Cost of Services: Telluride Medical Center’s Emergency Department
by Peter Hackett, MD, Emergency Services Director
Gordon Reichard, Telluride Medical Center Administrator
Aug 06, 2009 | 787 views | 0 0 comments | 15 15 recommendations | email to a friend | print

A recent local newspaper article contained some unfortunate and grossly inaccurate statements from an Anthem/Blue Cross Blue Shield (BCBS) spokesperson regarding their negotiations with the Telluride Medical Center for a contract with the Emergency Department.

The Telluride Medical Center negotiates regularly with six different health insurance companies for both the Emergency Department and for Primary Care (PC). We currently have acceptable agreements on 11 out of 12 of these negotiations. The only health insurance company we have been unable to reach agreement with has been BCBS and only for TMC’s Emergency Department. We are hopeful that we will eventually be able to reach agreement with BCBS for our Emergency Department, however we have not been able to get them to offer us rates that are comparable with the rates that we have negotiated with other health insurance plans for our Emergency Department. The latest rates offered by BCBS are below our costs. If we were to accept them, we would be subsidizing BCBS’s profits with the tax dollars we receive to support 24/7 emergency care. TMC refuses to do this.

Health insurance negotiations are very complex and for this reason the Medical Center uses an outside consultant to help us conduct negotiations. Therefore TMC’s contracted health plan negotiated rates are not set in isolation. All requested rates are reviewed by our outside consultant who feels that our request to BCBS was not excessive.

After reading the remarks attributed to BCBS in the newspapers, we contacted them to get some backup for their statements. We discovered that the remarks were made by a BCBS “spokesperson” and not by the actual team we are negotiating with. Not surprisingly, BCBS has refused to provide any backup for their statements. It is difficult to provide backup for statements that are not factual.

Although the cost of living in Telluride is significantly higher than other areas on the Western Slope, the Telluride Medical Center has its fees periodically reviewed by outside consultants to ensure that our fees are fair and reasonable compared to other medical operations. We have recently done a quick review of our emergency room fees and found that they are in line with fees for similar services at nearby emergency rooms.

The most unfortunate aspect of the BCBS spokesperson’s remarks is the impression it gave regarding our Emergency Department physicians. Telluride is fortunate to have a group of extremely qualified emergency physicians working at the medical center. Working at the Telluride Medical Center is a lifestyle choice. They are not asking for twice the amount physicians get in the surrounding area. As a matter of fact, their compensation is in the bottom quartile of the national range for emergency room physicians.

The cost of healthcare and health insurance is currently receiving a lot of nationwide attention. Working with many different insurance companies is a significant cost for a small operation like the Telluride Medical Center. Local taxpayers have regularly agreed to provide tax support in order to have high quality emergency care available locally on a 24/7 basis. We doubt that they want their taxes to be used to increase BCBS’s share of the over $400 billion in profits that the health insurance industry made last year. We will continue to try to reach an agreement with BCBS that is fair to everybody.
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