Our Request: Fair Market Value

Good morning!

Before I get to today’s topic, I want to wish our School of Medicine a Happy Match Day! And congratulations to all of our graduating students who will be announcing where they will take the next step in their medical education journey.

Now, on to today's topic.

Earlier this week, our patients who are members of a commercial Blue Cross & Blue Shield of Mississippi insurance plan and have an appointment with us in April or May received the letter found here. The letter provides an update on our contract negotiations with Blue Cross and offers patients an opportunity to move up their appointments to March. The current contract ends March 31, and we anticipate Blue Cross will force us out of their network effective April 1 if a new agreement isn’t reached.

As mentioned in a previous column, the Medical Center is attempting to negotiate a new contract with Blue Cross. (The State and School Employees’ Health Plan is not a part of this contract.) I had hoped that we would have come to a fair agreement by now, but it appears that we will be in protracted negotiations.

How did we get to this point? It comes down to us taking a stand as the state’s only academic medical center – an important factor that I’ll explain further.

I have maintained throughout the months-long discussions with Blue Cross that we want a fair contract that pays UMMC at a rate comparable to other academic medical centers in surrounding states and to be held to quality standards that take into consideration our unique role as a tertiary, quintenary and safety net hospital, which means we care for all patients. In particular, we treat the sickest patients, often with underlying diseases that add to the complexity of care.

While we proudly serve our fellow Mississippians in their greatest times of need, we know that to maintain the high level of service we provide and to expand our services to help even more patients, we cannot continue to be underfunded by Blue Cross by tens of millions of dollars each year. It is unfair to reimburse UMMC similarly to every other hospital system in the state, when we are clearly unlike any hospital system in the state.

I value what you do far too greatly to settle for the status quo any longer. Make no mistake; the position we are taking is about what’s fair – to you and to the people under our care.

Our proposal asks for a 30% rate increase that moves us closer to – not equal to or more than – market rates. We feel we should be paid in line with other academic medical centers in regional cities like New Orleans, Memphis and Birmingham.

Insurance reimbursement rates are typically measured as a percentage of Medicare rates. On average, academic medical centers are paid at 200% of Medicare but Blue Cross pays UMMC well below that benchmark.

We know the value we bring to Mississippi. Our health professionals here see it every day, from the premature infant in need of ICU services to the patient in need of a life-saving transplant.

Our partner hospitals understand it when they transfer a patient here because of our specialists, facilities and resources. This is demonstrated each day when many patients who require a higher level of care are transferred to us from hospitals across the state. Our thousands of patients and families benefit from the one-of-a-kind trauma care and children’s services.

Our communities depend on us during times of health crises. The most recent example is the two-year battle against COVID-19. Our health professionals and every person who works for UMMC worked tirelessly to help patients, and community hospitals relied on us to accept those who were the most critically ill because they knew the level of care we could provide. During some of the toughest times in our state from a public health perspective, we showed how much of a statewide resource we are and how much we play a part in the lives of all Mississippians.

I know “academic medical center” is mentioned a lot, but I want to take a moment to reflect more on what that means. It encompasses all that we are and weighs heavily in the Blue Cross conversation.

Our tripartite mission of education, research and health care sets us apart. We educate most of the state’s health professionals, discover causes and cures for diseases and add to the body of knowledge about patient care while providing excellent care for patients.

Each part of this work is an important thread in the fabric of Mississippi’s health system. In combination, they work to improve health care access and quality. We can provide the best possible clinical care through the latest treatments that may not be available anywhere else in the state. We have an irreplaceable role in our state.

We talk about our “onlies” because they matter in the lives of our patients and their families. We have the only children’s hospital, Level I trauma center, Level IV NICU and transplant center - services you can’t find anywhere else in the state.

When you think about the number of high acuity patients we serve each day, it’s incredible the amount of progress we have made in the quality care we provide. I mentioned our improved patient care ratings in last week’s column and our commitment to continue on this positive trajectory.

The years of Blue Cross underfunding have inhibited our ability to invest in the health professionals, facilities and services we know our state needs and deserves. From a statewide crisis to the critical care of a loved one, we are here for our state. We simply want a fair contract that recognizes this distinctive responsibility.

So when you read or hear about us taking a stand in contract negotiations with Blue Cross, just know this issue is about doing what’s right for our patients, our employees and the future of health care for all Mississippians. This is disruptive. This is tough. This is not where I wanted us to be. But it is important and it is our duty in ensuring A Healthier Mississippi, present and future.