UPMC's reach
- Thread starter JoeScaz
- Start date
Those ads are computer generated by Root Sports. You only see them if you're watching the game on that particular channel.
UPMC is a great entity but they desperately need a new PR approach. Their Evil Empire tactics to try to bury Allegheny/Highmark may be understandable in pure business terms, but health care is too political, especially senior care. Attempting to strongarm with the medicare supplement issue was a bad move. As shown in the news yesterday, the state is going to come down on them in any decision, even if they have the legalities on their side (which in reading the abstracts, they seem to have).
AGH = union
UPMC = non union
PG=SEIU
Dem=SEIU
it is that simple.
But their reach beyond Western PA is why I wish they wouldn't have dropped university markings in their branding. They are competing with Mayo, Cleveland Clinic, Harvard Partners, etc, on an international stage.
UPMC = non union
PG=SEIU
Dem=SEIU
it is that simple.
But their reach beyond Western PA is why I wish they wouldn't have dropped university markings in their branding. They are competing with Mayo, Cleveland Clinic, Harvard Partners, etc, on an international stage.
Pretty sure that even though it looked like they were rolling, that they are generated by computers for a specific audience. Somehow.
What is it about the fact that this started when Highmark CHOSE to get into the business by becoming an actual provider, not just an insurer, that UPMC haters fail to recognize? Highmark wanted their cake and to eat it too. Poor, poor Highmark. Also just a detail but an important one, did you know the state lawmakers and retirees health insurance (at least locally) is HIGHMARK? Hmmmmmmmm.......
(Edit: Just as an aside, both of my boys unfortunately had major surgery last May, within one week of each other. One at UPMC, one at a AHN facility. The followup paperwork is a case study in the 2 different networks. The bill from UPMC - 2 pages, itemized, clear to follow and most importantly, correct. The AHN bill? I should says bill(s) because they came for 2 months, a sheaf almost a 1/4 inch thick. It took us over 4 months to untangle it and amazingly, we just got a check out of the clear blue 2 months ago after an audit of one of the physicians or services was found to have overcharged us. I can't even get a clear answer what it was for! Although the physicians and supporting staff were outstanding at both facilities, AHN was (is still?) an administrative nightmare.)
Last edited:
And before anyone counters pittgirl by pointing out that UPMC started their insurance subsidiary first, there are major differences. UPMC Health Plan was formed as a for-profit subsidary back around 1998 as a reaction to intransigence on Highmark, then an absolute insurance monopoly that sat on something like $2.5 billion (now $4 billion) in cash reserves), in negotiating reimbursement rates for UPMC and other regional hospitals then forming a partnership called the Tri-State network of local hospitals (a regional partnership that was formed specifically as a counter the heavy handedness of Highmark and soon mostly morphed into the UPMC system). The reality is that UPMC's entrance into insurance was very different than Highmark's entrance into provider networks. UPMC Health Plan has always been an enclosed ecosystem for UPMC and affiliate hospitals and has always been upfront about it. In contrast, Highmark markets itself as providing universal doctor/facility access. However, in its written justification to enter the provider business through its purchase of failed West Penn-Allegheny, it had to explicitly stipulate in these state filings that it needed to divert ~20% of UPMC patients (equivalent to something like 70% of Presby's admissions) to its new facilities in order to be solvent, and Highmark also stated that it would no longer negotiate rates with providers, instead intending to dictate them through setting rates at first tier facilities (e.g. its own). The fact is, that shifting enough patients (eg operating revenue) from UPMC was a key condition of Highmark's takeover of West Penn being approved by the state. Yet, Highmark continues to paint pictures of full access to all facilities and is puts forth great efforts to force UPMC facilities into its provider network, even through political machinations, despite the bait and switch plan clearly outlined in the provider takeover strategies filed with the state. The failure to implement diversion of patients so far is also why Highmark has recently gone back to the state asking it to allow another $175 million infusion from its cash reserves into AHN. People that can't see that difference, and refuse to acknowledge the operational necessity in UPMC not voluntarily and cheerily participating in these strategies, spend too much time reading the PG editorial page culled straight from SEIU talking points and not thinking for themselves.
The problems with Highmark are hardly restricted to Pittsburgh. Geissinger, Excela...several other state medical systems all have problems dealing with Highmark and have railed against their heavy handed practices. There is a reason why, given a choice, community hospitals such as Hamot, Altoona, and Jameson have all chooses to join with UPMC over AHN, while others have chosen for-profit out-of-state partners (like Johnstown's Connemaugh selecting Duke Lifepoint over AHN). These are voluntary actions on the part of the local hospital professionals and boards that have devoted their professional lives to the health care sector. They certainly aren't SEIU mouthpieces.
