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Blue Cross, Emergency Room Doctors Reach Deal

Posted on: Friday, 30 December 2005, 18:00 CST

By Felice J. Freyer, The Providence Journal, R.I.

Dec. 30--The doctors who work in the emergency rooms at Miriam Hospital, Rhode Island Hospital and Hasbro Children's Hospital have reached an agreement with Blue Cross & Blue Shield of Rhode Island and will stay in the Blue Cross network.

The eleventh-hour settlement means that Blue Cross will cover doctor's services along with other aspects of emergency-room care at those hospitals, and every other hospital in the state.

The 50 doctors, unhappy with the payment rates Blue Cross had offered, had planned to drop out of Blue Cross' network on Jan. 1. But the new agreement keeps them in the fold.

If the doctors had dropped out, patients would have faced additional costs and paperwork -- but would still have been able to get emergency care at Miriam and Rhode Island Hospitals. Still, the dispute created a worrisome and confusing situation for patients, and hospital officials feared they would choose other emergency rooms.

"It's great news. It's a good way to begin the new year," said John F. Gillespie Jr., senior vice president of Lifespan, which owns Miriam Hospital and Rhode Island Hospital. (Hasbro Children's Hospital is a division of Rhode Island Hospital.)

The 50 doctors are members of the University Emergency Medicine Foundation, a nonprofit group practice affiliated with Brown Medical School. The foundation has a contract with the hospitals to provide physician services in the emergency departments, and also negotiates its own contracts with insurers.

Last month, when talks with Blue Cross broke off, the foundation put out a news release saying that low salaries were making it impossible to recruit new doctors. The group had 10 vacancies, and said it needed higher reimbursements from Blue Cross to fill them.

Blue Cross, the state's dominant insurer with 660,000 members, countered that the doctors wanted 75 percent more than emergency physicians elsewhere in the state, and that meeting their demands would be unfair and unaffordable.

Yesterday, both sides refused to elaborate on their two-paragraph statement announcing the agreement. The statement reveals nothing about the substance of the agreement, nor what broke the impasse. It mentions that the doctors and Blue Cross had "agreed to work cooperatively to address issues of mutual interest such as appropriate use of emergency department services."

Gillespie, of Lifespan, said that hospital officials had no part in the negotiations, but urged the doctors to settle their difference with Blue Cross.

He said that Blue Cross subscribers -- a group that includes most Lifespan employees -- didn't understand how the disagreement would affect them. That created an added source of anxiety at a difficult time for patients, he said. Also, many people might have preferred an emergency department where there would be no question about insurance coverage. Blue Cross had mailed subscribers a list of hospitals whose emergency physicians were in the network.

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Copyright (c) 2005, The Providence Journal, R.I.

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Source: Providence Journal

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