issue does not affect anyone that is on a traditional Medicare Supplement with Anthem. St. Anthony's is only looking at terminating the Anthem network for discounts.

[Roger Kaputnik]

See post #4 above!

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...ArticleID=18290

Anthem
Insurance firm, Sisters in dispute

Editorial

As if there wasn't enough to worry about with the economy taking us on a roller coaster ride, now it appears that those who have insurance with Anthem have to worry about being able to visit their local doctor or hospital.

Anthem Blue Cross/Blue Shield and the Sisters of St. Francis Health Services, the parent company for St. Anthony, Health Partners and other local care facilities, are arguing over money. Now, the people who might ultimately need medical services could find themselves having to dig deeper into their pockets for treatment.

And if they can't afford it, they'll have to go out of town for treatment.

It's a ridiculous dispute that has left tens of thousands of Hoosiers covered by Anthem in a bind. The Sisters of St. Francis own 11 hospitals, employ 300 physicians and own 60 professional practices in Indiana.

The dispute, as most disputes are, is over money. It boils down to how much the Sisters of St. Francis can get in reimbursement from Anthem. The hospital network wants more than it is getting now, but Anthem is balking at the amount of the increase being sought by the Sisters of St. Francis.

The hospital network says it has renegotiated contracts with Aetna, Humana, CIGNA and Sagamore insurance companies and wants Anthem to do the same. Both sides claim they expect to reach an agreement soon and that people needing treated shouldn't worry.

That's easy for them to say. The people who need treatment for cancer, a broken arm or who have already made plans for the birth of a child are now left wondering whether their insurance premium is worth the paper it's printed on.

It's bad enough they feel powerless as they watch the value of their 401k disappear. Now they're being used as pawns in a game of financial brinksmanship between two powerful health care businesses.

Our Opinion
The Issue:

Anthem Blue Cross/Blue Shield balks at increase sought by Sisters of St. Francis.

Our Opinion:

This financial brinksmanship is using patients as pawns in a game.

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...ArticleID=18356

Urge Anthem to settle with St. Anthony
In its editorial Wednesday, The News-Dispatch addresses the insurance reimbursement dispute between Anthem and Sisters of Saint Francis Health Services (SSFHS), of which St. Anthony Memorial Health Centers is a part, and states patients "are being used as pawns in a game of financial brinksmanship."

That is not the case. Our mission at St. Anthony is to care for our patients, and we do not see our fellow community members and patients as "pawns." We exist to protect the health of the community, the economic vitality of the greater Michigan City area, and to continue our top quality performance. SSFHS and St. Anthony are not receiving fair or timely reimbursement from Anthem, and we must have this to continue to serve our community. For over a year, SSFHS has negotiated with Anthem over the issue of year-old unpaid claims and the fact that Anthem pays other hospitals significantly more than St. Anthony and SSFHS for the same services. Reluctantly, when all else failed, we terminated the current contract.

Anthem and St. Anthony are different. Anthem is a for-profit company, with a primary goal of financial return to its stockholders. St. Anthony is a non-profit organization, with a mission to care for those of the Michigan City area, as well as Chesterton, Westville, and New Buffalo. We provide state of the art technology and have recently installed two cardiac catheterization labs and a CT scanner. We must have fair and timely reimbursement to operate these and all our services. We have proposed to Anthem that a neutral observer participate in the talks, but so far Anthem has not accepted.

We are making every effort to resolve this dispute as soon as possible. We will make allowances for Anthem patients after Nov. 3 if an agreement has not been reached. Anthem patients are our friends and neighbors, and we wish them no anxiety.

But I want you to know this - the community needs St. Anthony Memorial for three key reasons:

1. We provide high quality of care 24 hours a day in all weather conditions. We perform open heart surgery, deliver babies, and treat motor vehicle accident victims. We treat all and provide millions of dollars of charity care annually.

2. We are a critical and large component of our local economy. We are one of the largest employers in the area, employing more than 1,000 from our area.

3. We have won several national quality of care awards this year, recognizing us for top health outcomes in heart, orthopedics, and intensive care unit care. This is a new source of great pride for the Michigan City area, as it shows that we Michigan City area residents can compete successfully with the best-performing organizations (for-profit or non-profit) in the United States.

The editorial calls Anthem and SSFHS "two powerful health care businesses," but we're the ones saving lives in the middle of the night. We've been caring for Michigan City folks for more than 100 years. We are the home team!

