Tag Archive | "East End Health Alliance"

Empire and Hospital Alliance Forge Agreement

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By Bryan Boyhan

For the past eight months most subscribers to the East End’s largest health insurer were unable to enjoy the benefits of their insurance at the East End’s three local hospitals without first being admitted through the emergency room. Patients who are covered by Empire Blue Cross Blue Shield, which insures thousands of people in the five East End towns, including those employed by local school districts and municipalities, who needed to be admitted for procedures were told they would have to go to one of the other nearby hospitals, such as Brookhaven or Stony Brook University Medical Center, if they wanted to be covered.

The standoff between Empire and the three local hospitals in the East End Health Alliance — Southampton, Eastern Long Island and Peconic Bay Medical Center — ended last week with the signing of a 33-month agreement between the two parties. It also involved the behind-the-scenes help of a cast of local politicians, including assemblymen Fred Thiele and Marc Alessi, state senator Ken LaValle and, chiefly, congressman Tim Bishop, who Alliance spokesperson Paul Connor singled out.

“We are especially grateful for the unwavering support of Congresssman Tim Bishop, whose assistance was instrumental in bringing this negotiation to a conclusion,” said Connor in a statement.

The protracted negotiation hinged largely on one issue: at what rate the local hospitals would be reimbursed for service.

In an interview this week Connor, who is CEO of Eastern Long Island Hospital, said the Alliance was satisfied with the outcome.

“We wanted to get to a market rate and we achieved that,” he said.

During the negotiations, the Alliance argued the East End hospitals were not being reimbursed as well as other hospitals on Long Island. The relatively small size of the local medical facilities puts them at a disadvantage when negotiating, and was one of the reasons they joined together to form the Alliance.

“I would say we’ve reached an equitable agreement,” said Sally Kweskin, spokesperson for Empire. “It’s good for our members.”

All the while the Alliance was arguing they were not being reimbursed fairly, the insurance company said they only wanted to pay a rate that would prevent an increase in premiums to subscribers.

“We believe it achieves a balance between our cost and providing access,” said Kweskin. “We wanted an agreement that would be affordable to our members.”

Kweskin said the deal would not directly affect the cost of premiums.

“But that’s not to say other factors might not,” she quickly added. “Like the cost of pharmaceuticals or treatments.”

Said Connor: “It’s been an admittedly long road. At this time, however, we are forward looking and are pleased that we were able to reach an agreement with Empire that challenges us to be mindful of costs but also enables us to invest in initiatives and systems that will promote long term affordability and accessibility of healthcare services on Long Island for our growing communities.”

The newly-negotiated agreement runs through the end of the 2012 calendar year, and reinstates all the programs subscribers were entitled to, including both commercial and Medicare products.

While negotiations are completed with Empire, the Alliance is currently re-negotiating a contract with insurer Cigna.

“I wouldn’t be surprised if that went down to the wire, too,” said Connor.

He was, however, more optimistic about these negotiations.

“Empire was the only one we’ve ever gone out of network with.”

Empire and Health Alliance Near a Resolution

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By Bryan Boyhan

After months of grim news — or no news — there is a tone of optimism in the voices of those in the middle of the negotiations between the three East End hospitals and the region’s largest insurer, Empire BlueCross BlueShield. Since this past summer the sides have been at impasse, struggling mostly over the cost of reimbursement the insurance company would pay the hospitals of the East End Health Alliance, including Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital.

The impasse has put those hospitals out of the Empire network and, except for emergency care and a handful of other provisions, has forced Empire-insured patients to hospitals further west — such as Brookhaven Memorial and Stony Brook University — if they want to be covered by insurance.

“We’re very optimistic,” said Empire BlueShield BlueCross director of public relations Sally Kweskin, yesterday. “We’re keeping on track with negotiations.”

This is good news for the Empire-insured, since much of the talk over the past few months has been that the two sides were far apart and it was increasingly unlikely that negotiations would be successful.

