Questions on the Highmark-UPMC consent decrees?

As a physician in the Allegheny County area I want to let you to know about actions that the Allegheny County Medical Society (ACMS) is taking to make sure that you are informed about the upcoming Highmark/UPMC transition and to share plans we have to act as a conduit for physician questions about how the transition impacts your patients and your practice.

Healthcare providers have been on a roller coaster since the contract negotiations between Highmark and UPMC became public four years ago.  We are all familiar with the on-again, off-again negotiation process.  In that time period, Highmark acquired the West Penn Allegheny Health System, now known as the Allegheny Health Network, becoming an integrated health delivery system.  At that point, contract negotiations ended for all intents and purposes as UPMC stated that it could not contract with what had become a direct competitor.

Through the ensuing four years, ACMS has remained engaged and met repeatedly with senior leadership from Highmark, UPMC, UPMC Health Plan, and the Allegheny Health Network. We have met and worked with business and community groups, legislators, and state government leaders trying to place issues of patient care at the forefront of these negotiations.

The Society’s position at first had been to recommend and urge the two entities to reach agreement.  When it became clear there would be no agreement reached between the parties, we articulated principles to be addressed in the transition of patients given the termination of the contract. As physicians, we know that continuity of care, particularly for patients with chronic health issues, or in the midst of treatment, is not a simple matter.  Both UPMC and Highmark leaders acknowledge this and we have worked with them to keep patient care at the forefront of their planning for the transition.

We commend Governor Corbett, his team and Attorney General Kane who acted to negotiate consent decrees with both Highmark and UPMC and create a framework plan for the transition period as the contract terminates.  It provides conditions for continued care for in-network coverage for physicians and facilities for defined periods of time, assuring access for patients in a course of treatment.  In most cases it places the physician in the position of deciding when a patient may be transitioned while ensuring emergency department access is not interrupted.  It also provides a formal dispute resolution process that is overseen by the state.

While none of us knows how this situation will play out in its entirety, ACMS will continue to represent physicians throughout this process.  We will work to assure that patient and providers viewpoints are heard, and we will place patient care at the forefront of our discussions and decisions.

To help get you the information you need to care for your patients and to operate your practice, ACMS and the Pennsylvania Medical Society will continue to actively seek answers to questions facing physicians and their patients.  The best way to contact us is currently via email to acms@acms.org or stat@pamedsoc.org.  As this situation unfolds, we may also stand up a secure website to post and share physician questions and concerns and answers from the interested parties.  If you think such a website would be of value to you and your practice, please let us know.

The next few weeks will be crucial as the transition begins to take place in our region.  We hope you will share your questions and concerns with us so that we may get them addressed by the state and/or the plans and better prepare all physicians and their patients for the changes ahead.  As always, please contact me to share any ideas you have about other ways ACMS and PAMED can help support our physician community.

Most sincerely,
Kevin O. Garrett, MD, FACS

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Allegheny County Medical Society
713 Ridge Avenue
Pittsburgh, PA  15212
412-321-5030  FAX 412-321-5323