UPMC preserves access to Hillman Cancer Center for all Highmark-insured patients | TribLIVE.com
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UPMC preserves access to Hillman Cancer Center for all Highmark-insured patients

Natasha Lindstrom
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UPMC announced Thursday that it will preserve access at in-network rates for Highmark-insured patients who seek oncology care from Hillman Cancer Center’s 60 locations across Western Pennsylvania and Ohio.
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Erin Ninehouser (left), spokeswoman for the Pennsylvania Health Access Network advocacy group, and Vicki Arnett (center), whose husband is a cancer patient from Western Pennsylvania, and Allegheny County Controller Chelsa Wagner (second from right) were among several speakers during a May 14, 2019 rally in Harrisburg calling for urgent legislative intervention in the looming UPMC-Highmark divorce. Arnett’s husband is traveling to Atlanta for cancer treatments because as of July 1 his Highmark insurance will be considered out-of-network at most UPMC facilities, including the Hillman Cancer Center.

Days before a Commonwealth Court showdown against Pennsylvania Attorney General Josh Shapiro, UPMC announced Thursday that it will preserve access at in-network rates for Highmark-insured patients who seek oncology care from Hillman Cancer Center’s 60 locations across Western Pennsylvania and Ohio.

The decision applies not only to seniors and people with disabilities on Medicare Advantage plans but also to younger patients in commercial markets. It applies to patients seeking oncology treatment and follow-up care at the Hillman Cancer Center’s flagship facility at UPMC Shadyside and dozens of community-based locations.

As recently as Wednesday, Highmark-insured patients had been preparing to lose access to UPMC cancer doctors or confront a controversial prepay-in-full rule set to take effect on July 1. UPMC Shadyside is among 10 hospitals in Western Pennsylvania set to go out of network for Highmark commercial members on June 30, when a state-brokered 2014 agreement between UPMC and Highmark is set to expire.

UPMC officials attributed the decision to a spate of calls from Highmark insurance members as well as productive talks during a Thursday morning meeting among UPMC CEO and President Jeffrey Romoff, Allegheny County Executive Rich Fitzgerald and Pittsburgh Mayor Bill Peduto.

“We look forward to continuing these productive conversations and improving access to health care here in the Pittsburgh region,” Peduto and Fitzgerald said in a joint statement.

UPMC also reiterated in a news release and on its website prior commitments to preserving access at in-network rates to Western Psychiatric Institute and UPMC Children’s Hospital of Pittsburgh. On Wednesday, UPMC said it would drop the prepay requirement for more than 100,000 of Highmark’s Medicare Advantage insurance members.

Legal war rages on

Shapiro said Thursday that he’s “glad UPMC has finally made these welcome concessions to open vital taxpayer-funded institutions to all Western Pennsylvanians, as my office has repeatedly asked them to do for more than two years.

But Shapiro dismissed UPMC’s moves as a “coordinated, last-minute ploy” that UPMC could rescind at any time.

He criticized UPMC for choosing “to wait until the 11th hour — just before we are scheduled to meet in court on Monday — to finally commit to providing the care that its doctors and nurses do so ably at these specialty hospitals to all patients.”

“Schoolchildren, seniors, workers, police in Allegheny County and Pittsburgh are still not getting their fair share and they are still restricted from UPMC care based on the insurance card they carry, and UPMC is still violating Pennsylvania’s charities laws,” Shapiro said. “We look forward to making our case in court next week.”

Shapiro filed a far-reaching legal petition against UPMC in early February in which he accused UPMC — Pennsylvania’s largest employer outside government — of breaching its duties as a purely public charity while benefiting from hundreds of millions of dollars in tax breaks. Among other demands, he seeks to require UPMC to contract with any interested insurer “in perpetuity” and replace a majority of its board.

UPMC has accused Shapiro of overstepping his authority in a politically charged quest to reshape how health care works and siding with the interests of its rival Highmark over the public good.

A non-jury trial in Commonwealth Court set to begin Monday in Harrisburg will decide whether Shapiro can extend or halt the June 30 split of the two Pittsburgh-based rivals.

“UPMC, Highmark and the Pennsylvania Attorney General – who has jurisdiction over all charitable, nonprofit organizations – are in litigation, and everything needs to be reviewed by the Attorney General,” Highmark spokesman Aaron Billger said. “We look forward to working with the Attorney General and UPMC, if UPMC is willing to work in good faith.”

