This may be happening in your area and it is happening again in North Carolina.  A hospital and insurer Blue Cross and Blue Shield of North Carolina are playing a game of chicken over medical care reimbursement rates.  In full media cry the two speed toward each other to see who swerves at the last minute.  This time Moses Cone Health System of Greensboro is rolling down this track well-traveled by other medical institutions.  Moses Cone says it will cancel its Blue Cross contract November 1 if there is no agreement on better reimbursements.  Conversely, Blue Cross says it will not negotiate because the contract cancellation has been announced.  Feels like the old days of nasty union organizing disputes, doesn’t it?  Well, the institutions may see this as the art of hard-ball negotiating, but it alarms others.  In every one of these public rate fights patients and physicians wonder whether they will be collateral damage.   Everyone must make contingency plans.

Before I continue, you need to know that Moses Cone is a frequent client (although not on this issue).  I once worked with Blue Cross CEO Bob Greczyn when he led the state”s biggest HMO Healthsource, and other hospitals have previously asked me to assist in rate disputes with Blue Cross.

Every time I have been asked how to approach these negotiations I have counseled against a public brawl.  I say, “It will be perceived as a battle between two health care titans over who gets the most money.  Patients are secondary.”  I have never prevailed.  Typically one side notifies reporters of a negotiation breakdown. (After all, “truth” is defined by whoever holds the first press conference.) That triggers a counterattack and off we go.  It’s like the so-called “Russian” negotiation style during the Cold War.  Your opponent doesn’t matter, only winning.

You and I know there is a “wink, wink” “nod, nod” aspect to these Kabuki dance standoffs.  Blue Cross doesn’t want to lose Moses Cone any more than the hospital wants its patients to pay higher rates for out of network care.  While last minute deals usually appear, physicians, patients, and even the antagonists suffer.  These fights cost both sides tens of thousands of dollars and everyone pays.  And not just in money.  When charges and countercharges fly whom should we believe?  Who’s right?  Who’s the demagogue?  Without third party corroboration how can we know?  Thus, we believe neither.  Both lose credibility.

I know a hospital once involved in a similar dispute that now regrets the loss of good will and dollars, and would not do it again. I know another hospital that fought Blue Cross in spite of my warnings and spent money that will take many months if not years to recoup.

What is discouraging is that healthcare costs are squeezing hospitals and they have to cover their costs. Blue Cross is highly profitable and wants to stay that way.  So the prescription is written for further expensive, reputation-tarnishing fights like the one now involving Moses Cone.  It’s like an old Twilight Zone TV show where the same awful events happen over and over forever.

Our astronomically expensive and troubled health care system does not need this.  I urge insurance and health care officials to holster their PR guns, become the best leaders they can be, and find a way to negotiate rates without conflagrations.  If they can’t, I recommend the medical association or some objective third party arbitrate future rate discussions.  We must stop the madness.  It’s about patients.