New York-Presbyterian and Empire BCBS negotiating deal that could affect 300,000

With just weeks remaining in 2018, New York-Presbyterian is struggling to reach an agreement to remain in the Empire Blue Cross and Blue Shield network. If the two sides can't agree before Jan. 1, New York-Presbyterian estimates that about 300,000 patients could face higher charges next year.

New York-Presbyterian is informing patients about the status of negotiations through a letter and a new website, staywithnyp.org. The website states that "Empire/Anthem has demanded deep cuts that would slash more than $200 million in payments to New York-Presbyterian, all while the insurance giant generates billions in profits."

"It has been, to us, what appears to be negotiating to terminate," said Dr. Laura Forese, NYP's executive vice president and chief operating officer. "That's not where New York-Presbyterian wants to be, and our patients are caught in the middle of that."

The two sides have been working together through a four-year amendment to their contract, which was agreed to in 2014. It was derived from a contract reached in 2006.

NYP operates 10 hospitals in Manhattan, Brooklyn, Queens and Westchester County; the Gracie Square Hospital for psychiatric care; the Rogosin Institute, which treats kidney disease; and the Silvercrest Center for Nursing and Rehabilitation.

Empire members also would lose in-network access to the thousands of physicians that are part of Weill Cornell Medicine, Columbia Doctors and the health system's other medical groups. They still could seek care from those doctors and hospitals, but they could face higher charges for going to an out-of-network provider.

Forese declined to discuss contract details.

Indianapolis-based Anthem, Empire's parent, earned $3.8 billion last year. But New York-Presbyterian is far from destitute. The health system earned $843.1 million across its 10 hospitals, including $404.5 million from operations.

The union 32BJ, which represents 163,000 workers, including cleaners, doormen and security officers, recently publicized the results of its analysis, finding higher prices at New York-Presbyterian than at other hospitals. Empire administers its health plan.

In 13 hip replacements and hip-revision procedures performed on its members, the health system spent nearly $83,000 per procedure on average, 36% more than for 78 surgeries at other hospitals in the city, according to the union's analysis. For knee surgeries, New York-Presbyterian cost 8.9% more on average.

A spokeswoman for Empire said the insurer is negotiating "in good faith," adding, "It is our sincere desire to reach an agreement with New York-Presbyterian on reasonable terms so they can remain in-network with Empire. Our No. 1 priority during these negotiations is to protect consumers' access to healthcare that is affordable."

Empire members include those in employer-sponsored, Medicaid, Medicare Advantage and New York State of Health marketplace plans.

New York-Presbyterian suggests on its new website that patients "consider a different health insurance plan with which we are in network" as one way to avoid any repercussions from the contract negotiations. Medicare Advantage's open-enrollment period ends Dec. 7. Open enrollment for the New York State of Health marketplace ends Jan. 31.

In other markets, Anthem has failed to reach agreements before contracts expired, leaving thousands of patients facing potential out-of-network charges. Last year seven weeks passed before Hartford HealthCare and Anthem reached a three-year deal. Earlier this year Anthem's negotiation with Atlanta-based Piedmont Healthcare continued several weeks beyond the end of that contract. In both cases negotiators backdated the contract, lowering costs to the in-network rate.

"New York-Presbyterian and Empire BCBS negotiating deal that could affect 300,000" originally appeared in Crain's New York Business.