The Pennsylvania Supreme Court ordered a lower court to decide next month whether to extend two five-year consent decrees ending June 30 that require UPMC hospitals and physicians to serve Highmark Health enrollees.
The high court, in a 4-3 opinion Tuesday, said the Commonwealth Court must hold an evidentiary hearing to decide whether the decrees could be extended as requested by Pennsylvania Attorney General Josh Shapiro.
While it reversed the lower court's decision that the decrees' termination date could not be modified, the Supreme Court majority declined to extend the end date on its own.
Shapiro wants to at least temporarily extend the consent decrees while he continues litigating his claims that UPMC has violated its charitable obligations to the state.
He wants the court to enable open and affordable access to UPMC's provider network through negotiated contracts; require baseball-style arbitration if negotiations fail; and bar UPMC from engaging in excessive and unreasonable billing practices. He also seeks to replace UPMC's and Highmark's boards.
The state Supreme Court decision is the latest development in a bitter legal and political battle that began in 2011 when Highmark became UPMC's competitor in the Western Pennsylvania hospital market. The two powerful integrated systems have moved to establish exclusive plan-provider networks.
UPMC, which owns more than 30 hospitals and a health plan, objected to the attorney general's petition to extend the 2014 consent decrees indefinitely. It said the five-year transition provided by the decrees has allowed businesses and consumers adequate time to prepare for the end of the UPMC-Highmark relationship in Western Pennsylvania.
Highmark, which owns eight hospitals and a large health plan, intervened in the case, backing Shapiro's proposal to extend the consent decrees.
Shapiro lauded the Supreme Court's decision to reverse the lower court's ruling that the decrees' June 30 end date could not be modified by law. In a written statement, he said his office will now make its case in Commonwealth Court on an expedited basis that an indefinite extension of the end date is necessary "to ensure UPMC fulfills its role as a public charity."
Highmark highlighted the possibility that the consent decrees could be extended, saying the Supreme Court decision was a "critical step in preserving healthcare choice for consumers."
UPMC spokesman Paul Wood pointed out that none of the justices accepted the attorney general's position that the consent decree couldn't be modified, and that the justices agreed it wasn't necessary for them to extend the termination date through the court's extraordinary powers.
Meanwhile, Allegheny County Controller Chelsa Wagner on Tuesday presented petitions to the UPMC Presbyterian Hospital board signed by thousands of people who favor continued in-network access to UPMC facilities for Highmark enrollees.
