Legislator cites rising costs for providers
Blue Cross & Blue Shield of Rhode Island resisted doctors’ demands for better pay for years, only acquiescing after political leaders stepped in. UnitedHealthcare of New England took a little longer, only hiking reimbursements Jan. 1 for medical and surgical services, and this month for mental health.
Now, hoping to spare providers such fights in the future, state Rep. Arthur Handy (D-Cranston) is sponsoring a bill that would require insurers to pay at least Medicare’s rates for both medical and mental health services.
“It’s important to make sure the medical professions are compensated appropriately for their work and time,” Handy told the House Corporations Committee last week.
The bill itself, H-6139, declares that “it is in the public good” for providers to be paid “at rates realistic to the costs of: (1) health care providers’ work expense, including time, energy and skill; (2) practice expense, including medical equipment and office space; and (3) malpractice expense, namely insurance premiums.”
A formula devised by the Centers for Medicare and Medicaid Services (CMS) considers precisely those factors, adjusted regionally and updated annually. Handy’s bill would make the rates under that formula the minimum allowable in Rhode Island.
Years ago, Medicare rates were in fact the lowest most doctors were paid. But insurers had fallen behind, and Blue Cross, for example, was paying just about 85 percent of Medicare’s rates to most doctors before agreeing to go to 100 percent last year.
Since Jan. 1, United has been paying the Medicare rates for medical and surgical services.
Behavioral-health reimbursements just went up this month, but it’s unclear how they match up with Medicare rates.
Mental health providers, who’ve spent months lobbying United to improve its pay, came out in force to support Handy’s bill, as well as another measure, sponsored by state Rep. Edith Ajello (D-Providence), that would require mental-health reimbursements to be “comparable” to those paid “for medical services of a similar level and requiring similar expertise.”
Providers “have told me over the years that they cannot afford to treat patients who will depend on their insurance coverage for payment,” Ajello said. “That’s just bad health care.”
The Medicare rate bill, however, faces strong opposition from insurers.
Richard Burdett, of America’s Health Insurance Plans, said Medicare rates are set specifically for the elderly, and it’s not a good idea to make them the standard for everyone.
Brian Jordan, lobbyist for Blue Cross, said that although his company would be in compliance with the law, “it’s just a dangerous slope to go down.” No other profession, he noted, has legislation mandating minimum reimbursement rates.
And Jason Martiesian, lobbyist for United, said a state-imposed minimum could hinder his company’s ability to balance providers’ needs with employers’ need for affordable insurance.
“We just think it doesn’t make good business sense,” Martiesian said.
