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PA Internists ask General Assembly to Investigate Highmark Losses, Decisions

(Harrisburg)  The PA Chapter of the American College of Physicians has asked the House and Senate Insurance Committees to investigate Highmark’s losses from the Afffordable Care Act coverage, its decision to cut physicians payments by 4.5%, and contracting issues which allowed the insurer to use doctors as a risk pool, rather than use the billions of dollars it keeps in its reserves for such losses.

A copy of the letter to the House Insurance committee is printed below:

April 13, 2016

Honorable Tina Pickett, Chair
Honorable Anthony DeLuca, Democratic Chair
House Insurance Committee
Room 315A Main Capitol
Harrisburg, PA 17120

Representatives Pickett and DeLuca:

Highmark’s recent announcement that it would reduce payments to physicians by 4.5 percent starting April 1 is jeopardizing patient care and could result in further narrowing the network of physicians able to provide services under the Affordable Care Act.  Physicians who actually take care of these patients should not pay the price for the giant corporation’s inability to properly price its products.

It is unconscionable that physicians and other health care providers who work 24/7 taking care of our patients are mandated to take a pay decrease because an insurer mispriced its product.  I am writing today to ask you and the House Insurance Committee to review the Highmark action, the role of reserves and existing contracting procedures, and to require a more realistic system that ensures the patient comes first.  

The PA Chapter of the American College of Physicians, which represents the state’s internists, has called on Highmark to reconsider its decision, and to utilize its reserves to balance its books.  The College asked the state Insurance Department to review the action, but Commissioner Miller said the Department has no authority over physician payments, as they are governed by contracts between the insurer and health care providers.  

Highmark maintains reserves totaling billions of dollars intended to cover underwriting losses.  The insurer’s choice to make physicians its risk pool, rather than use their reserves is unfair, as is the current system.

This action is the result of a system that gives control of health care access to insurers, not providers or hospital systems.  In today’s market with the addition of 500,000 Medicaid patients and implementation of the ACA, insurers have even more power.  As a result, issues ranging from payments to credentialing, prior authorization, non-compete clauses, clinical judgment, retroactive reviews, and all-products clauses give physicians little choice, while allowing insurers to dictate care, not just costs.

The PA-ACP is concerned that further lowering of reimbursement rates (Medicare rates were reduced 10% in January for primary care services) will lead to fewer physicians participating under the ACA, retiring, or leaving Pennsylvania.  Those who continue may have to limit the number of patients they can see, just as is the case with Medicare and Medicaid.  This will only further limit our ability to best serve our patients and Pennsylvanians who need health care.

As internists, we advocate for our patients, and we want to ensure Pennsylvanians receiving health insurance from the federal marketplace continue to have access to quality health care on a timely basis.  Physicians and patients both have the right to expect that terms of contracts will be met.   And the public has a right to know that they are comparing apples to apples when looking at the costs of their health care insurance.  

Thank you,
G. Alan Yeasted, MD, FACP
President, PA Chapter, American College of Physicians

cc:     Rep. Marguerite Quinn
Rep. Mike Regan, Mike
Rep. Gary Day, Gary
Rep. Eli Evankovich
Rep. Robert Godshall
Rep. Warren Kampf
Rep. Thomas Killion
Rep. Steven Mentzer
Rep. Nick Miccarelli
Rep. Thomas Murt
Rep. Brad Roae
Rep. Justin Simmons
Rep. Curt Sonney
Rep. Todd Stephens
Rep. Mike Tobash
Rep. Dom Costa
Rep. Eddie Day Pashinski
Rep. Ryan Bizzarro
Rep. Kevin Boyle
Rep. Margo Davidson
Rep. Tina Davis
Rep. Michael Driscoll
Rep. Marty Flynn
Rep. Ed Gainey
Rep. Robert Matzie
Garth Shipman
Alan Cohn
John Nikoloff, ERG Partners