‘Not a magical meeting’

Hillman Cancer Center patients had been set to confront a prepay rule on July 1 as of Wednesday, when UPMC announced it would drop the direct prepayment requirement for most of Highmark’s Medicare Advantage members while retaining prepay for commercial and employer-insured Highmark patients at most UPMC hospitals.

“It wasn’t a magical meeting,” Fitzgerald acknowledged of Thursday’s morning meeting.

He and Peduto both emphasized that they have been having discussions around protecting patient access with executives and board members of UPMC as well as Highmark for the past five years.

“So, why now?” UPMC spokesman Paul Wood said by email Thursday.

“Highmark itself never requested access for its members to UPMC Hillman Cancer Center once the consent decrees expire on June 30 — preferring instead to offer to its members only its own, in-development cancer programs,” Wood said.

“Because Highmark never asked for access to Hillman, we naturally had to assume that Highmark was speaking for its members and that their own members didn’t want Hillman,” Wood said. “That was until we heard directly from so many Highmark members testifying about their misdiagnoses, praising UPMC Hillman for saving lives, how they would die if they were forced to go elsewhere, and telling us that their overwhelming preference for cancer care was UPMC.”

“Recognizing that the UPMC Hillman Cancer Center’s world-renowned clinical programs are unmatched anywhere in the region,” UPMC said in a release, “UPMC agrees that access is, indeed, critical to all.”

Patients still left out

Patient advocates lauded UPMC’s relaxed prepay rules but said that the looming UPMC-Highmark split still is threatening to impact tens of thousands of patients.

The prepay-in-full policy still will apply to employer-insured and younger patients of Highmark who seek nonemergency care at most UPMC hospitals after July 1.

“Many people have lost access already, and there are still people who are getting treatment and specialty care at UPMC Magee-Womens, at UPMC St. Margaret hospital, the eye and ear center, all the other hospitals where people have connections and don’t want to leave,” said Erin Ninehouser, spokeswoman for the advocacy group Pennsylvania Health Access Network.

“There’s a lot of unanswered questions,” Ninehouser said. “Patients need a contract, guaranteed, affordable access, not just a press release.”

Evie Bodick was one of the first patients Ninehouser called to notify of UPMC no longer requiring prepay for patients like her on Highmark’s Medicare Advantage Freedom Blue plan.

Just last week, Bodick, 74, of Springdale finished saying goodbye to her fifth UPMC doctor, her cardiologist, after already having said farewell and having what she lamented would be her last apointmentts with her “lung surgeon, PCP, breathing doctor and cancer doctor.”

“It was heartbreaking,” Bodick recalled by phone Thursday.

She’s still trying to ensure she can keep her doctors, as she’d already lined up five alternates within Highmark’s Allegheny Health Network.

Of UPMC’s latest announcements, “it’s a start,” Bodick said. “I’m really happy for the people who go to Hillman. … But it’s not enough. We’ve got to keep fighting. I’m not just speaking out for me. I’ve been speaking out on behalf of so many people.”

There’s still more work to be done, Fitzgerald and Peduto said, but much of it will be up to the courts and lawmakers.

“A lot of this work is going to be done in Harrisburg and in Washington,” Fitzgerald said. “You’re going to hopefully see folks coming together in a bipartisan manner when it comes to making sure we have access to health care networks.”

“Nothing happens when you’re fighting each other,” Peduto said.

Allegheny County Controller Chelsa Wagner said that residents “need a guarantee of unfettered access to untaxed, ‘charitable’ hospitals in perpetuity — not at the whim of profit-driven, corporate-style executives.”

“Our residents demand accountable and enforceable commitments to access arrived at in the light of day, not behind closed doors,” Wagner said. “This is what Attorney General Shapiro’s suit and legislation introduced in Harrisburg rightfully demand.”

House Speaker Mike Turzai released a statement lauding UPMC’s moves. He also called for legislation that would guarantee everyone access to cancer and pediatric specialty centers statewide, regardless of insurance card. He did not comment on legislation supported by House Democrats that would force UPMC to contract with Highmark.

“While we await further details and an agreement on terms, this marks an important step toward guaranteeing that our most vulnerable patients have access to our best medical care,” Turzai said. “It is important to note that today’s commitment by UPMC to provide continued specialty hospital access to all patients is the result of sustained dialogue and cooperation, not combativeness, lawsuits or antagonism.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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