The Sanitas-HCSC venture will evaluate future expansion in the five-state region where Health Care Service owns Blues plans on a “market-by-market basis,” executives said. Financial terms of the relationship aren’t being disclosed, but those involved say Sanitas and HCSC Ventures will contribute capital to “fund the start-up of the medical centers and the joint venture will contract with Sanitas to operate the medical centers.”
A federal judge in Alabama has ruled against UPMC in its bid to allow Blue Cross Blue Shield insurance plans nationwide — other than Highmark in Pittsburgh — to contract directly with the Pittsburgh health care giant.
The ruling Tuesday by U.S. District Court Judge R. David Proctor of the Northern District of Alabama rejected UPMC’s request to intervene in a 7-year-old lawsuit against Blue Cross Blue Shield plans by some of the insurance association’s members. The ruling can be appealed.
If the ruling stands, it could restrict patient volume at UPMC’s flagship hospitals in Pittsburgh after June 30 by making it harder for anyone with Blues coverage and living outside Pennsylvania to get treated there. More than 100 million members have coverage through Blue plans nationally.
Meanwhile, in a separate lawsuit, this one in the Pennsylvania Supreme Court, UPMC rival Highmark said it is bracing for the “immediate wrecking ball” of having to pay UPMC list prices after June 30 for its members who receive emergency care at UPMC hospitals — estimating that the cost for these services could increase by hundreds of millions of dollars.
About 7,000 urology and radiation oncology patients learned this week that their doctors will be dropped from their Empire BlueCross BlueShield insurance networks effective June 1.
It’s the second time in a week that a large LI-based provider network said it was being kicked off Empire networks without warning.
In the latest move, Integrated Medical Professionals of Farmingdale, a urology and radiation oncology practice with 52 locations, said it had been informed by Empire that its doctors are being taken out of the network.
Law360 (April 17, 2019, 9:37 PM EDT) — Western Pennsylvania’s top hospital group can’t try to sever exclusive licenses between Blue Cross Blue Shield and regional health plans as part of a larger antitrust brawl over the insurance giant’s dominance of geographic areas, an Alabama federal judge ruled Tuesday.
University of Pittsburgh Medical Center — which has fought a seven-year battle with Pennsylvania nonprofit insurer Highmark over contracts with UPMC providers — has sought to intervene in multidistrict litigation involving claims that Blue Cross has flexed its powerhouse status to divvy up regional health markets.
But U.S. District Judge R. David Proctor said the hospital system’s bid to get involved in one of the suits against Blue Cross was untimely because of the complex legal fight playing out in Pennsylvania, where state Attorney General Josh Shapiro has filed court papers to ensure patients are still covered at several UPMC providers tangled in the dispute.
Law360 (April 17, 2019, 6:22 PM EDT) — Health care providers and insurance subscribers asked an Alabama federal judge to certify several classes in their sprawling litigation accusing the Blue Cross Blue Shield network of stifling hospital reimbursements and hiking purchasers’ premiums with a scheme to divvy the market among its members.
The groups centered Monday’s certification bids on Alabama hospitals, physicians and companies, as the case against the network’s Alabama affiliate will be the first to go to trial, although dozens of other Blue Cross members across the country are targeted in the long-running multidistrict litigation centered on Blue Cross members’ alleged agreements to not compete with one another.
In that same vein, the provider group — which includes emergency services facilities, surgery centers, long-term health care facilities and doctors, among others — are only seeking damages for Alabama acute care hospitals for the time being, as counsel for the providers said there’s a “crucial need” for those facilities to get relief now.
“Acute care hospitals are all the same kind of entity facing the same kind of problems, and frankly, there’s a real emergency with respect to them,” Joe Whatley of Whatley Kallas LLP, representing the providers, told Law360 on Tuesday.
Those hospitals alone are owed nearly $4.4 billion from the insurance behemoth, the providers contend, and Whatley said for the six years this case has been pending, about a dozen of these hospitals have gone out of business in Alabama.
By: Morgan Haefner
Becker’s Hospital Review
Hospitals and health systems are among the largest employers in the U.S., according to a 24/7 Wall Street analysis cited by USA Today.
Here are 16 states where hospitals are the largest employers, based on the most-recent employee counts examined by 24/7 Wall Street:
1. Alaska: Providence Health & Services (Renton, Wash.)
2. Arizona: Banner Health (Phoenix)
3. Connecticut: Yale New Haven Health System
4. Delaware: Christiana Care Health System (Newark)
5. Idaho: St. Luke’s Health System (Boise)
6. Maine: MaineHealth (Portland)