“We’re looking to have some resolution in about two weeks,” said Kweskin.

“There are still some fundamental issues,” she said, “but we have made some progress on outside issues.”

The Alliance would agree.

“For the past couple of weeks we’ve made more progress on key issues than we have in the past five months,” said Paul Connor, president of Eastern Long Island Hospital and spokesperson for the Alliance.

He added, however: “I need to be cautious here. There is still work to do.”

Connor was hesitant to put a time frame on the negotiations, and said working out reimbursement schedules was “a fairly complex process.”

“There are all different types of rates,” he said.

Connor said there was no particular turning point that seemed to allow negotiations to open up.

“As time went by, we found more things we could compromise on,” he said.

He also credited Congressman Tim Bishop for helping to keep the two sides focused and moving forward.

“He’s been working very much in the background,” said Connor. “We’ve had a lot of help with this.”

At present, Empire-insured patients have full access to their doctors, but only limited access to the local hospitals. If admitted under emergency status, patients would enjoy the benefits of their prescribed coverage. But for scheduled procedures, they would need to go to an in-network hospital in order to get insurance benefits. The exception to this under certain plans would be if the patient lived beyond thirty miles of an in-network hospital.

Patients who are receiving benefits at one of the three member hospitals will be reimbursed directly by Empire. Those checks must then be signed over to the hospital as payment for the service.

Empire BlueCross and Hospital Alliance at Impasse

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The quiet period that had been exercised between insurer Empire BlueCross BlueShield and the three hospitals of the East End Health Alliance expired in the past two weeks as negotiations between the two parties have reached an impasse.

The Alliance took the opportunity recently to post on its website a message that argues, repeatedly, “Empire puts profits over patients.”

For their part, Empire posted on its website on October 12 an update that claims the Alliance is seeking an increase in reimbursements that is “unnecessary and would result in an immediate jump in health care costs on Long Island.”

The insurance company — which represents more clients on the East End than any other provider — and the local hospitals, including Southampton Hospital. Eastern Long Island Hospital and Peconic Bay Medical Center, have been at odds since this past summer, when negotiations first broke down at the time the agreement between them expired, and patients with Empire coverage were no longer covered by the hospitals. Since then Empire has made some concessions, and certain senior patients and those living within certain local zip codes, who live beyond 30 miles from another participating Empire Hospital (ie. Brookhaven or Stony Brook) would be covered at the Alliance hospitals.

In a posting on their website, Empire claims one reason the sides have not reached an agreement is that the Alliance is demanding an increase of over 60 percent over a 21 month period, adding the reimbursement rate would be greater than the reimbursement given to other similar hospitals in the state. The company says it has offered the Alliance several proposals, including the most recent a multi-year agreement with a “substantial” rate increase and a one time payment allowing the hospitals to invest in programs and operational changes which, it claims, would make the hospitals more efficient.

The Alliance argues that its hospitals are “among the most cost effective in the state”

“But Empire pays us less than it costs to treat you and your family when you need us — and significantly less than every other managed care insurance company we deal with,” read a post on the Alliance website.

What happens next?

“We’ve put reasonable proposals in front of them,” said Craig Andrews, an Empire spokesperson. “We’ve left it in their court.”

 “Empire BlueCross BlueShield remains willing to agree to a new, multi-year contract with substantial increases for EEHA hospitals, despite the difficult economy we all face,” said the insurer. “But there is a point where reason, and the hospitals obligation to manage their operations more effectively, must become a priority. The cost of health care is everyone’s responsibility, including EEHA hospitals.”

Empire Moves to Make Sure Local Docs Stay in Network

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As negotiations between the three East End hospitals and the area’s largest insurer continue in silence, a spokesman for Empire BlueCross BlueShield confirmed this week that the company is arranging to keep local physicians in network, even while the local hospitals will not be.

