Highmark-UPMC pact lasts until 2013
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Highmark customers who use UPMC doctors have an extra year not to worry about whether they'll be able to see them without paying higher, out-of-network fees, thanks to a deal announced Thursday between the region's dominant insurer and its health care provider.
The deal clears up the question of whether Highmark customers were going to be left in the odd position of having lower-cost, in-network access to UPMC's hospitals until June 30, 2013, but not its doctors, who could have become higher-cost, out-of-network to Highmark customers next year, under UPMC's view of the contract.
What Thursday's deal doesn't do, state legislators and health care advocates cautioned, was solve the bigger issue of getting the two warring companies to sign a new, long-term deal -- although most saw optimism for that in the announcement.
"I don't know if I'd call it a big Christmas present with a red bow on it, but it's at least a stocking-stuffer," said state Sen. Don White, R-Indiana, who chairs the Senate's insurance committee and has been trying to find some way to push both sides to a long-term agreement.
PG VIDEOFor the last seven months, UPMC has said it will not negotiate a new contract with Highmark because the insurer is in the process of buying UPMC's small, financially struggling rival, West Penn Allegheny Health System, and that now makes Highmark a direct competitor.
In a joint statement Thursday, the two companies said, in part: "The additional time period will provide certainty for UPMC patients and Highmark subscribers. Discussion sessions have taken place with the assistance of Governor [Tom] Corbett and via third-party mediation."
But in their own individual statements Thursday, UPMC saw the deal as merely giving Highmark customers more time to buy insurance other than Highmark, while Highmark saw it as a way to continue to try to get UPMC to enter another long-term contract.
"Highmark will continue to work toward achieving a long-term contract with UPMC that guarantees our members affordable access to all UPMC hospitals and physicians and preserves provider choice," the insurer said in its statement.
UPMC said, however: "This date provides 18 months for UPMC patients and Highmark subscribers to review the multiple competitive health insurance options now available to assure that their care will continue uninterrupted with UPMC physicians and hospitals."
In response to emailed questions about whether the deal was a change in position for UPMC, whether UPMC is reconsidering a long-term contract and whether it would now sit down with Highmark for further negotiations, UPMC spokesman Paul Wood wrote: "The quick answers to your 3 questions are no, no and no."
Even though UPMC had contended in a barrage of ads and in federal court over the last several months that June 30, 2012, was a hard-and-fast date for the end of the contract for its doctors, Mr. Wood wrote: "The simultaneous co-termination of the physician and hospital contracts on June 30, 2013, makes some practical sense."
Highmark had sued UPMC in federal court, contending those ads mislead the public because Highmark believed the contract with doctors, as well as with the hospitals, didn't expire until 2013 -- an issue UPMC has strongly disagreed with, saying it believe it could end the in-network contract for doctors as soon as June 30, 2012.
The federal case is still ongoing in court and though it would seem Thursday's deal resolved the issue at the center of the case, Highmark spokesman Michael Weinstein said: "At this point, the lawsuit continues."
Despite the lingering question of whether Thursday's announcement would lead to a longer deal, politicians and other observers saw hope in it.
"The agreement that we saw this morning between UPMC and Highmark is a positive step, but it is a very, very small step," state Rep. Dan Frankel, D-Squirrel Hill, said Thursday at a previously scheduled news conference at the Allegheny County Courthouse.
Mr. Frankel was one of nine bipartisan House members at the news conference they called to urge the Senate to approve a House bill passed last week that would create a blueprint for dealing with disputes between health systems and insurers like the one between UPMC and Highmark. The bill would force them into binding arbitration if they can't reach an agreement on a new contract.
"For a long-term solution, we urge our colleagues in the Senate to move forward with this legislation," said House Republican Leader Mike Turzai of Bradford Woods.
The legislators were critical of UPMC's stance that it will not negotiate with Highmark, which it sees as a competitor, even though UPMC has long had a health insurance arm.
"Maybe we let UPMC go too far," said Rep. Randy Vulakovich, R-Shaler, sponsor of the House bill. "I don't know."
Leo McCafferty, president of the Allegheny County Medical Society, which represents physicians in the county, said in a separate interview that he saw Thursday's agreement as a small break in the standoff.
"I think Yogi Berra said it best: 'It's not over till it's over.' Maybe a month ago we wouldn't have even reached this point," said Dr. McCafferty, who has an independent plastic surgical practice based primarily at UPMC Shadyside. "I think that great compromises come in baby steps and certainly this is a step in the right direction."
Paul O'Neill, the former Alcoa CEO and U.S. treasury secretary who has been critical of UPMC's role in the dispute, said he saw hope in Mr. Corbett's role in reaching the temporary agreement.
Still, he added, "because the need isn't past, it just kicked it down the road a bit. It provided a little bit of breathing room [to reach a new agreement], but I hope in the meantime no one stops breathing."
Bob Cranmer, a former Republican Allegheny County commissioner who wrote an opinion piece in the Pittsburgh Post-Gazette in November in support of UPMC's position, said he, too, was happy to hear of the agreement.
"I think it's significant that the two sides are talking," he said. "But I do think it will be hard to come up with legislation to force them into an agreement."
Mr. White said he intends to keep pushing for ways to get UPMC and Highmark to reach a new contract.
"But even though this gives us more time to work on it," he said, "I don't want to have this same conversation in a year."
First Published December 23, 2011 12:00 am
