Why Are Healthcare Facilities in Southeastern Pennsylvania Freaking Out Right Now?

In a matter of days, Independence Blue Cross, the largest health insurer in Southeastern Pennsylvania will change its reimbursement structure, resulting in a 50 percent payment decrease.

Starting on August 1, the new model will determine payment based on “positive results” rather than volume of services. For example, a dermatologist who might have normally been paid $100 for a full-body skin exam and $50 for a biopsy will now only receive $100 for both services if they were both performed during the same visit, a 33 percent reduction.

Healthcare workers have been protesting the upcoming changes. In a letter from the Pennsylvania Medical Society to Independence’s president and chief executive Daniel J. Hilferty, they wrote that doctors will be forced to schedule patients for additional appointments in order to maintain current revenue.

Ginny Calega, Independence’s vice president of medical management and policy responded by saying, “If we are really talking about good patient care, a good member experience, we would really hope that our providers would not resort to bringing somebody back on two different days. It’s not really in the patient’s best interest to do that.”

Last year, Independence made $16.7 billion in revenue. The provider officials are not disclosing how the new reimbursement policy will affect other spending and billing practices.