Physicians push back against Highmark reimbursement cuts

Provider groups say the payer is "bullying" providers and "jeopardizing" patient care
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The Pennsylvania physician community lashed out against a recent decision by one of the state's major insurance carriers to cut payments by 4.5 percent, claiming the cuts are placing an unfair burden on providers that could negatively impact patient care in the long run.

Earlier this week, Highmark Inc. announced it would reduce physician payments for Affordable Care Act plans after reporting a $500 million loss on marketplace plans in 2015. Alexis Miller, Highmark's senior vice president for individual and small group business, told PennLive that the insurer raised premiums and eliminated coverage offerings to cover the losses, and physician payment cuts is one more way for the company to remain viable in the federal marketplace.

However, Scott Shapiro, M.D., president of the Pennsylvania Medical Society, told the news outlet that Highmark was "bullying both healthcare providers and their patients" and said the decision would "jeopardize healthcare delivery in Pennsylvania." Shapiro also pointed to Highmark's $4.5 billion surplus and argued providers were bearing the brunt of the company's "poor financial and business planning" that underestimated the risk level of new ACA patients.

Other providers within the state echoed similar concerns. Lee A. Meyers, executive vice president and chief operating officer of Physicians' Alliance Ltd., told LancasterOnline that physicians groups are expected to shoulder the burden of care coordination with inadequate reimbursement. Dr. Karen Rizzo, a past president of the Pennsylvania Medical Society and current board member of the Lancaster City and County Medical Society, told the news outlet that the cuts would limit access to care and that physicians have limited means to take action against the cuts.

Major insurers across the country have been searching for ways to offset significant losses on ACA marketplace plans. Most notably, UnitedHealth has indicated it plans to pull out of federal exchanges following a $720 million loss in 2015. Late last year, Humana also announced it would be trimming down its ACA marketplace offerings, while Cigna CEO David Cordani argued the marketplace needs to provide more flexibility for insurers.

To learn more:
- read the PennLive article
- here's the LancasterOnline article

Related Articles:
Highmark will cut physician payments to stem ACA-compliant plan losses
UnitedHealth's exchange exit threat: What it means
UnitedHealth loses $720M on exchange plans in 2015
Cigna CEO: ACA marketplace needs to offer flexibility to insurers
Humana cuts back on ACA exchange plan offerings