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News

Blue Cross Blue Shield opposes CCMH request

By BRETT DUNLAP
POSTED: November 6, 2009

PARKERSBURG - An area insurance company is urging the state to reject an application by Camden-Clark Memorial Hospital to perform emergency angioplasty.

Fred Earley, president of Mountain State Blue Cross Blue Shield, sent a letter this week to the West Virginia Health Care Authority asking the state board to turn down Camden-Clark's Certificate of Need (CON) application to perform the emergency procedures.

In his letter, Earley said the community is being best served by St. Joseph's Hospital and its open-heart facilities.

''We feel the current SJH services represent the superior alternative in terms of cost, efficiency and appropriateness,'' he wrote. ''The application needlessly duplicates services currently available at St. Joseph's Hospital.''

Camden-Clark is seeking the authority's approval to perform emergency percutaneous coronary intervention, also called Primary PCI, or emergency angioplasty.

Camden-Clark's Certificate of Need is for emergency angioplasty only based on the standards set by the West Virginia Health Care Authority, said Greg Smith, marketing director.

''It is not for elective angioplasty, nor open-heart services,'' he said. ''Approval of this service by the West Virginia Health Care Authority will allow Camden-Clark Memorial Hospital Emergency Services Department to provide this service to any patient that has an immediate need of life-saving angioplasty.

''Our Emergency Service Department treats approximately 42,000 patients a year and the quicker angioplasty patients can be served on an emergency basis the better the outcomes.''

Earley wrote that CCMH has failed to adequately provide detailed documentation establishing the policies and procedures that will be used when a cardiac surgery transfer to another hospital must occur.

''None of the documentation contained in the application show a detailed plan, procedure or protocols for triaging patients and determining whether emergency transfer is appropriate, including a decision tree, contact numbers, procedural steps to be taken in facilitating an emergency transfer from CCMH to another hospital for cardiac surgery,'' he wrote. ''Since St. Joseph's Hospital is about one mile distant from CCMH, timely transfer of patients should not consume a major part of the golden hour (the first hour of the heart attack).''

Any expansion of service at Camden-Clark would draw services away from St. Joseph's Hospital, Earley said. He added that the standards require two full-time experienced interventional cardiologists must be available to support the program.

''It does not appear that CCMH has a firm commitment from two full-time interventional cardiologists,'' Earley wrote.

Patient safety should be a primary focus in reviewing this application, he said.

''Permitting the offering of Primary PCI at CCMH, which does not offer cardiac surgery services, would only seem to needlessly increase the potential for adverse patient outcomes,'' Earley wrote. ''In summary, MSBCBS is concerned the development of this proposed service amplifies health risk in the community, rather than remediates it.

''The application presents no pressing need to duplicate services in a manner which could increase risk to patients. As an affected party, we request the board reject this application.''

St. Joseph's Hospital applauded Mountain State Blue Cross Blue Shield's position on the matter.

''We are pleased to have the largest insurance company in the Mid-Ohio Valley and the State of West Virginia going on record with the Health Care Authority, citing patient safety, physician coverage, and duplication issues with the Camden-Clark emergency angioplasty CON,'' said Jill Parsons, St. Joseph's Hospital vice president. ''The letter from Mountain State Blue Cross Blue Shield to the Health Care Authority illustrates that opposition to Camden-Clark's CON is truly about patient safety and not about competition between two hospitals.

''It's about doing what is best for the patient. Emergency angioplasty is best performed at a facility that has on-site open-heart surgery, exactly the way cardiac services have been offered at St. Joseph's Hospital since 2004.''

Smith said the concerns expressed previously by St. Joseph's Hospital, and now by MSBCBS, are without merit, and in many instances, do not even apply to the emergency angioplasty services they are seeking.

''Our application is about bringing this life-saving treatment to the biggest hospital and busiest emergency room in the Mid-Ohio Valley,'' he said. ''It is about staying state-of-the-art, and delivering the best available cardiac care to the community. It is also about delivering this care in the most timely and safest manner possible.''

