New York Presbyterian and Empire extend contract

From Anthem Health:


New York-Presbyterian and Empire BlueCross BlueShield have agreed to a multiyear deal to keep the 10-hospital health system in Empire’s network. The accord ends a public fight that stoked fears that about 300,000 NYP patients would face higher out-of-network charges next year.

The agreement will also maintain Empire members’ access to New York-Presbyterian’s medical groups, including Columbia Doctors and Weill Cornell Medicines. Their current agreement was set to expire on Dec. 31 and covered people in employer-sponsored, individual, Medicare and Medicaid plans.

A spokesman for NYP declined to disclose further details of the contract. The typically private nature of managed care negotiations spilled out into the open last week when the City Council scrutinized New York-Presbyterian’s prices.

“We are pleased that this agreement will allow patients to continue to choose to receive care from NewYork-Presbyterian and its affiliated physicians,” both sides said in a joint statement.

The union 32BJ, one of the city’s most politically active unions, whose membership includes cleaners, doormen and security guards, complained at a City Council hearing last week about the cost of care at NYP compared with other city hospitals. The union uses Empire to build its network.

NYP and Empire had struggled to agree on appropriate payment rates. Self-funded clients, such as 32BJ, had pushed Empire to negotiate better rates on services. The union made public that for 13 hip replacements it had paid the health system nearly $83,000 on average, more than $25,000 above what other city facilities charged. For vaginal deliveries, the union paid nearly $24,000—about $7,000 more than its average at other city hospitals.

New York-Presbyterian said a potential $200 million cut in reimbursement would have threatened its ability to invest in patient care and support the training of future physicians.

If the two sides had not reached a deal, NYP stood to lose a major source of patients, while Empire faced the prospect of selling policies without U.S. News’ top-rated New York hospital in its network. New York-Presbyterian had begun advising patients to consider other insurers on a website set up to notify them that its contract with Empire was set to expire.