Prior to this decision by Empire, local doctors who have admitting privileges to hospitals that are members of the East End Health Alliance — including Southampton, Eastern Long Island and Peconic Bay Medical Center — would have fallen out of network on September 29.

But a spokesperson from Empire confirmed yesterday that the insurance giant is working on a deal to keep the patients of those same physicians covered.

“We’re reaching out to the doctors now,” said Craig Andrews, media relations representative for Empire. “Members will be getting letters as well.”

The September 29 date falls 60 days after the hospitals’ contract with Empire was terminated, leaving patients on the East End with a choice of traveling further west on the island to an in-network hospital for such procedures as elective surgery, or going to a local hospital and be treated as an out-of-network patient. In response, the local hospitals, all agreed to waive certain fees in an effort to bring costs down. Patients admitted under emergency status, however, are still treated as in-network and enjoy the benefits of their specific plan.

Tentatively, and Andrews said details were still being worked out, the arrangement with physicians will allow them to remain in-network and care typically associated with a physician will still be covered based on an individual’s plan. In case of hospitalization, however, the patient would still be considered by Empire as out-of-network in an Alliance hospital. Andrews said Empire is working on an arrangement to allow local physicians to gain admitting privileges to other Long Island hospitals covered by Empire, including Stony Brook and Brookhaven.

Empire and The Alliance Negotiate in Silence

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Now almost into the third week since the August 1 deadline passed, effectively excluding the three East End hospitals from the Empire Blue Cross Blue Shield coverage network and preventing East End residents from being covered when using their local area hospitals, both camps have grown quiet. The East End Health Alliance — comprised of Southampton Hospital, Peconic Bay Medical Center and Eastern Long Island Hospital – has been at odds with health insurance provider Empire Blue Cross Blue Shield during the contract renegotiations over the rate of reimbursement that Empire gives for patient procedures.

Over the past weeks both Empire and the Alliance have been vocal in their displeasure with the other side. Congressman Tim Bishop, who came out on the side of the alliance, said “no reasonable person can describe Empire BCBS’s posture here as negotiating in good faith” at a July 20 press conference. While Jill Hummel, Vice President of Health Services for Empire Blue Cross Blue Shield, in an August 5 interview, called the Alliance “unconcerned” with their patients welfare before the August 1 deadline.

Accusations of lying and profit-mongering have been leveled on both sides, and negotiations looked for a while at a standstill. As late as August 5 Alliance Spokesperson Paul Connor III said that he was “not optimistic” about reaching a compromise with Empire anytime soon.

But what a difference a week makes, as an agreement between both parties looks more likely than ever. Last week both camps voluntarily agreed to an indefinite “quiet period” where they both agreed to put a halt to all press conferences and statements. An Empire spokesperson said the “quiet period” is meant to put an end to the bickering on both sides so the renegotiation process could go on unmolested.

Connor, wishing to respect the “quiet period”, refused to comment about the contract negotiation except to say that, “There has been a lot of discussion and negations with Blue Cross…some progress, I am more optimistic than I have been.” 

Deadline Passes, Hospitals Will Waive Some Fees for Empire Policy Holders

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By Andrew Rudansky

With the passing of the August negotiations deadline, the three member hospitals of the East End Health Alliance  — Southampton, Peconic Bay Medical Center and Eastern Long Island — are now no longer in the Empire Blue Cross Blue Shield network. But the Alliance has agreed to make it less painful, financially, for local residents insured by Empire.

The main point of contention in the negotiations is the rate at which Empire would reimburse the Alliance hospitals for services rendered to patients.

In response to passing the deadline the Alliance has adopted a new policy, waving any additional co-pay charges, for elective procedures, that Empire policy holders would incur for being “out-of-network.” Paul Connor III, President of Eastern Long Island Hospital and spokesperson for the East End Health Alliance said that the premise of this policy was to try to eliminate any of the costs that Empire puts on its members for using any outside facilities.

