Last week, our community health reporter IsabelleTaft answered your questions about the BCBS/UMMC dispute on Reddit in her first AMA. Take a look back at the conversation: Latest development:
Thanks for the question! To me, the crux of the issue is: Does UMMC need to be paid more than other MS hospitals as the state's only academic medical center and the only place where people in our state can go for specialized care in many areas, and should Blue Cross pay that? Blue Cross argues that its obligation to customers is to keep their rates low, and that to do that it needs to keep its payments to hospitals as low as it can.
According to UMMC, between 2014 and 2017, BCBSMS made annual changes to the rates they pay UMMC that yielded an overall reduction in reimbursement for care. In the 2018 contract, UMMC got an overall 1% increase in our rates from the previous year’s contracted rate. Since then, UMMC says there have been no changes to their rates.
The other major point of contention in the contract negotiations is the Blue Cross quality care program. The program, first rolled out last year, measures hospital performance across 15 different categories that include topics like blood clots after surgeries and the rate of readmissions.
UMMC has quality care programs with other insurers, like Medicaid, but the difference is that program was negotiated between the two parties. Another difference is that the Blue Cross quality care program is directly tied to reimbursement rates. There are penalties for not meeting certain targets, and reimbursement levels are increased if others are met. No other quality program UMMC has with commercial insurance providers is tied to reimbursement rates.
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