Shapiro has plan to make consent decrees permanent
Rep. Dan Frankel, D-Squirrel Hill, recently called them “kind of a half-baked idea” and Commonwealth Court Senior Judge Dan Pellegrini notably described them from the bench as “terrible agreements” the year after they went into effect. The judge even threatened to throw them out.
Such as been the history of the oft-maligned Highmark-UPMC consent decrees — forged early in the heat of the two parties’ near-decade-long dispute and only after state officials shuttled the documents back and forth between offices because the two sides would not meet in the same room.
Attorney General Josh Shapiro now says he wants to make the consent decrees permanent, albeit with modifications that would prevent UPMC “from denying access and treatment to Highmark subscribers generally and Community Blue and Medicare Advantage members specifically,” as stated in a court filing on Thursday.
When signed in 2014, the fiveyear consent decrees represented more of a truce than a peace treaty, and the truce didn’t always hold. The idea was to give everyone — patients, doctors, hospitals and insurers — time to adjust to the coming world of two separate health systems in competition for members and patients. But the road has been bumpy, with each side developing their own interpretation of particular provisions.
The continued acrimony means these decrees may take more than a little modification.
One of those voicing support for Mr. Shapiro’s plans Thursday was Jessica Brooks, CEO and executive director of the Pittsburgh Business Group on Health, whose members make up one of the area’s major employers.
She also was an early critic of the consent decrees when they were signed, writing in a Post-Gazette commentary that “they may be creating more confusion.” They did indeed create the occasional conflict, with accusations of manipulating prices or directing physicians from certain hospitals.
Mrs. Brooks said her hope now is that the attorney general’s suit will bring long-term stability and certainty, as well as protection from surprise bills from out-of-network providers.
But she also believes the consent decrees in their current form should not be the benchmark.
She cited one member whose child was seen by a specialist from UPMC Children’s Hospital of Pittsburgh, which was in-network for their insurance, but follow-up care was provided by out-of-network providers, “causing an administrative and payment nightmare.”
“The consent decrees still cause issues today,” she said.
But the consent decrees still represent the last time Highmark and UPMC agreed on something, which she hopes gives Mr. Shapiro a foundation to build on.