UPMC reverses stance on specialty hospitals

In-network status to remain for Highmark

UPMC Hillman Cancer Center will remain available to all insurers on an in-network basis — including all Highmark commercial and Medicare Advantage members — after the Highmark-UPMC consent decrees expire June 30, UPMC officials said Thursday.

In addition, UPMC spokesman Paul Wood gave assurances that UPMC Children’s Hospital of Pittsburgh and UPMC Western Psychiatric Hospital would remain accessible to Highmark members.

The announcement followed an hourlong meeting that included UPMC President and CEO Jeffrey Romoff, Pittsburgh Mayor Bill Peduto and Allegheny County Executive Rich Fitzgerald at UPMC’s corporate headquarters in the U.S. Steel Tower, Downtown.

Mr. Peduto said UPMC brought up allowing Highmark and all other insurers access to the Hillman Cancer Center, catching the two public officials off guard.

“It was not part of the agenda,” he said. “It was a surprise to both of us that they were willing to put it on the table.”

Just weeks away is the June 30 expiration of the 2014 consent decrees that laid out how Highmark and UPMC would go their separate ways after they were unable to reach terms on a new contract in 2011. UPMC said at the time that it would

not contract with Highmark, which it considered a competitor after the insurer announced its intention to buy the former West Penn Allegheny Health System.

The dispute has left patients confused or forced to choose between their physicians and their insurance plan.

Mr. Peduto acknowledged there may be strategic value for UPMC in making the offer, coming days before a Commonwealth Court hearing at which state Attorney General Josh Shapiro will seek to force UPMC to extend the consent decrees.

“But at the end of the day, we both had to agree to support the endeavor because it was going to help people,” Mr. Peduto said of himself and Mr. Fitzgerald.

Now cancer patients who want to continue seeing their doctors at the UPMC Hillman Cancer Center, or parents who want to make sure their child can be treated at UPMC Children’s “can rest easy that they won’t have to change doctors,” the mayor said.

“You can’t walk away from that.”

“There’s still work to do,” Mr. Fitzgerald said. “The goal is, if you have an insurance card, you should be able to show up at any facility of your choosing and get in-network care.”

In a joint statement released Thursday, the two officials said they had worked toward ensuring access over the five years since the consent decrees were signed.

“This is how progress happens — by continuing to work together and engaging with all parties,” the statement said.

Highmark wants formal agreement

Highmark spokesman Aaron Billger said a formal agreement is still needed from UPMC about its intentions in opening Hillman to Highmark members on an innetwork basis.

Moreover, he said, UPMC’s announcement shouldn’t affect a four-count lawsuit that the state attorney general filed in February against the health care giant because written agreements are still needed. Two days of hearings are scheduled next week on the lawsuit in Commonwealth Court.

“We need to secure contract language and agreements so that their practices align with their commitments,” Mr. Billger said. “We look forward to working with the attorney general and UPMC, if UPMC is willing to work in good faith.”

As for the timing of Thursday’s announcement, Mr. Wood said Highmark had never asked for continued access to the Hillman center after the consent decrees expire, “preferring instead to offer to its members only its own, in-development cancer programs.”

Without such a request, he said, “We naturally had to assume that [Highmark] was speaking for its members and that their own members didn’t want Hillman.”

Mr. Billger said that simply was not true.

“We have always asked for full in-network access to all of UPMC,” he said. “Full access includes Hillman, which is a UPMC facility. Frankly, full access is what the Pennsylvania attorney general’s case against UPMC is about — preserving access for the entire community to a nonprofit, charitable organization.”

Attorney general not convinced

Mr. Shapiro criticized UPMC’s announcement on the brink of arguments next week in Commonwealth Court, adding that consumers were “still not getting their fair share.”

“Instead of agreeing previously, UPMC chose to wait until the 11th hour — just before we are scheduled to meet in court on Monday — to finally commit to providing the care that its doctors and nurses do so ably at these specialty hospitals to all patients,” Mr. Shapiro said in a statement.

“Schoolchildren, seniors, workers, police in Allegheny County and Pittsburgh are still not getting their fair share and they are still restricted from UPMC care based on the insurance card they carry, and UPMC is still violating Pennsylvania’s charities laws.

“We look forward to making our case in court next week.”

Allegheny County Controller Chelsa Wagner issued a blistering rebuke to UPMC, saying it “should not be congratulated for deciding not to slam its doors on cancer patients.”

“Our residents who built UPMC with their tax dollars and charitable contributions need a guarantee of unfettered access to untaxed, charitable hospitals in perpetuity — not at the whim of profit-driven, corporate-style executives who have terrorized desperate patients,” she wrote in a statement. “When a robber baron tries to convince us he’s Santa Claus, we should all remain very skeptical.”

Ms. Wagner conducted a series of public hearings in recent months, featuring Highmark members with serious illnesses as they faced the cutoff of treatment by UPMC doctors. After a rally by union activists and others May 28 in Oakland, Ms. Wagner presented the UPMC Presbyterian Shadyside hospital board with petitions containing more than 10,000 signatures of people supporting continued access to UPMC facilities for Highmark members.

Easing public pressure

Michael A. Cassidy, a health law specialist at the Downtown firm of Tucker Arensburg, said UPMC’s announcement could bring revenue to the medical system by increasing patient volume at Hillman Cancer Center while taking some punch out of the attorney general’s lawsuit.

Many Highmark members have been sharply critical of UPMC in recent months for restricting access to institutions that public money and philanthropy helped build.

“It’s a lot less public pressure,” Mr. Cassidy said. “It takes some air out of it.”

Mr. Cassidy also wondered whether UPMC’s latest announcement would eventually free the medical system from other enforcement actions.

In his lawsuit, the attorney general sought to replace all of UPMC’s board with people who have no prior experience with the system.

“It depends on what else [UPMC doesn’t] have to do,” Mr. Cassidy said. “It’s more revenue for UPMC than Allegheny Health Network and if they get more revenue and don’t have to give up anything, that’s a pretty good deal. But we don’t know that yet.”

UPMC’s decision to welcome Highmark members to the cancer center comes as the health system faces financial challenges and virtually all hospitals in the region are reporting fewer admissions.

While operating revenue for the year ending Dec. 31 rose $3.1 billion to $18.7 billion at UPMC, operating income fell 33 percent to $166 million as the operating margin slipped to 0 percent from 0.6 percent a year earlier, according to annual financials.