We are critical to the Michigan City economy, are your friends and neighbors. We are proud that these friends and neighbors are winning national quality of care awards! We are here for you.

If you hold Anthem insurance, I urge you to contact Anthem and urge them to reach agreement with SSFHS and St. Anthony Memorial.

Jim Callaghan, M.D.

President

St. Anthony Memorial Health Centers

[Roger Kaputnik]

See post #4 above!

See post 4.

I can change the last sentence to This Is A Negociating...

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...ArticleID=18437

Kora: Patients should speak to Anthem
MICHIGAN CITY - One way to deal with the standoff between the Sisters of St. Francis Health Care Services Inc. and Anthem Blue Cross/Blue Shield of Indiana would be for patients to take up the cause, Dr. Vidya Kora says.

For example, they might want to think about negotiating with employers for coverage by a different company. And they might want to think about telling Anthem officials what they are doing.

With assets in excess of $3 billion, a network of 13 growing hospital campuses in Indiana and Illinois, the Sisters say they may be forced to terminate their relationship with the health insurance company because Anthem has failed to pay in a timely manner.

Anthem, however, has a different view. Tony Felts, communication director for Anthem Blue Cross/Blue Shield of Indiana, said the disagreement is not about payment issues, but rather about rates. He claims SSFHS is asking for a 50 percent increase within 39 months after a contract is signed.

"We have been negotiating for about a year now," Felts said.

Gene Diamond, regional CEO of the Northern Indiana region for the Sisters, isn't ready to allow his organization to take the blame for contract termination.

"We believe Anthem breached the contract (by failing to pay in a timely manner) and there are provisions in the contract for dealing with that," he said.

Unions representing employees who are insured by Anthem also can participate in applying pressure to the insurance company as they discuss with employers the possibility of buying insurance for someone else, he suggested.

The founder of the Franklin Clinic and former chairman of the La Porte County Democratic party who will finish his term as county coroner at the end of the year, Kora knows something about political organizing.

Legislators usually understand the organizing process as well.

State Rep. Scott Pelath, D-Michigan City, is concerned about the stalemate between the sisters and Anthem.

"At a local candidate forum Sunday evening (Oct. 19) in St. Francis Hall at St. Anthony Memorial, more than half the candidates there said they had been born at St. Anthony," Pelath said. The legislator lives just about a block from the St. Anthony emergency room.

A rupture between the sisters and Anthem could affect thousands of Indiana patients, he said. "Many state employees are with Anthem, he said, and all county employees as well as the La Porte teachers and the United Steel workers at Arcelor-Mittal.

Pelath has experience in insurance negotiations at the state level and has offered to set up an intermediary relationship between the sisters and Anthem.

"We have been in favor of working with an impartial third party all along," said Dr. Jim Callaghan, president and chief executive officer of St. Anthony Memorial, one of the hospitals owned by SSFHS.

As for the reimbursement rate, Callaghan said, "We want fair treatment." He encourages patients to "side with their physicians" in the matter.

Felts said he was unaware of Pelath's offer. As a spokesman, he said, he is not privy to all the elements of negotiation.

In a news release this week, the sisters said, "For more than a year, St. Anthony Memorial and the Sisters of St. Francis Health Services have worked diligently to resolve claims issues with Anthem while seeking contract terms comparable to other hospitals in the marketplace. Long-term agreements have successfully been secured with Aetna, Humana, Sagamore and Cigna. It is the hope of all at St. Anthony Memorial that an agreement will be reached with Anthem. SSFHS is seeking to be reimbursed at the same rate Anthem pays other hospitals for like procedures.

"At this time, Anthem members and all physicians can continue to use St. Anthony Memorial without disruption of services. After Nov. 2, St. Anthony Memorial hopes to have in place options that will allow Anthem patients to continue receiving services without incurring additional out-of-pocket expenses through the remainder of 2008."



Contact Deborah Sederberg at dsederberg@thenewsdispatch.com.

[Roger Kaputnik]

Another misleading headline from the ND: St A will not "refuse" treatment to or turn people away because they have Anthem insurance. They will still see the patient but the patient will have to file on his own for insurance benefits and will not get the discounted price for services.

This is about the negotiated prices for services between St A and Anthem, as noted above (see post 4). Once again, CBTL has the skinny on what is going on!