“Yes we could be losing money,” said Connors, “but we believe that it would be an advantage for the out-of-network holders if they could still use Alliance hospitals, that they are used to using.” Citing the “greater good” Connors believed that the policy would be “a gesture towards the community.”

In response to this news Hummel said, “We are very happy that they are concerned with the financial impact of these negations on their members.” Hummel added that she wished the Alliance had exhibited this same concern for their patients before the deadline passed on August 1.

Despite the passing of the deadline both sides are committed to continue the negotiation process.

Craig Andrews, Public Relations Director at Empire Blue Cross Shield said that Empire’s “goal has been to resolve this, it is our goal to get them back in our network.”

Empire has refused several offers made by the Alliance calling the proposed rates “not realistic.” Jill Hummel, Vice President of Health Services for Empire Blue Cross Blue Shield called the rates proposed by the Alliance as “far in excess of what we offer to comparable hospitals.”

The Alliance has maintained that the rates they have proposed, rates that Andrews claims are between a 50 to 60 percent increase from the pervious agreement, are “market rates,” rates similar to the ones the Alliance has with other insurance providers. Andrews says that Empire’s counter offers to the Alliance are in the “double-digits” but would not elaborate further. Hummel said “We put on the table a very substantial multi-year proposal,” one that she claims would be adequate to cover the operating needs of an efficiently run hospital.

Congressman Tim Bishop, who held a joint press conference with the Alliance on July 20, is not the only politician to side with the hospitals during the contract negotiations. State Assemblymen Fred W. Thiele, Jr. said “I come down on the side of hospitals.” Thiele says that the dispute between Empire and the Alliance is adversely effecting many of his constituents. Thiele as well as all of the other members of the New York State Assembly are policy holders of the states insurance plan, a plan Empire Blue Cross Blue Shield provides.

The failure of both sides to come to an agreement prompted the Alliance announced that they were going to hold a press conference on Friday August 7, at 10 a.m. at the Peconic Bay Medical Center in Riverhead. Expected to attend the press conference would be State Senator Kenneth P. LaValle, State Assemblymen Marc S. Alessi and Thiele. Thiele, a Republican, said that this press conference with Alessi, a Democrat, transcended partisan politics. “This is about the public welfare,” said Thiele.

However on Tuesday, August 4, a second press release was sent out announcing that the press conference would be cancelled. Thiele said the cancellation of the press conference was an “indicator that serious negotiations might restart.”

In photo above, Congressman Tim Bishop and Alliance spokesman Paul Connor at press conference two weeks ago.

Still No Deal With Empire BlueCross BlueShield

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The contract negotiations between Empire Blue Cross Blue Shield and the East End Health Alliance are reportedly still at a standstill. With only one day left, before the deadline (Friday at midnight) — when 40 percent of Eastern Long Islanders would no longer be covered at local Alliance hospitals — things do not look good.

Paul Connor III, spokesman for the Alliance, said, “Anything is a possibility…but when I see how far we still have to go I am not optimistic.”

Craig Andrews, Public Relations Director at Empire Blue Cross Blue Shield, said, “we gave them our proposal, they sent back a counter proposal but not much has changed. The rates in the proposal they sent us are too high.” Andrews added, “It is only Wednesday and we do have up until midnight on Friday.”

Regardless of the deadline, emergency cases and pregnant women beyond the first trimester would still be covered at local hospitals.

