HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that while the Rochester, N.Y., MSA has historically experienced equitable cooperation between hospitals, physicians, health plans and the business community, recent collaboration has been driven by the dominance of two local insurers, which is increasing tensions between health plans and physician groups. According to the latest Rochester Market Overview, while current efforts to control costs are increasing tensions, at the same time, health plans and health systems are collaborating to attract physicians to the area.
Excellus BlueCross BlueShield formed an agreement with the University of Rochester Medical Center, the area's largest health system, to entice physicians to the area with higher reimbursement rates. This agreement boosts reimbursement for about 2,700 local physicians, or about one-third of the physicians in the Rochester area. In exchange for increasing physician reimbursement rates, officials from the University of Rochester Medical Center agreed to encourage physicians to prescribe generic prescription drugs, lower physician-practice overhead and prevent hospital-acquired infections. Additionally, Excellus BlueCross BlueShield is targeting the overuse of medical imaging to help control costs.
Doctors affiliated with the Greater Rochester Independent Practice Association were recently granted approval by the Federal Trade Commission to negotiate collectively with all payers. The Greater Rochester Independent Practice Association is a partnership between ViaHealth, the area's second-largest health system, and local physician groups.
"The medical community in Rochester, N.Y., has long felt that the area's dominant insurer, Excellus BlueCross BlueShield, has increasingly infringed on doctors' rights," said Mark Cherry, market analyst with HealthLeaders-InterStudy. "With a significant fraction of area physicians represented by the Greater Rochester Independent Practice Association, its ability to negotiate with all payers may bring more health plans to the market as physicians look toward out-of-market insurers. Such action will likely increase tension between physician groups and the area's current insurers."
Another significant player in the Rochester healthcare market is the Finger Lakes Health Systems Agency, which is the strongest regional hospital regulator in the state. Its resurgence can be credited in large measure to the high consolidation of health plans in the Rochester area.
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