Hospital fires back over Anthem claim



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Exeter Hospital is taking issue with Anthem Blue Cross and Blue Shield in New Hampshire over treatment of its medical staff as the contract dispute between the hospital and the state’s largest insurer heats up. Robert Noonan, vice president of provider engagement and contracting at Anthem, had characterized Core Physicians as a group practice of physicians that Anthem said was fully employed by the hospital. With the insurer embroiled in a dispute with Exeter Hospital -- which it says is the highest-cost hospital in the state -- it notified physicians, including those affiliated with Core, that reimbursement for Anthem members admitted to Exeter could be seriously affected. But Dr. Michael Pangan, a family practitioner and board manager of Core, Mark Whitney, vice president of strategic planning for Exeter Hospital, and Glenn Klink, vice president of managed care contracting at Exeter, emphatically rejected the claim that Core is part of the hospital. "The hospital and Core are distinct," said Whitney. "Core is an LLC, with its own board and management infrastructure. The physicians are not employees of the hospital." On Oct. 1, Anthem sent a letter to every physician it was aware of who had practicing privileges at Exeter Hospital, including Core. According to Exeter officials, Anthem said in the letter that if a new contract isn’t approved before the Dec. 31 deadline, Exeter Hospital’s medical staff provider agreements with the insurer would also terminate. This has created something of a Catch-22 for the physicians of Core. While Core and the hospital may be separate entities with separate Anthem contracts, Pangan said, of the 120 physicians in the group, only "half a dozen" have privileges at hospitals other than Exeter. "Like most contracts, there’s a whole host of compliance provisions in Core’s contract with Anthem, including the stipulation of having privileges at a participating hospital," said Klink. "If that hospital has been dropped, the physicians will be in breach and will be dropped." Pangan said to apply and receive privileges at another hospital in three months would be next to impossible. "To be credentialed at a new hospital by Jan. 1 would be logistical nightmare," he said. "The process takes months. And there would be no way to link up our electronic records with another hospital’s system." Klink said he was concerned that another group practice, an independent OBGYN physicians' group, could be in a similar situation. "They, too, only have privileges at Exeter," he said. "What are they going to do?" Whitney said he does not understand what he called Anthem’s "callous disregard for where patients get their health care." Exeter officials said they also are concerned that Anthem continues to market Exeter as a participating provider for 2011 to employers in the area. "They are selling policies for next year as if Exeter is still a member when it may or may not be," said Whitney. Klink added: "We have asked them to stop, and they have refused to do so." Exeter Hospital’s sunsetting contract was described by Anthem/s Noonan as being "evergreen," meaning its provisions can rolled over year after year. But because of the high cost of health care all along the continuum, "that type of contract was unsustainable," said Noonan. He said Exeter charges about 50 percent more for the same procedures as other hospitals around the state. "We are negotiating to bring rates in line with others, but still allowing financial stability for the hospital and access for our members," said Noonan. Exeter’s Whitney said Anthem is using old data and the severity of illness of the patients at Exeter was underrepresented. "That ‘50 percent more’ statement is from a 2008 report. It’s an outdated and inaccurate claim," he said. "It doesn’t reflect what we’ve been doing in the past six years to slow the growth of cost." Klink said the hospital has undertaken significant measures to hold cost increases to around 3.5 percent. "Last year, we kept increases to less than 2 percent," he said. "This year, they were around 2.5 percent." But when asked why the New Hampshire Insurance Department’s cost-comparison tool shows a typical gall bladder removal surgery costing $14,000 at Exeter and $8,500 at Elliot Hospital in Manchester, Whitney said, "It totally depends on how the reported charges are bundled. It’s nearly impossible to make an apples-to-apples comparison." The Exeter representatives are characterizing the contract negotiations as remaining "at a standstill." Klink said that while he "concedes we previously negotiated a better contract with Anthem in the past than some other hospitals," Anthem’s proposed new contract called for "draconian" measures. "They have proposed three years of year-over-year reimbursement cuts. To think that an organization can survive with three years of reductions." said Klink. "We have been modifying our rates for the last six years. We cannot continue to run an organization with draconian cuts without making draconian cuts ourselves and destroying the underlying system." At this point, Anthem members are still covered for care at Exeter Hospital. Its current contract runs through Dec. 31. The state Insurance Department automatically extends Anthem’s coverage for 60 days beyond the expiration date, and the insurance commissioner can extend the period for additional 60 days beyond that. "There is no immediate threat," said Whitney. Klink said Exeter’s next step is to continue with its "education campaign," which includes a blog posted on the hospital’s Web site home page. "We want our patients to be very aware of what’s going on," he said. "We are encouraging people to go to the blog and get engaged." – CINDY KIBBE/NEW HAMPSHIRE BUSINESS REVIEW Leadbeater returns to Belknap econ development agency Eliza Leadbeater of New Hampton has been returned to the helm of the Belknap County Economic Development Council with her appointment as interim director of the economic development agency. She takes over the job following the departure in September of Jennifer Boulanger. Leadbeater was the first executive director of the BCEDC, serving from July 1992 until her retirement in April 2007. During her tenure, she helped to create the Belknap County Revolving Loan Fund, programs focusing on relocation assistance, and a business information center, among other accomplishments "It’s an interesting time for the council," said Leadbeater. "This truly is an interim position – I’m retired, but I have to admit I missed it." Leadbeater has also been instrumental in the development of the Granite Media Center in Tilton, a soundstage and offices for those working in the film and creative industries, as well as a myriad of other projects focused on economic and rural development and small-business support in the Lakes Region and around the state. She was named Outstanding Woman in Business by NHBR in 2007 and was the winner of the newspaper’s 2004 Business Excellence Award in Public Service. "The council is determined to find the right person to serve as its new executive director and recognizes that the search process may take a number of months. However, we also recognized that this is a very important time for the county and that we could not defer work on economic development projects until our new executive director is hired," Michael Persson, chair of the BCEDC. "The board was extremely fortunate to have someone with Eliza’s experience agree to assist us with these projects while we continue to conduct our search." – CINDY KIBBE/NEW HAMPSHIRE BUSINESS REVIEW Edit ModuleShow Tags