How 3 hospital-payer contract disputes could disrupt patient care

Hospitals challenged with staff shortages, declining inpatient volumes and rising expenses are looking to cut costs and increase revenue wherever possible, and many are pressing commercial payers for rate increases as they renegotiate contracts. 

But some payers are refusing to bend to providers' demands, despite the precarious financial situations many hospitals and health systems are facing, which could have serious ramifications on patients' access to care. 

Here are three contract disputes between hospitals and payers that Becker's has reported on in the last two weeks: 

1. As of March 13. Allentown, Pa.-based Lehigh Valley Health Network, a 13- hospital system, will largely stop accepting Aetna insurance in 2023, according to The Morning Call.

The decision was made after years of Aetna allegedly refusing to pay for care or delaying care for patients, LVHN claimed. Some Aetna coverage will remain for emergency care or for serious treatments such as cancer care, according to the health system. 

LVHN declined to comment to The Morning Call, and Aetna could not be reached, the report said.

2. About 20,000 patients could be left out of network if UnitedHealthcare and Syracuse, N.Y.-based SUNY Upstate University Hospital cannot sign a new contract before the current one expires Dec. 31. 

UnitedHealthcare said Upstate is seeking a significant price increase that would make it one of the most expensive hospitals in New York for its Medicare Advantage plan, according to Upstate argues the cost of care and demand for staff have risen, leading it to up pay for employees and manage rising supply costs while dealing with the financial challenges of the pandemic. 

UnitedHealthcare said the sides have agreed to a "cooling-off period" for beneficiaries enrolled in community plans and fully insured commercial plans, allowing them to have in-network coverage through Feb. 28, 2023 while contract negotiations continue. 

3. CMS could end Wilson (N.C.) Medical Center's Medicare contract for the second time this year after the agency said the hospital is breaking a federal law that ensures access to emergency care. 

Duke LifePoint told Becker's the hospital was placed back in jeopardy status after CMS flagged pending cases involving violations of the Emergency Medical Treatment and Labor Act. The EMTALA cases were flagged earlier this year when the hospital was first placed in jeopardy status. A state survey in May identified immediate jeopardy to patients' health and safety, leading the hospital to submit a corrective action plan to CMS June 28. 

A Duke LifePoint spokesperson told Becker's the review of the EMTALA cases — which were identified in May and July — "did not take into account the corrective action plan that was implemented in July and recently completed." The hospital said it implemented a plan to address the issues and is confident it will pass a CMS review in the coming weeks.

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