 
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Member Comments
View Comments: | 1-25 |26-26 | Post a comment
Uselesstriviadiva
11-12-09 4:12 PM
parent of students...mahybe you should go to school with them...most policies employers offer do have a pre-existing clause.. HOWEVER..if you have been covered by insurance the preceeding 60 days it is waived..(yes even welfare counts) In other words..say you're covered now by 1 policy...and want to move to another policy next month.(if you change jobs or private policies,plans etc...) you can do that... your current insurance will send you a Letter of Credible Coverage showing that you had been covered for X amount of time, you show that to the new insurance and WA-LA...(actually Voila! but don't want to get too technical here) You're covered......therefore ....learn to read your policy..they teach that here in Fantasy World.

icuindytrav
11-07-09 4:11 PM
More frightening than the money motive that doubtfully is behind this announcement IS that the health insurance provider - the only one offered for CCMC employees, doesn't have the statistical faith in positive outcomes for the high risk, high technology and UNDER THE MICROSCOPE procedures in the Cardiac Treament world. Advice - go the the Hospital Comparison Site at Medicare.Gov. It's frightening to me as a healthcare provider.

Parentofstudents
11-07-09 3:08 PM
Uselesstriviadiva must live a fantasy world. Those of us with pre-existing conditions don't have the option to change insurance. I would not be covered for the conditions or would not be able to get coverage without extremely high rates. Many people in the real world can't just "Pick new coverage" or a new carrier. Come back to reality.

thatsjustme
11-07-09 8:41 AM
mac5858 says: "You people need to figure this out. Duplicate services like this = duplicate costs to the hospitals = duplicate cost being tranferred to the patients (private insurance companies)= higher premiums = you people blaming the insurance companies again for premiums going up."

i thought the mantra was more choice in the marketplace because that equals competition which results in lower costs. are you suggesting people's medical choices should be limited? the competition would negate the need for a public option which would make sure there is competition.

so how do you want it? competition or no competition? choice or no choice?

Marcolian
11-06-09 11:48 PM
Wow, such anger toward BCBS. Everyone does realize, beyond the duplication of services comment, there is a whole paragraph of things that CCMH apparently hasn't provided for the CON. If something goes wrong during a Primary PCI and the appropriate people/procedures aren't in place to correct it, guess who gets to foot an outrageous bill? Yep, BCBS. Given that St. Joe's, a whopping 1 mile down the road, has fully service cardiac facilities, it is probably less costly to BCBS to have procedures done there, especially if something goes wrong.

As far as this being an issue concerning money: why do you think CCMH wants to do Primary PCI in the first place? I doubt it is out of the goodness of their hearts.

Uselesstriviadiva
11-06-09 11:15 PM
reality...technically they dont have any right to tell a hosp what services to provide and they're not trying to..that's the STATES decision... also insurances don't tell you not to go to a particular hospital. It's YOUR choice if you choose to go to hospital x or y...they just say whether they will pay or not. No insurance company is ever the one denying you care..that's YOUR choice. If you choose to go to hospital X..and they don't particpate with your insurance you will still get treated...you'll pay..but that's YOUR choice. It's kinda like your company giving you a coupon for something at Kmart..and you CHOOSE to go to Walmart because it's more convenient/nicer cashiers/whatever..and not use the coupon..IT"S YOUR CHOICE.

reality
11-06-09 10:47 PM
tubaman,you are an idiot,this scenario is exactly the reason we need health insurance reform,insurance companies think and act like the mafia,they need reigned in, what right does bcbs have to tell a hospital what services they can provide, you talk as though you work for an insurance company.

Uselesstriviadiva
11-06-09 4:17 PM
BCBS is apparently trying to keep your insurance premiums down. Do you really think that all the highdollar equipment costs associated with this would ONLY be passed on to people that use it? Of course not...it will be passed on to everybody. When basically you are already paying for the equipment at St Joes why do you want to pay for duplicates 15 feet down the road? (and BWB1966...if you can't go to Camden Clark due to your insurance restrictions DON"T, you picked the coverage or choose not to find another carrier)

bwb1966
11-06-09 3:32 PM
I am sure during a cardiac event that I will have time to file an appeal with my insurance company and the state insurance commmission to get this procedure that is needed in an emergency.

If insurance companies are concerned with the current health care bill, they have only themselves to blame. They, not patients, hospitals, doctors or elected officials, created this current mess.

bwb1966
11-06-09 12:43 PM
This is simply business as usual. Eight years ago my wife was expecting and needed to see a specialist about diabetes--immediately. The only one available was a specialist at St. Joseph's. fifteen minutes before her first appointment the insurance company called to tell her she could not go to the appointment. They claimed they could treat he gestational diabetes over the telephone. She went to the appointment anyway and we paid for it ourselves.

