Hospital in Oregon Suing Coordinated Care Organization for Cancelation of Contract as They Assumed When Taking Over Prior Care System

Willamette Valley Community Health is the organization to oversee care for Medicaid Patients in part of Oregon with almost 68,000 patients.  Before this company another company, Marion Polk managed the care for the same group of patients and was the party creating contract.  Willamette replace them and that is where Salem hospital came under their jurisdiction of contracts and providers.  Salem was left out as far as a participating provider at this point and was paid at a lower rate.

The hospital states they do have a contract and can’t just be dropped.  The compensation would go to around 55% and that’s a lot of money to be lost for any hospital.  The hospital has already done a report stating that they have been underpaid by over $18 million from Medicaid.  Supposedly all contracts were cut of with Willamette except for one, and well if you read, that’s the way it seems to be done.  In the OC I watched it as United Healthcare bought IPA, new contracts and they are never for more money.  In this last year, the hospital barely broke even.  I keep reporting more and more stories as such as big business, keeps cutting the hospitals in pay and they are the 3rd party management companies.  Its is obvious that we need a larger spread of medical expenses and a Single Pay plan would do that.  BD

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Gov. John Kitzhaber’s plan for improved health care for Medicaid patients promised better coordination, better outcomes and fewer costs. But launching the new collaborative system has come with a dispute over who gets paid how much.

Salem Hospital has filed a lawsuit against the local coordinated-care organization, consequences from which could mean less revenue for the hospital.

Salem Hospital has filed a lawsuit against the local coordinated-care organization, consequences from which could mean less revenue for the hospital.

Willamette Valley Community Health is the local coordinated-care organization formed to deliver care to Medicaid patients in the Mid-Valley. Coordinated-care organizations, or CCOs, are a key part of Oregon’s overhaul of the Oregon Health Plan and include a network of providers expected to deliver more comprehensive mental, physical and dental care for thousands of low-income

At the heart of the dispute is compensation — how much WVCH would pay Salem Hospital for its services to enrollees. Hospitals that contract with a managed care organization receive a reimbursement rate that is 68 percent of the Medicare reimbursement rate.

In fiscal year 2012, Salem Hospital barely broke even, reporting an operating margin of 0.8 percent.

http://www.statesmanjournal.com/article/20130112/NEWS/301090121/Salem-Hospital-sues-area-coordinated-care-organization?nclick_check=1