Blue Cross of California, Scripps Clinic End Contract Because of Reimbursement Dispute
Blue Cross of California on Jan. 1 plans to end its HMO and point-of-service contracts with Scripps Clinic in San Diego County because the insurer could not reach an agreement with the medical groups over reimbursements, the San Diego Union-Tribune reports. Last year, the clinic informed health plans it would only accept fee-for-service payments and not capitation contracts, in which providers receive a monthly amount per patient. The clinic, which serves about 17,000 Blue Cross patients, has been "bleeding red ink" and has negotiated fee-for-service contracts with Cigna, Health Net, Blue Shield, PacifiCare and Aetna. However, Blue Cross officials said a change in the contract would force the company to pass higher fees on to enrollees. "It has been proven that capitation is effective, and it has not been detrimental to medical groups," Lisa Mee-Stephenson, a Blue Cross spokesperson, said. "Whenever costs have gone up, we've increased the capitation rates," she added. However, Marc Reynolds, senior vice president for payer relations at Scripps Health, said, "The overriding issue is, we want to move away from taking on the risk for the services." According to the Union-Tribune, California hospitals have "increasingly moved away" from capitation, but the San Diego-area health care industry has been "reluctant" to follow suit. Unless the clinic and Blue Cross agree on a last-minute resolution, about 22,000 patients may have to find a new provider or switch health plans. The contract dispute does not involve Blue Cross' Medicare+Choice plan. Blue Cross also has ended its contracts with Scripps Mercy Medical Group and Scripps Penn Elm, which were seeking higher per-patient reimbursement rates, the Union-Tribune reports (Fong, San Diego Union-Tribune, 12/13.)This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.