The problems with Highmark are hardly restricted to Pittsburgh. Geissinger, Excela...several other state medical systems all have problems dealing with Highmark and have railed against their heavy handed practices. There is a reason why, given a choice, community hospitals such as Hamot, Altoona, and Jameson have all chooses to join with UPMC over AHN, while others have chosen for-profit out-of-state partners (like Johnstown's Connemaugh selecting Duke Lifepoint over AHN). These are voluntary actions on the part of the local hospital professionals and boards that have devoted their professional lives to the health care sector. They certainly aren't SEIU mouthpieces.
I don't believe I said anything hateful. In fact I started out with a compliment.
Locally, UPMC is already treated as a pariah. And now their dubious tactics are failing with the state government, which is now coming down on them even though they are in the right (it appears) legally.
They should have taken a different approach rather than the hardass one they've adopted, especially when involved with the seniors. That's a very delicate market to risk alienating in geriatric Pennsylvania.
With AHN as poorly run as you describe, UPMC would likely still have prevailed and would have had Highmark on its knees.
LOL - UPMC would likely still have prevailed...... So let me get this straight. Highmark for many years is an insurance carrier that is in network with UPMC facilities. Okay. Highmark goes out and buys an existing but bankrupt health provider thereby becoming a competitor of UPMC. And btw, their hospitals don't accept UPMC insurance (one of those pesky details), but yet somehow UPMC is the bad guy here because Highmark will become out-of-network at their facilities too. I get that I'm not a health professional, so maybe you can explain how this seems okay.
In case you haven't kept track, but at least to this lowly consumer, what has kept AHN solvent at this point are the lawmakers, by extending UPMC to accept their insurance beyond the deadline that was previously set. We have Aetna insurance. For years we were out-of-network with UPMC. Somehow we survived. Those with Highmark will do the same. I do feel bad for those who don't want to change their doctors, but this isn't a UPMC problem. They should look to Highmark for basically making them hostage to their business decisions.
I know you guys hate us PSU guys, but the anti-UPMC faction is right on. And you don't know how right-on they are.
They have nothing to do with Pitt, trust me. Nothing. What is going on locally with Highmark is only the tip of the iceberg wrt the way they treat employees, patients, and the world at large. It's a sick culture that is on the verge of not collapse, but definitely reorganization. It's too late for Levine to step in and take control, I think, but if such a situation were to present itself it would be ideal for the region.
Highmark's leaders are assholes, as well, but it's all relative. Anybody in Pittsburgh who hopes for fair, legitimate, and truly "region-beneficial" health care for this region should be lining up behind Highmark during this current controversy. County and state government get that, which is why they have done so, but the critical mass has not been reached yet. But it's close.
Disagree with me merely because of my PSU orientation, at yours/our peril, but it's true. This is not a Pitt issue at all.
They have nothing to do with Pitt, trust me. Nothing. What is going on locally with Highmark is only the tip of the iceberg wrt the way they treat employees, patients, and the world at large. It's a sick culture that is on the verge of not collapse, but definitely reorganization. It's too late for Levine to step in and take control, I think, but if such a situation were to present itself it would be ideal for the region.
Highmark's leaders are assholes, as well, but it's all relative. Anybody in Pittsburgh who hopes for fair, legitimate, and truly "region-beneficial" health care for this region should be lining up behind Highmark during this current controversy. County and state government get that, which is why they have done so, but the critical mass has not been reached yet. But it's close.
Disagree with me merely because of my PSU orientation, at yours/our peril, but it's true. This is not a Pitt issue at all.
This may be a Pitt board, but who said anything about defending UPMC because they are affiliated with Pitt? If you read my previous message, you would know that up until a year ago, we had NO UPMC doctors. None. My beef is with the distortion of the facts and the portrayal of UPMC as some kind of evil wizard. Someone wants to point to their size or whatever, have at it. But to think that this exists because of poor little Highmark is pure spin. Highmark made a BUSINESS decision that came back to bite them. And now they want the legislators to bail them out. I love how they've made this into David vs. Goliath. Highmark made a deliberate financial decision to enter the provider arena to compete with UPMC, just as West Penn and Allegheny General did for years before that.
What I also find extremely amusing is that for years there were many in this region under many different insurance plans who were out-of-network with UPMC. I guess I must have missed the hue and cry that somehow this was "unfair practices". We found practitioners and hospitals regionally who were in network just fine. Check your own insurance plan. Are you IN-network everywhere? Of course not.
