Tufts Medical Center Battling Blue Cross

On January 9, 2009, there was an editorial in the Boston Globe detailing Tufts Medical Center’s struggle to receive fair reimbursement rates from Blue Cross Blue Shield of Massachusetts. Here’s the straight scoop: Hospitals like Tufts that are not part of a larger healthcare system or network are at a disadvantage when negotiating with BCBS because they simply don’t have the leverage. Because of its size, if a group like Partners HealthCare in Massachusetts were to walk away from negotiations with BCBS, the insurance company would definitely feel the pain. It goes without saying that because of its size and leverage, Partners hospitals get much better reimbursement rates from BCBS than does Tufts Medical Center. Meanwhile, Tufts is an inner city hospital that sees the sickest, most complex cases in the region and its physicians deserve to be fairly reimbursed.

Blue Cross Blue Shield of Massachusetts – Big on Profits, Not Patient Care

Quoting from the Globe editorial: “Tufts deserves a better deal from Blue Cross. And the state deserves a better payment system than the current one – a monument to inequity and inefficiency.” I agree.

BCBS Massachusetts – Big Pay for its Executives, Not for Local Physicians

At a time when hospitals, medical centers and many Americans are struggling to survive, Blue Cross Blue Shield generates big profits. They made nearly $209 million in net income off of $6.7 billion in premiums in 2007, with operating income of more than $53 million. (Source: Boston Business Journal) I went to their website and the 2008 Annual Report has not yet been published. And they have a tradition of richly compensating their executives. Cleve Killingsworth, president and CEO of Blue Cross Blue Shield of Massachusetts, ended 2007 with total compensation of more than $3.6 million. Former BCBSMA chairman and CEO William Van Faasen was paid more than $16 million as part of his overall retirement package in 2006. He remained as the company’s chairman through the end of 2007. (Source: Boston Business Journal)

The real risk here is to healthcare consumers, people in Boston who have BCBS as their insurance provider, who may no longer be able to see their physician of choice should Tufts and BCBSMA not be able to reach an agreement. It is possible that beginning February 1, Tufts Medical Center and Floating Hospital for Children physicians and affiliated practices will no longer be able to accept BCBSMA’s HMO plan.

There is a Facebook Group titled “Tufts Medical Center Campaign for a Fair Contract” where you can go to register your support for Tufts and your indignation at BCBSMA’s practices. Tufts has also set up a website to answer questions about the conflict and offer up your opinion. The website URL is www.keepmydoc.org.

You can contact BCBSMA at 800-262-2583 or email grievances@bcbsma.com. Or feel free to contact the members of their Board of Directors:

Blue Cross Blue Shield of Massachusetts Board of Directors

George R. Alcott III
President, Local 1301, Communications Workers of America
Plymouth, MA

Mara G. Aspinall
Senior Advisor
Genzyme Corporation
Cambridge, MA

Brian M. Barefoot
(Retired) Former President, Babson College
Babson Park, MA

Samuel Cabot III
(Retired) Former Chairman
Samuel Cabot Incorporated
Newburyport, MA

Helen G. Drinan
President
Simmons College
Boston, MA

Richard C. Garrison
Senior Vice President and Catalyst
Vertex Pharmaceuticals, Inc.
Cambridge, MA

Paul Guzzi
President and Chief Executive Officer
Greater Boston Chamber of Commerce
Boston, MA

Robert J. Haynes
President
Massachusetts AFL-CIO
Malden, MA

Marian L. Heard
President and Chief Executive Officer
Oxen Hill Partners
Boston, MA

Philip W. Johnston
President
Philip W. Johnston Associates
Boston, MA

Cleve L. Killingsworth
Chairman of the Board and Chief Executive Officer
Blue Cross Blue Shield of Massachusetts
Boston, MA

Karen Kruck
Senior Managing Director and Head of Strategy
State Street Global Advisors
Boston, MA

Gloria C. Larson
President, Bentley College
Waltham, MA

William G. Lavelle, M.D.
Professor and Chairman
Department of Otolaryngology
University of Massachusetts Medical School
University of Massachusetts Memorial Medical Center
Worcester, MA

James H. Lunt
President and Chief Executive Officer
Rogers, Lunt & Bowlen Company
Lunt Silversmiths
Greenfield, MA

Ralph C. Martin II
Managing Partner, Bingham McCutchen LLP
Managing Principal, Bingham Consulting Group
Boston, MA

Robert F. Meenan, M.D.
Dean
Boston University School of Public Health
Boston, MA

Benaree P. Wiley
Principal, The Wiley Group
Brookline, MA

Post by Dan Dunlop, The Healthcare Marketer