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...amp;TM=47111.78

St. Anthony using patients as pawns
You've got to admit, the guy's got nerve! And the makings of a bona fide political candidate! Jim Callaghan, M.D., in his letter Friday, "Urge Anthem to settle with St. Anthony," appeals to the public and bellyaches about how the poor "non-profit" - just one of a huge conglomerate-organization - isn't using their "patients as pawns." His letter is urging them to be pawns!

Being in cahoots with insurance, drug, health-care facilities, construction and other profitable organizations, he shouldn't worry about his profit margin. (Are there no profit-motivated stockholders in any of these alliances?)

And, his "new source of great pride for the Michigan City area ... shows residents can compete..." This comment is really out of line! The public is NOT competing; he is! Health care should be available for EVERY local citizen, not just his precious insured ones.

The "new" IS being experienced by residents all right! In our real world, there is a financial crisis too. He needs to share his "winning national quality of care awards" with the public so they can afford food, clothes, shelter, gasoline ... and health insurance.

Clarence Grott

Westville

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...ArticleID=18443

Use La Porte Hospital instead for quality care
In an article Monday, Dr. Vidya Kora urged patients utilizing Sisters of St. Francis Health Care Services Inc. to speak with Anthem about potentially asking employers for insurance coverage by a different carrier in response to the current negotiations and possible termination of the contract between SSFHS and Anthem.

I propose another alternative. Use the physicians and health care services of La Porte Regional Health System/La Porte Hospital. They welcome all patients with Anthem coverage. Physicians of La Porte Regional Health have offices on County Road 400 North, in Michigan City and on Johnson Road, which are conveniently located between La Porte and Michigan City.

La Porte Hospital is electively accredited by Joint Commission of Healthcare Organizations, which is important as patients because it ensures we get safe, quality care. In addition to this, La Porte Hospital is one of a very small percentage of hospitals nationwide that has received Magnet Designation for excellent nursing services. I know if I am a patient in the hospital, I want great care by the nurses at a hospital that is adequately staffed. These are only few of the several awards and accreditations this hospital has been given. They provide excellent care.

Just as important as this is the fact that La Porte Hospital and physicians value my individuality and my freedom of religion. Not I, nor anyone in my family will be denied/or make it burdensome to receive at La Porte common treatments and medical regimens such as birth control pills, tubal ligation and vasectomies based on their beliefs, but will give me the right to choose based on my own beliefs.

For these reasons, I encourage all patients to look at all the options available to them, getting medical services provided to them by La Porte being one of them.

Carol Gunter

Michigan City

[Roger Kaputnik]

Why don't Anthem policyholders call the Sisters and tell THEM to settle? I do not think the average snakeskin-boot-wearing public sees them as a not-for-profit entity. A construction company?! Huh???

[JHeath]

Why don't Anthem policyholders call the Sisters and tell THEM to settle? I do not think the average snakeskin-boot-wearing public sees them as a not-for-profit entity. A construction company?! Huh???

My thoughts exactly, Roger. While people need to know that they can still receive care through SSFHS with their Anthem plans, it will be much more expensive at an out of network rate. What do you do if you're in the midst of a cancer treatment plan or if you're in the hospital (and it's beyond your control)? It's not exactly simple to switch care providers in certain instances...and I can come up with a lot of scenarios for this.

What a mess they've made...

[JHeath]

As if things weren't enough of a mess, I just heard that St. Anthony's is changing insurance providers, and is offering their employees a plan through none other than ANTHEM. How's that for irony?

Hey, N-D...pick up a story here.

[Roger Kaputnik]

Nationwide single-payer eliminates this scramble for our money.

[Southsider2k12]

http://thenewsdispatch.com/main.asp?Sectio...ArticleID=18617

Anthem, Sisters close to reaching agreement

Laurie Wink
The News-Dispatch

MICHIGAN CITY - A contract agreement is close to being reached between Anthem Blue Cross/Blue Shield of Indiana and Sisters of St. Francis Health Services Inc., the parent company for St. Anthony Memorial in Michigan City.

The contract has been extended to Friday, Nov. 7, according to Jim Callaghan, chief operating officer and vice president of medical affairs for St. Anthony Memorial.

After a weekend of intense negotiations, both organizations reported that "significant progress in negotiations have taken place and both SSFHS and Anthem are confident that a long term contract extension will be completed in the next few days," according to a statement.

"Hopefully we will have an agreement sometime this week," Callaghan said.

"We know it's been an anxiety-ridden situation for everybody and we're looking forward to having it resolved," Callaghan said Sunday evening.

The contract was scheduled to terminate at midnight Sunday.