Bishop Aids Health Alliance in Fight With Empire

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By Andrew Rudansky

With only 11 days left before Empire Blue Cross Blue Shield’s contract with several area hospitals expires, The East End Health Alliance, a partnership between Southampton Hospital, Eastern Long Island Hospital in Greenport, and Peconic Bay Medical Center in Riverhead, is scrambling to return to the negotiating table. Congressman Tim Bishop, a Southampton native, intervening on behalf of the alliance held a press conference at the Southampton Hospital’s Parrish Memorial Hall this Monday, July 20 urging Empire BCBS to return to the negotiating table to renew the contract before the July 31 deadline.
“I don’t want to be melodramatic and suggest that we are on the verge of a health care crisis,” said Congressman Bishop, “but we are certainly on the verge of a tremendously adverse situation that affects public health on eastern Long Island.”
This situation should not be unfamiliar to many local residents, as this isn’t the first time the East End Health Alliance has run up against insurance companies. In May of 2008 with Oxford Health Insurance and then once again in September of 2008 with GHI/HIP, the Alliance both faced stern opposition at the negotiating table. In both of those cases the Alliance was able to successfully negotiate new contracts.

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Empire BCBS is much different than Oxford Health Insurance and GHI/HIP in terms of scope. Empire BCBS is Eastern Long Island’s largest health care provider, covering over 40% of all policy holders in the area. Many of these policy holders receive their Empire BCBS coverage from public schools and municipal jobs. The Alliance claims that they cover over 300,000 residents between the three of them, and if 40% of that number could no longer be covered by their insurance plan when they are admitted to those hospitals it would be, said Bishop, “intolerable and suggests that patient well-being is a secondary concern to [Empire BCBS’s] bottom line.”
Andrew J, Mitchell, President and CEO of Peconic Bay Medical Center said, “There are so many different varieties of health plans within the Empire BCBS product line, that it would be very difficult to estimate the number of people” that would be unable to come to Alliance hospitals due to insurance problems. Mitchell added that without adequate reimbursement from the insurance companies, Alliance hospitals could not provide the same scope of services that they currently do provide.
“[Current negotiations] are really going nowhere,” said Paul Connor III, President of Eastern Long Island Hospital and spokesperson for the East End Health Alliance. Connor was impressed with Congressman Bishop’s interest in the issue. “Tim [Bishop] is a tremendous advocate for our hospitals and health care,” said Connor.
Bishop used the platform to reiterate his support for a government alternative to the current health care system. “This is exhibit A on why we need comprehensive health care reform,” said Bishop.
If the contract expires before a settlement can be made many local area Empire BCBS policy holders could be redirected to hospitals in Patchogue or Port Jefferson, or be required to pay “more expensive out-of-network rates.”
Even if the two sides fail to come to some sort of agreement before the July 21 deadline, New York State law mandates that all emergency patients or pregnant women in their first trimester be admitted to a hospital regardless of their insurance status. Also only Alliance hospitals will be affected and personal doctors will remain unaffected.
“I believe this status results from Empire’s failure to negotiate in good faith,” wrote the congressman in a letter addressed to Mark Wagar, president and CEO of Empire BCBS and Angela F. Braly, president and CEO of WellPoint. The letter, written directly after the press conference, stated that the Alliance hospitals are asking for reimbursement rates similar to ones they have with other insurance providers. Similarly, according to the letter, the rates proposed by Empire BCBS would result in a loss of $500 per day by hospitals.
“No reasonable person can think that this is sustainable, no reasonable person can describe Empire BCBS’s posture here as negotiating in good faith,” said Bishop at the press conference.
George D. Keckeisen, MD, president of the Southampton Hospital Medical Staff, said, “This is a problem that needs to be addressed…and we hope that with the pressure we can bring to bear from the both health care provides, both the physicians community and nurses, in addition and in conjunction with the hospitals administration…that the Blue Cross provider will actually come to the table and make a realistic proposal that we can all live with.”
Bishop’s strongly worded letter concluded with the congressman saying that he might request a federal investigation of unfair practices in the negotiations if Empire BCBS does not capitulate to what Bishop believes are more reasonable rates.

Top: Congressman Tim Bishop with Paul Connor III, spokesman for the East End Health Alliance, at Monday’s press conference.

Inset: Bruce LaValle, R.N., speaking with Jasmine Dozier, R.N. (left) and Diane Groneman, R.N. (right).