By SUZANNE HAUGH, Special To The Bulletin | Published August 6, 2009
Saint Joseph Hospital, the only Catholic and faith-based hospital in the Atlanta area, is seeking a fair and equitable resolution to a contract dispute with health insurance provider UnitedHealthcare.
The success of hoped-for negotiations affect those like Betty Garvin and her husband who look to Saint Joseph Hospital for their medical care. Garvin and her husband travel 40 minutes from their Woodstock home, passing three hospitals on their way to Saint Joseph.
Her husband’s doctor, who treats his peripheral arterial disease, has performed six surgeries to save his leg from amputation.
“They have taken wonderful care of my husband,” Garvin said, adding also that the hospital’s spiritual quality of care “means the world to me.”
“They build up faith and courage and that helps (patients) emotionally deal with what they’re facing. … They don’t preach religion; they talk faith and courage. They don’t talk denominations; they talk faith and courage.”
These days her husband has his good days and bad days, she continued.
“We need this hospital desperately. We need United; it’s my insurance. We’re needing them to come through. If not, I don’t know what we’ll do.”
At stake in contract negotiations would be the loss of “in-network” coverage for outpatient procedures and other care of members who have UnitedHealthcare as their primary health insurance provider should the company no longer remain among other managed care providers currently at Saint Joseph Hospital.
“The focus of this story should be on patients,” said Deacon Bill Garrett, chief mission officer at Saint Joseph Hospital and a deacon at All Saints Church, Dunwoody.
Persons using UnitedHealthcare for secondary coverage should not be impacted if negotiations do not succeed, but those using UnitedHealthcare as their primary carrier would be affected “in a substantial way,” he continued.
Deacon Garrett spoke of the unique atmosphere and experience available at the 410-bed, acute-care hospital that draws on the experience and care of more than 750 physicians and a highly motivated and qualified nursing staff.
“We’re top of the line in quality care, having the latest and greatest instruments and equipment.”
He is quick to tell of the hospital’s distinct designation as a recipient of the Magnet Award, the highest recognition a hospital can receive for quality nursing care. (Saint Joseph has received this designation four times in a row and remains only one of two hospitals worldwide to achieve this.)
And what fundamentally sets Saint Joseph apart from area hospitals comparable in size and services is a culture and mission that attends to the spiritual well-being of patients and their family members, as well as those who work there.
“We believe the spiritual care of patients is important and is what people have come to expect of Saint Joseph,” Deacon Garrett said. “It’s available to every patient, no matter their faith tradition. We meet with family members and patients, and we really do believe it makes a difference in the quality of care. They feel the different experience here—like they have God on their side.”
One who can attest to the mission of Saint Joseph is Sister Valentina Sheridan, RSM, director of mission integration at the hospital. A Sister of Mercy, she is well versed on the “mission of mercy” evident since the hospital’s founding in 1880 by her order.
“Our mission has always been to provide compassionate care for those in need. That ongoing mission is what has attracted business men and women who support such a mission.”
It permeates the atmosphere at Saint Joseph today, she added. “From the doctors and nurses to the housekeepers and transportation helpers, the spirituality of Mercy is fostered, recognized, rewarded and celebrated. No other hospital in Atlanta has such a mission.”
She prays for a “just settlement” in contract negotiations with UnitedHealthcare.
“Saint Joseph Hospital is itself committed to justice in the workplace. It is seeking justice from UnitedHealthcare in its reimbursement policies and procedures so that the high level of care Saint Joseph’s is known for can continue to be given to patients.”
Saint Joseph has successfully renewed contracts asking for similar changes in reimbursement rates with all of its other managed care providers, a list that includes Aetna, Cigna, Blue Cross, Humana, Coventry, PHCS (Prudential) and Kaiser.
Without a contract, UnitedHealthcare members would still be able to receive care at Saint Joseph but would be considered “out-of-network” and have to pay privately.
Deacon Garrett spoke of how current insurance reimbursements from UnitedHealthcare do not reflect advancements in medical procedures and practices made since the “evergreen” contract was first negotiated with UnitedHealthcare over seven years ago.
He explained the situation through the example of someone coming in for a stent or pacemaker. Because of medical advances, these procedures are now done on an out-patient basis. They are not covered by UnitedHealthcare since the contract only approves coverage for those done on an in-patient basis.
“It’s $35,000 just for the (pacemaker) implant. We don’t get anything from UnitedHealthcare.”
New medical technologies, which Saint Joseph is noted for having, often cut down on the length of hospital stays, sometimes as much as 80 percent (from 7 to 2 days for many surgeries), “yet United still pays SJHA a flat rate per day instead of a flat rate per admission, unlike all other insurers,” stated an op-ed piece by Kirk Wilson, chief executive officer and president of Saint Joseph Health Systems.
“As such, (Saint Joseph) now receives 2/7ths of the payment it used to receive for the same procedure despite the fact that the overall cost of the care provided to the patient has not gone down due to extraordinary costs during the first 36 hours of care.”
In the last 18 months, Saint Joseph has served 8,500 UnitedHealthcare members, who comprise a little less than 10 percent of its patient population.
“Primarily our interest is on the patient; all other managed care providers see our perspective.”
“A lot of people are concerned and upset,” Deacon Garrett added, when talking about their current patient population, most of whom are “on the older end.”
He listed some of the unique features at the Catholic hospital—its chapel, daily Mass (which is televised for patients unable to attend in person), morning and evening prayers, crucifixes in every room. And there’s always a priest or chaplain available 24/7.
“People don’t want to go anywhere else.”
A meeting was scheduled between representatives from Saint Joseph and UnitedHealthcare for Wednesday, Aug. 5, after The Georgia Bulletin went to press. Further updates will be posted on the newspaper’s Web site at georgiabulletin.org.