With a Sept. 30 deadline looming for contract negotiations between Naples Comprehensive Health and insurer Florida Blue, the health care system hosted a public meeting Sept. 17 designed to answer community members’ questions about the standoff and further explain its position.
While NCH executives provided a lot of answers, several community members said after the meeting they were still left with a lot of questions—and a lot of concerns as time runs out on the negotiations.
Without a contract by Oct. 1, NCH would no longer be in network for about 40,000 Florida Blue members, resulting in higher out-of-pocket payments for those still choosing to use NCH services, facilities and physicians.
At issue is NCH seeking a 9.5% increase in payment rates from Florida Blue for each year of a three-year contract, down from an initial request of 13.5%. NCH officials said Florida Blue’s last offer was 5% and described the negotiations as ongoing, but “at a stalemate.”
In a news release announcing the public meeting, NCH said it is seeking “fair reimbursement from the insurance company to cover the rising cost of patient care and preserve local access to doctors and vital services for families across Southwest Florida.”
NCH President and CEO Paul Hiltz said NCH is currently reimbursed up to 40% less than other health care facilities in the region, despite nearly identical costs to provide services.
“We know from Florida Blue’s own data that we are paid 30% to 40% less for providing the exact same services that our competitors are providing,” Hiltz told the audience made up of about 75 community members and NCH staff. “We don’t think that’s a fair proposal.”
Hiltz said the negotiations with Florida Blue are not personal or acrimonious but a matter of fairness. He noted cost increases coming out of the pandemic and said the quality of care at NCH has increased, as well. A handout from NCH at the meeting noted that it is recognized by U.S. News and World Report as a top 20 health system in Florida, is the only Joint Commission for the Accreditation of Hospitals—certified comprehensive stroke center in Southwest Florida and offers the only birthing center in Collier County.
“We just want to be able to provide that care to this region for a long, long time, and to accept less than fair payment would really put our organization at risk financially,” Hiltz said. “We just can’t do that, so we’re going to be very firm about this and really try to stand up for our physicians, our nurses and, most importantly, our patients.”
NCH Chief Operating Officer Jon Kling said “it’s just simple economics,” noting that the system emerged from the pandemic with 37% higher costs and a 4% increase in reimbursement and stands to lose millions of dollars if it goes out of network with Florida Blue. He also noted the system has never been out of network in the almost 22 years he has been there.
“If we want to remain a locally governed, locally owned, not-for-profit system … we have to be paid fairly so we can hire people at their competitive rates,” Kling said.
For its part, Florida Blue officials see the proposed NCH increase as excessive and said it would burden customers and the community with skyrocketing costs.
“We are committed to keeping NCH in our network but cannot agree to their excessive demands for a 30% rate increase over several years, because those increases are paid by our members and customers,” Florida Blue said in an open letter from West Florida Market President Phillip Lee. “Many across the Naples area are already struggling to make ends meet, and it’s our duty to protect them.”
Lee’s letter also states that if NCH chooses to leave the network, Florida Blue will ensure members “a seamless transition to other high-quality providers in the area.” The letter stated that “some Florida Blue members who are currently receiving treatments or are pregnant can continue receiving services [at NCH] with the same benefits and cost sharing” and said emergency services will still be covered at in-network rates.
In another statement made following a Florida Blue community meeting with nearly 50 members of the business and nonprofit communities via Zoom on Sept. 16, the insurer reiterated that Florida Blue is committed to keeping NCH in-network and is hopeful that an agreement can be reached.
“We’re asking NCH to do their part in addressing the spiraling cost of health care services and improving care delivery,” Lee said in the statement. “Clinical inefficiency drives up the cost of health care for everyone, and we expect NCH to use its market dominance and scale to improve performance and deliver value to our members. Unfortunately, NCH leaders have refused to work with us on these issues.”
With time running out on the negotiations, some patients said they are caught in the middle with little recourse and plenty of unanswered questions.
Anna Myers of Bonita Springs, whose husband, Jim, is a cardiac patient at NCH, said she has been a Florida Blue customer for 30 years and is concerned at the lack of progress in the contract negotiations.
“I’ve seen all kinds of the politics of medicine and all the changes and everything,” she said. “This time it’s not just ‘oh, we’re in negotiations and we’ll work it out.’ This time it’s starting to get really, really serious. And I feel like I’m a pingpong ball between two entities that really don’t think about the pingpong ball they’re batting around, and I just don’t think it’s fair.”
Clifford and Susan Schneider of Naples said they came to the public meeting hoping to find out more about the negotiations and were not reassured by what they heard. Clifford Schneider said it could be devastating to them if NCH becomes an out-of-network provider on their Florida Blue Medicare Advantage Plan.
“We’re in network here with NCH. If something were to happen to us and we needed surgery, or some kind of procedure, it could be very expensive,” he said after the meeting. “And it just all sprung on us all of a sudden, with not much time to make a decision because within two weeks we may have to decide if we’re going to switch health plans.”
