Turn up the heat: The region must keep the pressure on UPMC
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January brings a new year, and for many people the turning of a page. Not so for the impasse between UPMC and Highmark over the hospital system's vow to deny in-network rates to Highmark insurance customers.
Oh, sure, UPMC's sugar-coated TV commercials about its Patient Care Assurance Plan have gone away. So has the steady patter of news stories and commentaries about the $9 billion enterprise's refusal to negotiate a new service agreement with Highmark. Even Harrisburg is quiet about the spate of bills that were introduced only months ago to pressure both parties to come to the table.
It's enough to make you think everything's hunky-dory.
What took all the heat out of the room was the joint announcement, right before Christmas, that millions of Highmark customers will have an extra year to use their UPMC doctors without paying higher, out-of-network charges. That means that June 30, 2013 -- not 2012 -- is the day of reckoning. On that date not only UPMC doctors but also UPMC facilities will no longer be available at lower, in-network rates to patients with Highmark insurance.
The difference between in-network and out-of-network is significant, and in the case of UPMC, out-of-network charges are particularly high. The Post-Gazette's Steve Twedt reported Jan. 12 that a review showed out-of-network charges at UPMC Presbyterian/Shadyside were higher on average than at The Cleveland Clinic and the University of Pennsylvania, double that of Ohio State University and more than double that of Allegheny General Hospital.
The decision to delay UPMC's cutoff of in-network rates for physicians, after a discussion that took place with the help of Gov. Tom Corbett and third-party mediation, was progress and we said so last month. It gives both sides more time to sit down, negotiate and, the public hopes, reach an agreement that will allow Highmark subscribers to keep affordable rates of coverage at UPMC.
Despite this positive step, the largest health care system in Western Pennsylvania remains steadfastly opposed to a new contract with the region's largest insurer. If there was any doubt, let's play back the response by a UPMC executive on Dec. 22 to three questions from a Post-Gazette reporter.
Asked whether the new date was a change in position for UPMC, whether UPMC is reconsidering a long-term contract and whether it will negotiate further with Highmark, the UPMC vice president replied: "no, no and no." So much for a happy new year.
For that reason, Western Pennsylvania must keep pressing UPMC for talks. No one has the right to deny people reasonable access to hospitals built, in part, by their tax dollars, their donations and the breaks accorded UPMC by their public charities law.
Legislators who initiated bills to bring both parties together must keep pushing them toward enactment. Gov. Corbett -- who in November said, "They're both charities and they're both nonprofits, and something is getting lost in between" -- must stay on the case.
It could be that UPMC postponed its physician cutoff as part of a major shift in its PR strategy -- to take the heat off itself, rehabilitate its image and give people more time to become customers of its own insurance plan, which is an underperformer in the market. UPMC even stunned the Gateway School District, Monroeville and Allegheny County this month when it said it would not accept $371,297 in property tax refunds, even though it had received a property tax exemption for its upcoming UPMC East hospital in Monroeville.
Call it the UPMC charm offensive.
But there is nothing charming about yanking affordable access away from millions of insurance card holders, average Pittsburghers who only want quality medicine for themselves and their loved ones. It makes you wonder why UPMC wants to open that $258 million facility in Monroeville while its CEO and board of directors have embarked on a corporate strategy of turning millions of customers away.
It doesn't make sense to add hospital capacity to a hospital system that is erecting barriers to patients. It's also behavior that is unbecoming to a "charity." Now there's a subject for a legislative hearing.
First Published January 22, 2012 12:00 am
