10/29/13 — BCBS, hospital head back to table

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BCBS, hospital head back to table

By Matthew Whittle
Published in News on October 29, 2013 1:46 PM

A meeting Monday between Wayne Memorial Hospital CEO Bill Paugh and Blue Cross and Blue Shield of North Carolina CEO Brad Wilson did not bring an end to the current impasse over the future of their relationship, but it did at least restart the discussion.

In a joint press release Monday night, both the hospital and the insurance company announced their intent to immediately restart negotiations, which have been stalled for nearly two months.

"We think the meeting was productive," Blue Cross spokesman Lew Borman said this morning. "It was an open discussion."

On Sept. 5, Blue Cross announced that it would terminate its contract with Wayne Memorial on Dec. 5 if a new agreement was not reached by Dec. 4.

Its primary concern is that the current contract gives the hospital the ability to raise Blue Cross rates for outpatient procedures because they are tied to a fixed percentage of the basic charge.

The insurance company is pushing for a contract that would allow it to negotiate allowable rates on outpatient procedures that are independent of the hospital's basic charges -- a fixed rate for a fixed amount of time. It is, Blue Cross officials say, a provision that is standard in all of its new contracts.

The hospital, however, has balked, saying that such an agreement would jeopardize its long-term financial health and ability to improve facilities and bring new services to the county.

And so since September, the two sides have been preparing for the contract termination, which would put Wayne Memorial in out-of-network status for Blue Cross customers.

Now, however, while that deadline still exists, both sides expressed a measure of hope that an agreement can be reached.

"We both agreed it is in the best interest of the citizens of Wayne County for both sides to come back to the table to attempt to achieve a compromise," Paugh said in the release Monday. "We need to make the best use of everyone's time between now and the expiration of the current contract, and we are directing our teams back to the negotiating table to make that happen."

"Today's conversation was a good start," Wilson agreed in the release Monday. "While challenges remain, both sides agreed to work as hard as we can in the days ahead to reach an agreement that provides our customers access to quality, affordable health care."

However, Borman said, just because the two sides are talking again, that does not mean the insurance company has changed what it wants.

"The issues are still the same at this point," he said. "We're looking for agreement on the foundational principles we talked about" -- meaning the provision that led to the impasse is still a focal point of any discussion.

But, Paugh said this morning, at least it is on the table for discussion.

"We talked about getting back to the table, because there's never going to be a resolution without both parties at the table. And we agreed the negotiating teams would go back and take a look at all of the points of contention," he said. "And we both agreed there aren't things we can't talk about, though as we've said all along, the devil's in the details.

"But both sides want to reach a resolution that meets the needs of the people we serve in this community."