Sigh. I'll repeat. I never said UPMC is technically or legally wrong, in this or anything else. I said that they should have been more wary of the political mine field they are treading on by extending their Highmark fight to the senior care landscape. Never mind who is actually right or wrong, UPMC is being positioned as the sole badass. And, like the rest of the Highmark battle, it's at least in part because UPMC seems to relish that position in the PR tactics it takes.
Problem is, the state politicians are starting to come down on them for it, as witnessed by the ruling on Friday. UPMC may well be totally in the right, from all I read (Highmark withholding payments and unilaterally imposing different rates). But what good did that get UPMC? The judge told em, "tough spit." Why? Certainly not legal grounds, from what I read. A big reason why is that UPMC's posturing for these past few years has public opinion solidly against them, and it's up another notch further with just the hint that they are now throwing their weight against seniors. Much like PSU fans, geezers vote, so that will get sleazy PA politicians to react every time.
I'm no lawyer, but I guess I'm having a hard time understanding how Highmark has any legal standing here at all. Perhaps someone can explain it to me. Anyone with Highmark insurance can easily obtain healthcare services at this time. JUST LIKE EVERYONE ELSE DOES WHO ARE OUT OF NETWORK WITH UPMC. Why should Highmark be shielded?
And the statement that UPMC postured as if Highmark wasn't doing exactly the same thing? Really I don't care what the lawmakers say - this will come down to a court of law and I defer to someone who can show me the legality of Highmark's position. If healthcare isn't free enterprise, then all hospitals and providers would have to accept any insurance plan. But they don't. So again, I defer to someone who can connect the dots for me.
I find it funny that everyone pretty much agrees that one way to potentially reign in health care costs would be to have true competition in the marketplace, something that in most markets is sorely lacking. Well, if the idiot politicians would get the heck out of the way, Western PA could truly have real competition in it's health care market. You'd have UPMC with it's hospitals and insurance plans. You'd have Highmark with it's hospitals and health care plans. And you'd have third party insurance providers contracting in some cases with both hospital networks and in other cases with one hospital network or the other. If we could just get the idiot politicians out of the way, we may end up with a system based on competition here. Imagine that!
What better way to get prices under control than giving the public a real choice? If Highmark's rates are too high, people can buy their insurance elsewhere and use other hospitals. If UPMC's rate's are too high people can buy their insurance elsewhere and use other hospitals. Nothing gets prices under control faster than some real competition.
What better way to get prices under control than giving the public a real choice? If Highmark's rates are too high, people can buy their insurance elsewhere and use other hospitals. If UPMC's rate's are too high people can buy their insurance elsewhere and use other hospitals. Nothing gets prices under control faster than some real competition.
So when Highmark changed their reimbursement rates to UPMC in direct contradiction to the contract that they agreed to, UPMC should have just thrown up their hands and said, "rats, I guess it sucks to be us"? I'm not sure why UPMC should have gone into this with any expectation other than the judge actually upholding the clear text of the agreement that UPMC and Highmark, under the supervision of the state, agreed to. Why should they have expected anything other than the judge making the clearly correct ruling, which would have been one in their favor?
The best part of the judge's decision was where he ordered UPMC and Highmark to get together under state supervision and negotiate an end to this dispute. It's like as if he doesn't understand that that was exactly the process that was used to get the agreement that Highmark has now unilaterally decided to violate.
Football aside, if you all knew what I knew, you'd never in a million years defend UPMC. Trust me on this: this goes far beyond stupid football.
If you knew what I know, you would never support Highmark! I worked with Highmark/Blue Cross/Blue Shield for 38 years.
Since you brought up football, if you knew what I knew about penn state, you would never defend them.
Over the past few years, UPMC has been funneling a LOT money into IT projects that they can privatize and sell to other organizations. I don't blame them for wanting to make money, but there have been numerous rounds of layoffs and reorganizations to make these for-profit departments stronger while weakening those projects focused directly on patient care here in Pittsburgh. AHN is far behind UPMC in IT, but they are putting their dollars and workforce behind strengthening their electronic records and interconnected systems. I don't know if AHN will be able to compete with UPMC long-term, but they should see improvements in efficiencies once their new systems are fully implemented.
Per
Because this is politics, that's why.
UPMC is playing it poorly right now, and getting reamed, as Friday showed.
Because this is politics, that's why.
UPMC is playing it poorly right now, and getting reamed, as Friday showed.
Did a Penn State fan just criticize UPMC for its sick culture?
