A group of Boise orthopaedic surgeons is going public with a dispute over how much Blue Cross of Idaho pays them for their work.
"This is something that we've been contemplating for many years," Dr. Jeffrey Hessing said Wednesday. "The issue of how things are paid for in medicine is a huge issue."
For the seven physicians who make up Orthopaedic Associates, the issue is the amount of money Blue Cross pays them as in-network providers for a variety of procedures, including surgeries such as arthroscopies to repair knees, shoulders and other joint problems.
The orthopaedic group has dropped out of Blue Cross but still is under contract because of a 90-day grace period. The doctors and Blue Cross will meet next week to try to come to an agreement, Hessing said.
If the doctors don't sign a contract with Blue Cross of Idaho, patients with Blue Cross traditional or PPO plans will be responsible for paying a bigger share of their bills out of their own pockets.
Blue Cross covers just over half of insured Idahoans.
"Yes, we are still negotiating with this group of doctors," spokesman Stewart Johnson said in an e-mail. "We are disappointed, however, that they chose to engage in a public debate over what is a routine part of our business."
Arthroscopies are the bread and butter of orthopaedic practices, according to Hessing.
Hessing says orthopaedic physicians who contract with Blue Cross to provide care for Blue Cross customers are getting paid less and less each year for their work.
An example he gave: In 1996, Blue Cross paid him $3,100 for a knee ligament repair. His charge was $3,500. In 2007, Blue Cross paid $1,850 for the procedure.
"We have taken reductions year after year after year after year," he said. "You can see what it did to me in 12 years."
Hessing said he makes two-thirds the income he did 12 years ago, even though malpractice insurance for orthopaedic surgeons can reach $50,000 a year, among the highest for any medical specialty.
New graduates often have medical school loans totaling $100,000 to pay off as they practice, he said.
Blue Cross said it didn't think the doctors were getting a raw deal.
"In general, our reimbursement to physicians is going up," Johnson said. "We are especially increasing reimbursement to primary care physicians, who in Idaho, as well as in the rest of the nation, are generally paid far less than specialists."
"Our data shows us that in Idaho, specialists (such as orthopaedic surgeons) are reimbursed at considerably higher rates than they are in surrounding states," Johnson said.
If Orthopaedic Associates fails to sign on the dotted line, "the Treasure Valley has 53 other orthopaedic surgeons in the Treasure Valley in its PPO network where our members can receive in-network benefits," he said.
Colleen LaMay: 377-6448
