GOVERNMENTNews in brief - Aug. 21, 2006Blues' pay policy upheld by Calif. court Blues' pay policy upheld by Calif. courtA Los Angeles court in August rejected a request by the California Hospital Assn. to block a Blue Cross of California payment policy that the medical community says unfairly cuts rates and interferes with doctors' medical decision-making. The CHA sued the plan in June, arguing that the policy violates state anti-kickback and insurance laws. The insurer proposed to reduce fees by 20% for endoscopic procedures performed in outpatient hospital settings, while raising rates by 5% for services rendered in an ambulatory surgery center or a doctor's office. The California Medical Assn. did not join the lawsuit but asked the Blues plan to rescind the policy out of concern that it would reduce patient access. According to the ruling, the CHA "provided no evidence demonstrating that the policy will interfere with a physician's medical opinion as to what is best for his or her patient." The decision puts the lawsuit on hold for 60 days and asks the state Dept. of Managed Health Care to evaluate the payment policy. "This is far from resolved," said CHA spokeswoman Jan Emerson. The CHA will also meet with the DMHC before deciding whether to go forward with the lawsuit, she said. Josh Valdez, the Blues plan's senior vice president of health care management, said the ruling recognizes that the lawsuit was about "potential lost revenue for hospitals, not patient safety." The policy was intended to reduce patient costs, he said. Copyright 2006 American Medical Association. All rights reserved. |
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