At least three physician groups in Minnesota, including Midwest Spine & Brain Institute, have received a letter from Blue Cross and Blue Shield of Minnesota notifying them they'd been dropped from the Blue Cross network. The letter was unsigned and didn't give a reason for terminating the contract.
"We are in uncharted territory," says David Chang, MD, of Midwest Spine & Brain Institute. "It's kind of surreal. This is devastating for everyone involved, especially our patients who are frequently going through complicated medical procedures that require long-term support and care."
Midwest Spine & Brain Institute had contracted with Blue Cross of Minnesota for 29 years continuously — for nearly the practice's entire existence – and was designated by Blue Cross as a high quality provider. This decision will impact thousands of patients, including some of the most vulnerable patients the practice serves. There are patients who are vulnerable because of their age or socioeconomic status and may not have other options for treatment.
"We have some patients who could unfortunately end up as part of the opioid epidemic if they don't have access to other treatment options. They have gone through the process for treatment and can't start over again," says Dr. Chang. "These patients are going to lose the opportunity to see the level of specialists we have."
Dr. Chang and his partners often see patients who have very complicated cases because of their level of expertise. Often they are providing a second, third or fourth opinion for people who are running out of options.
For one patient and her newborn, there may not be many other places to turn. She was admitted to the hospital in the third trimester of pregnancy with excruciating leg pain from a massive lumbar disc herniation. Doctors had tried to alleviate the pain with steroids and narcotics to no avail. Her care team felt surgery was indicated, but her high risk obstetrician felt the standard prone position for spine surgery would put undue pressure on the fetus.
Dr. Chang and his colleagues from Midwest Spine resurrected a somewhat antiquated lateral position in order to both successfully remove the herniated disc and avoid stress to the fetus. With her leg pain resolved, she gave birth two months later to a healthy baby boy. However, she had gradually developed worsening low back pain. She has been unable to feed or take care of her baby. According to Dr. Chang, "She will need further MRI scans and might even need a lumbar fusion. But because Blue Cross administrates her medical assistance, this single mother is going to be dropped from our practice and can't afford out-of-network fees. This is a terrible situation."
The woman is unable to feed or take care of her baby until she receives further care.
All health insurance payers are required to be non-profit organizations in Minnesota BCBS of Minnesota is the biggest provider. Minnesota state law requires the nonprofit health providers to maintain a capital reserve that historically has been anywhere between two to four months' worth of expenses, or $118 million in 2012, according to a City Pages report. However, that year BCBS of Minnesota reported $827 million in reserves — 700 percent above the necessary amount.
CEOs of Blue Cross plans across the country are doing well, according to an AIS Health report, citing in 2014 there were 33 Blue Cross CEOs who earned more than $26 million collectively in salary and $102 million in total compensation. The base salary for non-profit health plan CEOs overall was up 2.6 percent year-over-year in 2015 and total cash compensation jumped 2.9 percent. Towers Watson data shows targeted total direct compensation grew 4 percent. The most recent salary report for BCBS of Minnesota's CEO Michael Guyette shows his compensation near $2 million per year, according to the City Pages report.
Midwest Spine & Brain Institute is not the only healthcare provider being cut off by Blue Cross. The insurer is also terminating its relationship with Duluth-based Integrity Health Network. IHN represents more than 20 independent health care clinics in Central and Northeastern Minnesota, and approximately 30 percent to 50 percent of its patients will be affected by Blue Cross' decision.
"Going forward we are going to make every effort possible to shine the light on this to help Blue Cross reconsider the importance of patients being able to see their doctor," says Dr. Chang.
In the meantime, Midwest Spine is connecting with patients and consulting them about future options.