ED doctors protest Blues payment shift

Emergency physicians in Massachusetts say the insurer's decision to put payments in patients' hands will be a burden for both plan members and doctors.

By Robert Kazel — Posted Feb. 7, 2005

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Boston-based BlueCross BlueShield of Massachusetts, the state's biggest health plan, instituted a new policy at the start of 2005 under which reimbursements for emergency physicians' professional fees will be mailed directly to patients if a medical group isn't part of the Blues network. Patients will be asked to pay the physicians in turn.

BlueCross already has 90% of the emergency physicians in the state in its networks. The groups that are not -- representing 10 hospitals in the state -- always have received direct payment for their services. Many doctors are accusing the Blues plan of making a blatantly calculated decision to try to force them to accept discounted HMO and PPO fee schedules. The change, they say, will be both burdensome for physicians and perplexing for many patients.

Donald Hansen, MD, head of the ED at Jordan Hospital in Plymouth, Mass., said his group of 14 emergency physicians negotiated with the Blues last year for better fees, but the fees were lower than those offered by other plans in the market.

"They wouldn't budge," Dr. Hansen said. "You can't support a full staff of emergency room physicians on what they were offering. They're just trying to strong-arm their emergency room physician groups."

Deborah Devaux, the Blues plan's senior vice president of health care contract management, said the company's reimbursements to emergency physicians as a whole have been increased by 40% over the past 18 months. Costs must be held down, or some employers will drop employee coverage, she said.

She said the company contends that there's no reason to make life easier for out-of-network emergency physicians by expediting patient reimbursements.

"Why [should the doctors] participate is the question, if the health plan makes it very easy not to participate?" Devaux asked.

Asking patients to forward checks to physicians, though, will make some less willing to seek out emergency medical care, said Elijah Berg, MD, president of the Massachusetts College of Emergency Physicians.

"This method injects confusion into the patient's minds about whether it's a covered service or not," he said. "Sure, [contract] negotiations can be difficult, but injecting patients into it is not appropriate."

Experience shows that when plans send reimbursements directly to patients, doctors' costs rise because of an increased need for billing and collections, said Michael Bishop, MD, an emergency physician in Bloomington, Ind., who serves on the reimbursement committee of the American College of Emergency Physicians.

In addition, patients are unhappy about the extra trouble or, if they're confused about what to do or are dishonest, in a minority of instances simply keep the payments, he said.

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