MOREHEAD CITY — Carteret Health Care is among the hospitals throughout the state that did not sign up for a new payment model to remain as in-network providers for the more than 725,000 state employees, teachers, retirees and their families who are part of the State Health Plan.

State Treasurer Dale Folwell, whose office oversees the State Health Plan, announced changes to the plan’s pricing structure, known as the Clear Pricing Project, last October. He says the changes will save money and bring more transparency to expenditures, but many health care providers in North Carolina do not agree.

Only five out of more than 125 hospitals throughout the state agreed to the treasurer’s new pricing structure, according to The Associated Press. The deadline to sign up for the plan was Monday; those who did not sign up will be considered out-of-network beginning in January, which means some health plan members could see higher medical costs.

CHC said in a statement it believes the changes could be detrimental to all health care in North Carolina, as they do not take into consideration the actual cost of providing care. The changes will limit the plan members’ access to critical and specialty health care services, especially in rural communities like Carteret County, the hospital claims.

“Our board and management have been very deliberative in evaluating what has been proposed, and we are deeply committed to price transparency and quality care,” CHC President Dick Brvenik said Thursday. “However, we are also committed to the long-term care of Carteret County, and there’s some major economic concerns with this proposal.”

The pricing model is tied to Medicare rates, but critics say those reimbursements aren’t enough and could force some hospitals to cut services. Mr. Brvenik said based on the hospital’s projections, CHC could lose up to $5.3 million annually under the new plan. While he said CHC is in good financial shape, other community hospitals are not, and the changes could force some hospitals to limit services, reduce staff or close entirely.

“This could impact rural hospitals in particular. Because of our size, changes impact us more than if we had the size, like some bigger hospitals do, to scale services,” he said.

Some hospitals contend one solution to controlling State Health Plan expenditures is to focus more on preventive care, according to AP.

The health plan initially set a July 1 sign-up deadline, but Mr. Folwell later sweetened rates and reopened provider sign-ups through Monday. Without agreements, hundreds of thousands of people could be forced into more out-of-network costs come January.

Mr. Folwell has said the plan is falling behind financially as medical expenses grow, and in July 2018 he asked medical providers to help cut $300 million from the $3.3 billion annual spent on the State Health Plan.

Many of the state’s major hospital systems also did not sign up for the new health plan, including Cone Health in Greensboro, UNC Health Care and Charlotte-based Novant Health and Atrium Health. Atrium says it sent an alternative proposal to plan officials in June.

“We hope the state treasurer and the State Health Plan will be open to collaboration to find a reasonable and cost-conscious solution that benefits all residents of North Carolina,” Atrium Health said in a statement. UNC Health Care officials and Mr. Folwell have held negotiations.

Mr. Brvenik said CHC supports House Bill 184, which would study potential solutions for a redesign of the State Health Plan. If the Senate passes H.B. 184, it would immediately stop the proposed changes and yield a more collaborative approach to health care.

“Taking these extra steps can benefit all healthcare throughout North Carolina and give an opportunity to examine better ways to contain healthcare cost in the short and long term for both the State and the State Health Plan members,” the hospital said in a statement. “The study plan as proposed in House Bill 184 will provide needed time for a thorough analysis to address cost savings and price transparency of the State Health Plan.”

In the meantime, Mr. Brvenik said hospitals should shift their attention to providing value-based care, which aims to reduce costs for patients and health care providers by ensuring individuals receive the most appropriate services for their needs.

Mr. Folwell, a Republican elected treasurer in 2016, is unhappy with the current process in which the health plan pays for medical expenses that providers bill to Blue Cross and Blue Shield of North Carolina, the plan’s third-party administrator. While Blue Cross negotiates what are considered confidential rate agreements with individual hospitals on behalf of the health plan — Mr. Folwell’s Clear Pricing Project sets prices for specific procedures.

Thursday, Mr. Folwell announced the plan’s network for 2020 will consist of Blue Options Network and the new North Carolina State Health Plan Network, which will consist of more than 68,000 providers combined. About 28,000 out of 61,000 medical providers statewide, including the five hospitals, signed up for the new plan.

Open enrollment for State Health Plan members opens in the fall.