900PAnDC
11-06-09 11:26 AM
OH, BWB1966; I hope your not covered by a Federal program because either someone has lead you astray or your rights under Federal Laws are being violated via the restriction to care versus patient safety.

I think you need a clarify from your HMO.

You have administrative recourse with your Plan, at the local Insurance Department and via Federal patient's rights. you also have additional Legal recourse.

You might also have the right to change plans, probably annually via open enrollment.

wildbill
11-06-09 11:09 AM
What the heck does BCBC have to do with this? And why are they sticking their noses into it?

bwb1966
11-06-09 11:02 AM
This is just an example of the "Death Panel" program. It is much cheaper for the patient to die in the emergency room awaiting transport than to allow the procedure. I and many others cannot go to St. Joseph's Hospital for ANY procedures due to restriction imposed by my current HMO. If I arrive at CCMH needing this procedure I must wait to be transported to either Charleston or Morgantown (Sorry, Marietta is out of our service area according to the death panel at my insurance company).

900PAnDC
11-06-09 9:46 AM
YIKES!! STandard & POOR reports Camden wants to start a CARDIAC SURGERY PROGRAM? What's Up? What will THAT cost? OPEN HEART at two hospitals a mile apart???? Is CCMH lagging in the Financial Dept, Did they expand sometime recently, taking on more debt? Are they 'digging' for Revenue? I live in DC and get paid to monitor this stuff. The Medicare Quality ratings are interesting too. (Highest Cost, Lowest Quality? could that be true?)

tubaman
11-06-09 9:41 AM
And you dummies voted for Obama and his socialized healthcare agenda. Get used to this kind of garbage: hospitals and insurance companies fighting over who will do what. You Obama lovers asked for it, and now you got it.

As to the argument presented by BCBS, it's a bunch of garbage. The cost of the procedures stays the same, regardless of the location. The amount BCBS will pay CCMH is the same amount they would pay StJoes for the same procedure. The costs incurred by CCMH to get this program up and going comes out of CCMH' profits.

Mac5858
11-06-09 9:29 AM
You people need to figure this out. Duplicate services like this = duplicate costs to the hospitals = duplicate cost being tranferred to the patients (private insurance companies)= higher premiums = you people blaming the insurance companies again for premiums going up. Just sit back and relax and your government will fix it all soon (or so you think).

jasper
11-06-09 9:15 AM
Well I bet Blue Cross just lost a good paying customer.. CCMH has Blue cross for their employees...

900PAnDC
11-06-09 9:06 AM
I'm surprised standards don't require more docs to support the program. It's not easy staffing a program 24-7 with only two Docs. Too bad patients can't choose when to have a heart attack, so they can do it when the Doctor's 'IN'. What's the proposed volume of procedures? More is better, practice makes 'perfect'; however, things will not go well probably 1% to 4% of the time.

geodelta
11-06-09 8:51 AM
Funny that MSBCBS is CCMH health insurance carrier.... And I find it very ironic that St. Joe pulled their bid to contest the angioplasty last week. It sounds like St.Joe and MSBCBS is working together on this?

gorilla
11-06-09 8:19 AM
Sorry it should read - creates competition and controls cost.

gorilla
11-06-09 8:15 AM
Free enterprise is he freedom of private businesses to operate competitively for profit with minimum government regulation which creats Competition is required to control cost in all business sectors.

Brooks
11-06-09 7:48 AM
I'm sure it has nothing to do with the fact that St. Josephs is a "private" FOR PROFIT hospital, and CCMH is not. Right? BCBS ***** to begin with, they are just another rip off insurance company, one of the WORST. Ask them how much money they are spending on LOBBYING in DC against ANY kind of Health Care Reform. It's millions folks. They don't care about people...none of them do...it's all about PROFIT. Hey....it's the American way!!

thatsjustme
11-06-09 7:37 AM
why is an insurance company trying to come between a hospital and its patients? is there a sweetheart deal between sjh and msbcbs?

time4change
11-06-09 7:35 AM
What is ST. Joseph's trying to do buy Mountain State Blue Cross Blue Shield vote.It is all about money not people!!!!!!!!!!

Bandit
11-06-09 5:13 AM
Sounds like a bunch of crap to me. It is indeed called competition and having a choice. Don't they already perform duplicate services at both hospitals???? Let them both have the certification to do so as long as they have skilled qualified personnel to perform the procedure, or could it be perhaps that CCMH is afraid of St. Joseph's having the better skilled workers and equipment???

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