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Editorial

UMMC, Blue Cross Blue Shield and caring for Mississippians

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Dr. Adam Protos
Dr. Adam Protos (UMMC)

By Dr. Adam Protos
Chief, Adult Cardiac Surgery Services
University of Mississippi Medical Center

 

Like many Mississippians, I have been confused and angry about the recent clash between the state’s largest hospital and the state’s largest insurer, but probably for different reasons than most.

As chief of cardiac surgery at the University of Mississippi Medical Center, I’ve had a front row seat to how this battle is impacting my patients. That’s why I felt compelled to share my perspective.

First, I think it’s important to remember what this fight is really about: having the ability to support the state’s smaller hospitals with services and levels of care that they don’t or simply can’t offer. Every week I take multiple calls from around the state from doctors taking care of seriously ill patients. These rural or community hospitals are not equipped to give patients the life-saving heart surgery or treatments they need. As the state’s only academic medical center, UMMC offers many unique services, such as organ transplant, heart failure surgery and complex aortic surgery. These services are in addition to training the next generation of the state’s physicians and research scientists.

Complex services are often crushingly expensive, and we offer them to every patient regardless of their ability to pay. We have been stretched to the breaking point over the last two years because of COVID-19, but we have never shied away from the challenge of providing for patients, including opening a mobile hospital in a parking garage during the height of the pandemic. For us to continue to fulfill our mission, we NEED to be paid on par with other academic medical centers in neighboring states such as Alabama, Tennessee and Louisiana.

Based on national actuarial data, we know UMMC is in many cases being paid less than half of what other centers are receiving for the same services. For example, if a patient in Meridian decides to cross the state line to have bypass surgery at the University of Alabama at Birmingham, that hospital will receive a substantially higher reimbursement than UMMC would from BCBS Mississippi for the SAME operation. In response to this, all we are asking for is the minimum amount to bring us within the normal range these other centers are receiving.

As someone who spends most of his time caring for patients, I wasn’t an expert on the insurance industry, so I was confused about this disparity when we’re providing the same services. I did some research. What I found was equally shocking: Blue Cross Blue Shield of Mississippi is a for-profit company with some of the largest cash reserves of any insurance company IN THE COUNTRY. Meanwhile, my colleagues and I are stretching every dollar to provide the most complex care to the sickest patients in the state.

Make no mistake, if BCBS starts paying UMMC fairly, I won’t get an extra dollar added to my salary, but we might be able to upgrade our operating rooms, train more of the state’s doctors in better facilities or offer more surgeries to profoundly sick cardiac surgery patients. This helps everyone in our state because no matter what you’ve heard, if you find yourself needing complex cardiac surgery, suffering life threatening trauma, or needing an organ transplant, there is a significant chance you’ll wind up at the doors of UMMC.

So please, help us get the support we desperately need; and if you’re still on the fence about where you stand on this issue, just remember: UMMC is here to provide the life-saving care you and your loved ones expect in your greatest times of need.

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