June 30 upheld as UPMCHighmark end date
Appeal expected to state Supreme Court
Highmark insurance members will no longer have discount access to many UPMC doctors after June 30, a Commonwealth Court judge ruled Friday in what is unlikely to be the last word in the bitter divorce of Pittsburgh’s warring health care systems.
Judge Robert Simpson ruled the consent decrees that guided business relations between Highmark and UPMC for nearly five years end June 30, closing the doors to UPMC doctors for thousands of people in Western Pennsylvania who have Highmark health coverage. He wrote that “all the parties were aware of this transition approach” and therefore the attorney general and Highmark “cannot state a cause of action for extension of the termination/expiration provision of the consent decrees.”
An appeal of the decision to the state Supreme Court is expected — the second time in as many months the issue could go before the justices.
Judge Simpson’s ruling comes eight days after UPMC unexpectedly announced that it would continue allowing innetwork access for Highmark members after June 30 to three UPMC specialty hospitals, including Children’s Hospital in Lawrenceville. UPMC specialty hospital access for Highmark members had been a bitterly divisive issue in public hearings in the Pittsburgh area that were conducted in recent months by Allegheny County Controller Chelsa Wagner.
In a statement Friday, Highmark spokesman Aaron Billger said the ruling was a setback, not a defeat in
“preserving health care choice for consumers.” He also said that neither the attorney general nor Highmark had received a written offer from UPMC to open three of its specialty hospitals to Highmark members after the end of the consent decrees.
UPMC spokesman Paul Wood said the health care system was “pleased” by the ruling, but Attorney General Josh Shapiro said he would continue to pursue his case, despite the judge’s opinion. He stopped short of saying whether his office would appeal the ruling.
“Make no mistake — our work here is not done,” Mr. Shapiro said in a statement. “We will announce subsequent legal steps next week.”
The state Supreme Court last heard an appeal of the agreement’s runout date on May 16 before ruling in a 4-3 decision May 28 to return the issue to Commonwealth Court to decide.
Judge Simpson heard two days of arguments in the case June 10-11 in Harrisburg.
The issue of when the consent decrees expire was first raised in February by the attorney general, who filed a four-count civil lawsuit against UPMC for allegedly violating its nonprofit taxexempt status in excluding Highmark members from access to institutions that public and philanthropic dollars helped build.
Friday’s ruling focused on just one aspect of the lawsuit — the end date.
In court papers, UPMC lawyers said the attorney general was exceeding his authority in trying to get UPMC to accept Highmark members and replace UPMC’s board.
During the two days of hearings earlier this week, UPMC lawyer Leon F. DeJulius from the law office of Jones Day argued that the consent decrees were never intended to be extended indefinitely. Moreover, the attorney general had not provided independent evidence that the consent decrees’ modification clause included an extension.
“This was not a document negotiated for an indefinite extension,” Mr. DeJulius told the court. “There’s not one document that supports the attorney general’s case.”
In earlier testimony, executive deputy general James Donahue said the Highmark-UPMC agreement was the first time in his 34-year career with the attorney general’s office that an extension had been sought. However, the extension was justified by serving the public interest, where Highmark members — some critically ill — would be forced to find new doctors outside UPMC.
The attorney general’s lawsuit seeks a UPMC mandate to reach agreements with “any willing insurer,” an idea that legal experts say is without precedent.
Still pending in Commonwealth Court are three counts in the attorney general’s lawsuit, including alleged violation of the Charities Act, breach of its fiduciary duties by UPMC’s board and the consumer protection law.