“The Clear Pricing Project is just the beginning. I appreciate that 28,000 providers – independent primary care providers, behavioral health providers, independent provider networks and the 5 courageous hospitals – have chosen to provide care to those who serve in state government,” Mr. Folwell said in a release announcing the new network. “These medical providers should be applauded.”

The North Carolina Healthcare Association, representing the state’s hospitals, has strongly opposed the plan. Association spokeswoman Cynthia Charles said “decisions about whether or not to opt-in to the treasurer’s new offer remain up to individual hospitals and health systems.”

The Associated Press contributed to this report.

Contact Elise Clouser at elise@thenewstimes.com; by phone at 252-726-7081 ext. 229; or follow on Twitter @eliseccnt.

 

(11) comments

Osprey

The authors headline is quite misleading. The state plan establishes fixed rates which are much lower than industry standards and expects private institutions to simply accept discounted payments. 5 of 125 hospitals in the state have signed on. Maybe the headline should read "CHC among 96% of state hospitals that have rejected the State Employee health care plan".


Core Sounder

At least someone is trying to control run-away medical cost. Can anyone please tell us why Hospitals charge 100,000 dollars for certain procedures but willingly settle for 18,500 as payment from most insurance companies? Are they simply hoping that some fool will actually pay the entire 100K?


sick and tired

Not defending the hospital because they certainly are making a profit but for them to get 18,500 from the insurance they have to bill 100,000. If they billed the insurance for the actual $18,500 they'd end only getting a couple of thousand. Ask your doctor, and if they have been your doctor for a long time, and they trust you, they'll tell you. There use to be a Dermatologist in Medical park in Morehead who had a sign in her office that explained this fact. She has retired now, but we talked about it at length when I had an appointment with her. Then I asked my doctor, who has been my doctor my whole life. He confirmed it. Asked the girl at my dentist who files the insurance claims, same answer. So basically it's bill high because they know they will have to settle for much less OR bill the actual amount and go out of business.


David Collins

If anyone of you think things are mucked up now , just let the single payer scheme enter the picture . As the man once said , you ain’t seen nothing yet . 300 + million on the public dole ? Where is the money going to come from ? Can you say Y O U . Who decides who gets triage and who gets actual medical care ? Can you say civil service workers ? The same crowd that employed by the VA . That should comfort most everyone . Shouldn’t it ?


Core Sounder

so where does it stop? The hospitals bill insurance companies for 10 x the amount they really want and end up getting paid by the insurance company approximately 20,000 after charging 100,000. Even at that the hospital still made a 7500 dollar profit if the truth were told. have never gotten over the time that Carteret General charged my wife almost 3 grand for the use of a pair of forceps almost 20 years ago. Could buy a brand new medical grade pair for less than 200 dollars plus they are re-usable if sterilized.


beachmami13

Single payer would be really so much different from what we have here. I wonder what they will do though with ppl who aren't American citizens (or maybe that's part of the plan). I know years ago I lived in Canada with my husband, who was a permanent resident. Even tho he was considered a permanent resident, I didn't qualify for any medical care while I was pregnant. We had to pay it all out of pocket. Now if the US did that and prevented non citizens from getting emergency care or other care, we could save money that way, as there is a lot of money spent because of that issue.


Core Sounder

beachmami13, I agree that non citizens should not be supported with taxpayers dollars. However the problem is that someone get paid a lot of money for giving these illegals all of these freebies at us working taxpayer's expense of course. Was told years ago to simply follow the money trail and you will find the real source of our problems. That's true then and true today. Afraid that even if we did stop paying for illegal health care the hospitals and medical folks would still find a way to take our money by increasing their charges.


beachmami13

[thumbup][thumbup][thumbup][thumbup]


David Collins

Sounder , just do what the illegals do . Lie on the forms and just walk away . They do it just that easily . Seriously , it is going to take a time to Jesus meeting with the folks and the hospital administrators . Lots and lots of folks and no politicians allowed . The things you get charged with are beyond the realm of common sense and that includes phantom Dr. visits on the weekends when your guy is off . Could tell a few stories about that subject .


David Collins

Not time to Jesus meeting , meant a come to Jesus meeting .


chainsaw

tell us your stories, collins as that inquiring minds want to know.


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