Physician response to insurance provider dropping medical system

As an independent physician who has partnered with Memorial Hermann’s highly successful clinically-integrated physician network (MHMD) and serves on the network’s board of directors, I am disappointed and confused by the actions of BlueCross BlueShield of Texas (BCBSTX).

The current contracts between BCBSTX and Memorial Hermann expired at midnight (Monday, Feb. 28). Of the contracts expiring, one is the health system’s agreement that deals with hospital payment rates, and two are the physician agreements – one for MHMD and the other for Memorial Hermann’s Accountable Care Organization (ACO). I want to be very clear: The contracts I am addressing here are the physician contracts, not the health system’s hospital contract.

As we entered the final hours to reach a deal, MHMD leadership exhausted all options in order to keep your trusted physicians from going out-of-network. As a concerned patient or community member, you may be wondering, “Why are they in this battle, again? And why haven’t they reached an agreement already?” Allow me to explain.

We are independent physicians, meaning we are not employed by Memorial Hermann Health System, or any health system for that matter. And as independent physicians, we are simply trying to take care of our patients and keep our private practices afloat. To that end, we created an ACO with a valued partner in Memorial Hermann, to help promote the highest quality care at a predictable and managed cost. In doing so, we have saved incredible amounts of money for Medicare and many other insurers, including BCBSTX.

Yet, this current negotiation seems more personal and about something different. It threatens the viability of many of our practices – some of which include anywhere from 25 to 50% BCBSTX patients. It threatens the viability of our ACO, which is about much more than BCBSTX.  Furthermore, and most importantly, it threatens longstanding relationships with our valued patients, most of whom we have cared for and come to know personally over many years or even decades (in my case, over 33 years). Now BCBSTX is reassigning these patients indiscriminately to new doctors. One patient in Katy was reassigned to a doctor near Galveston. Another was assigned to a physician in Waco. From Houston? This makes no sense.

These patients receive care from us for multiple medical problems, many with a complex history of hypertension, diabetes or heart disease, relying on coordinated care through us to other specialty providers including eye doctors, cardiologists and wound care teams. All of that will be disrupted, in the middle of care. Patients will be forced to start over from scratch with strangers. Again, why? It makes no sense.

We want to remain independent. That is our preferred avenue through which to care for patients. But if we cannot sustain our practices, we cannot help anyone. It seems BCBSTX has lost sight of valued partnerships and putting the patient first. We just want to practice medicine. We just want to be your physicians. And that is what’s truly at stake here, and why we have refused to give up without a fight and are still fighting now. Because we think our patients are worth fighting for.

By J. Kevin Giglio, M.D., Primary Care/Family Medicine