I worked for UPMC until my retirement a few years ago. Trust me, the only thing those predators want is to eliminate competition. UPMC is run by an egomaniac whose mission is to put pressure on non UPMC hospitals. Recently they've announced a 5% staff reduction due to reduced patient utilization even though they opened an unnecessary hospital in Monroeville (UPMC East). That new hospital was built to put pressure on Forbes and not for patient needs. They've done this numerous times before. Another example was opening a surgi center in Natrona Heights some years ago to take business from Allegheny Valley Hospital. Anyone who ever attended the chief honcho, Jeff Romoff's admin and staff meetings knows what the game plan is......search and destroy,
With AHN, it is "system", not "systems". EPIC is going to do it all (EHR, registration, billing). Drawback is EPIC is not the easiest for getting data out (i.e. analytics). But John Paul was the one who made everything happen at UPMC and he won't go down without a fight.
well Nittany, you must not have been around when John Paul was at those senior staff meetings. He is probably more vicious than Romoff. If you think AHN will be any less cut throat than UPMC with JP running the show, you are fooling yourself.
Slick- I was there when JP was running the ship but Romoff's was more of a predator with a bigger ego. You may be right though.......JP hates UPMC and Romoff since they canned him and imposed a very restrictive non-compete clause in his lucrative severance agreement for a period of years. I could tolerate JP. Romoff was intolerable with his airing of his radical left wing political views that he'd rant about at each Directors Meetimg. If you attended you know what I'm talking about.
You can say that again. As I documented the mind-boggling mess that were my sons bills from an AHN surgery, this past fall he had to his ever present routine followups. We decided to do it at Wexford Wellness given its proximity to our home. A few weeks later I got a bill asking for the full amount (thousands). Went back to Aetna who I assumed were at fault - no, it was the "way" the physicians were identified out of AHN when submitted to Aetna. I called Wexford Wellness, an lo and behold I got a, "Yes, we know there is a problem and will resubmit under your request." Under my request? And you KNOW there's a problem? WTF? The beauty was a month later when we get the SAME bill. I call again and they asked if we would pay the full amount and then would refund even though they knew he had coverage and it was their administrative issue. OUTRAGEOUS. They really need to get their sh*t together.
Yes Nittany, JP could simultaneously charm your socks off while carving your heart out with a dagger.
Actually the Highmark move to become an integrated healthcare system was taken in response to UPMC starting up their health insurance business to compete against Highmark BCBS.
UPMC Senior Management are despicable megalomaniacs. The built their empire on the backs of the communities where they now turn away droves in people.
Honestly there should be a law against the integrated health model. To be both a healthcare provider and a healthcare insurer is a surefire conflict of interest.
Well that's a vague notion which screams credibility.
I'll throw my lot in with academic based health providers every time.
Most people with some sense know the future of health systems will be being self insured, so they control their own detiny.
Last edited:
Why you think UPMC is so much worse than Highmark is beyond me. Highmark is as heavy-handed as you can get.
The Highmark/UPMC battle aside ......
UPMC Hospital system was rated #12 in the country out of ~5,000 hospital systems evaluated by USN&WR.
14 specialties at UPMC were ranked and 7 of those in the top 10 in the country.
UPMC was ranked #1 in the Pittsburgh area and #1 in Pennsylvania.
That is pretty impressive for UPMC and I can also say that the AHN has some very good physicians as well..... all good for western Pa. patients.
UPMC Hospital system was rated #12 in the country out of ~5,000 hospital systems evaluated by USN&WR.
14 specialties at UPMC were ranked and 7 of those in the top 10 in the country.
UPMC was ranked #1 in the Pittsburgh area and #1 in Pennsylvania.
That is pretty impressive for UPMC and I can also say that the AHN has some very good physicians as well..... all good for western Pa. patients.
I don't think even the most ardent Nitter would argue on the quality of care by UPMC. It is just they are bullies.
I am a conservative Republican. I assure you it's no joke to those who have had access to UPMC doctors and hospitals revoked.
I know you love all things Pitt and Pitt related, but on this issue I respectfully disagree with your position. UMPC is rapacious.
They have turned this Highmark issue into a blood feud. UPMC appears to have no issues with its own market dominance and monopolistic practices. They don't give a damn about the patients or the community. They only care about money, market share and power. They sure as hell don't act like a non-profit. Close down a hospital in Braddock that typically had 70% of its beds full to open a brand new hospital 2 miles from Forbes Regional in a market already well served?
I will say it again, the integrated healthcare model of being both a provider and an insurer is rife with conflicts of interest
Similar threads
