MetroWest wants new deal with Blue Cross
MetroWest Medical Center has told employees it may end its contract with Blue Cross and Blue Shield of Massachusetts unless the insurer narrows the gap in payments between the hospital and its competitors.
In a letter obtained by the Globe, leaders of the hospital and its physicians organization said rates paid for their services are as much as 40 percent lower than what other health care providers receive. MetroWest, owned by Vanguard Health Systems, operates Framingham Union Hospital and Leonard Morse Hospital in Natick, which have a total of about 300 beds and more than 740 affiliated physicians.
“We need to ensure that Blue Cross understands that we are serious about standing up for what is fair,’’ the letter says. “Because of this, with the support of the [physicians organization] leadership, the hospital may have to cancel their contract by submitting a 60-day notice.’’
Dennis Irish, a spokesman for the hospital, said negotiations with Blue Cross-Blue Shield on a five-year contract are ongoing, and that the next session is scheduled for Monday.
“At this point there is no likelihood of [contract] termination,’’ Irish said yesterday. He declined to comment further.
Blue Cross-Blue Shield spokesman Jay McQuaide said the company does not publicly discuss payment negotiations.
The letter, signed by MetroWest chief executive Andrei Soran, physicians organization president Dr. Bart Alfano, and hospital chief medical officer Dr. Michael Gottlieb, said five months of negotiations have not produced an agreement on rates that will be paid to the hospital for medical care it provides. The hospital is seeking higher reimbursements as part of an “alternative quality contract’’ that would pay it a certain amount for each patient and reward the hospital and physicians with more money if they meet specific quality benchmarks.
MetroWest executives said in the letter that they doubt the new payment plan will reduce the gap between the hospital and its competitors, particularly if it is based on current payment levels. The hospital’s contract with Blue Cross-Blue Shield expired Oct. 1, but an interim pact is in place.
Doctors in the 260-member MetroWest Health Care Alliance physicians organization also have individual contracts with Blue Cross-Blue Shield, Alfano said, but they are forming a physicians group that would become part of a new agreement between the hospital and the insurer.
Earlier this year, a showdown between Tufts Medical Center, its affiliated doctors, and Blue Cross-Blue Shield could have forced thousands of patients to change insurance coverage or doctors. Like MetroWest, Tufts argued that its competitors were being paid significantly more for the same services. An agreement was reached that raised some payments while moving the hospitals and doctors into the alternative quality plan.
“The hospital feels during this interim period, while we negotiate a new contract, they should have some kind of reasonable rate increase,’’ Alfano said. “The physicians support that because we don’t want the hospital to be in any more financial trouble than they already are. We’d start losing services for our patients.’’
In June, MetroWest scored a victory when Newton-Wellesley Hospital, owned by Partners HealthCare, decided not to build a surgery center in Framingham that MetroWest said would threaten its viability.
