Contract expirations spell opportunity for Medical Center
VUMC hopes to serve Middle Tennesseans affected by the recent breakdown of contract negotiations between area hospitals and health care insurers.
BlueCross, BlueShield of Tennessee and the HCA network of hospitals haven’t had a commercial contract since Feb. 1.
The expiration applies to 900,000 Blue Cross members statewide, but only about 200,000 of them live near HCA hospitals, which are clustered around Nashville and Chattanooga.
At the urging of employers and Metro Council, BlueCross and HCA agreed to try again to strike a contract, but in April their mediation process broke down.
HCA has announced that, until the end of the year or the end of employers’ insurance reenrollment periods, its hospitals will continue to serve these BlueCross members without charging out-of-network penalties. Nashville area HCA hospitals include Centennial Medical Center, Horizon Medical Center, Skyline Medical Center, Summit Medical Center, Southern Hills Medical Center and Hendersonville Medical Center.
Contract negotiations have been abandoned by Aetna U.S. Healthcare and Ascension Health, which owns five Tennessee hospitals including St. Thomas, Baptist and Middle Tennessee Medical Center. Aetna will no longer have a contract covering care at St. Thomas effective May 11, or at Baptist effective Aug. 27. Aetna has 144,000 members in Middle Tennessee. Those Aetna members who use St. Thomas or Baptist can continue to do so at in-network rates until their current enrollment periods expire, which in most cases doesn’t occur until the end of the year.
Contract negotiations have also broken down between Ascension and PHCS (Private Healthcare Systems); their contract expires May 12. PHCS covers approximately 100,000 people in Middle Tennessee.
Vanderbilt’s corporate relations staff have contacted employers to invite employees affected by these contract expirations to begin using the services of Vanderbilt Medical Group and Vanderbilt University Hospital. VMG has set up a new phone line to help streamline access for these new patients (similar to the 48-hour outpatient access line available for staff and faculty at 343-8863).
The VUMC Physician Liaison Office is identifying community physicians whose referral patterns are most impacted by the contract expirations; Vanderbilt will invite these doctors to refer patients.
VMG is also planning a new central referral line for all community physicians.