Page 15 - SFHN1019pagesfinalUF.qxp_SFHN 0608 Friday 5.0

Proven Solutions Needed

for Out-of-Network Care

Holy Cross Hospital Partners
The Dade County If the insurance industry
Medical Association is allowed to pay out-of-net- with FAU to Create
(DCMA) has been work physicians their aver-
actively engaged in the age in-network contracted
ongoing debate in rate, they will be incen- Nursing Award for Veterans
Congress over how to tivized to further manipu-
address out-of-network late local markets by nar- Holy Cross Hospital, in collaboration with partners West Palm
care and protect patients rowing their networks and Beach Veteran Affairs Medical Center, C.L. Brumback Primary Care
from the financial impli- dropping higher quality Clinics, FAU Community Health Center and Community Health of
cations of receiving physicians that may cur- South Florida, Inc., has announced a new Health Research and
treatment from a physi- rently have the ability to Services Administration Award at Florida Atlantic University’s
cian that is not in their negotiate higher reimburse- Christine E. Lynn College of Nursing.
insurance carrier’s net- ment. Such actions would The award, the Caring-based Academic Partnerships in
work. Our concern is BY FRASER COBBE result in decreased quality, Excellence: Veteran RNs in Primary Care (CAPE-V), is open to vet-
that any insurance com- reduced access to care, erans who would like to earn their BSN degree to practice in a pri-
pany driven solution higher out-of-pocket costs, mary care setting and work with vulnerable and underserved popu-
may negatively impact patients on a and more out-of-network billing for rou- lations. With CAPE-V, BSN students who are veterans will receive
much larger scale. tine care, which is the total opposite of stipends, enriched curricula and a 180-hour clinical immersion
There is consensus in Washington DC the stated goals of this initiative. experience in a community-based primary care center. RNs working
that we need to protect patients from the We seek a solution similar to the State in primary care and the College of Nursing faculty and students will
impact of receiving a surprise medical of New York which has seen a 30% receive professional development training focused on veterans and
bill from a physician they believed to be reduction in out-of-network billing as primary care.
in their insurance carrier’s network. they utilize charge-based benchmarks This project aims to create healthier communities through educat-
The DCMA supports that position. The which encourage insurers to come to the ing and clinically training nursing students, specifically veterans, in
difficult choice before Congress is how table and negotiate reasonable contracts primary care to better serve the unique needs of veterans and who
to accomplish that goal without jeopard- and expand networks. are ready and willing to serve rural and underserved communities.
izing access to care and further deterio- Congress should pursue proven solu-
ration of networks and local market- tions that will protect patients and not Veterans who would like to earn a BSN degree can apply for the award
places. result in a one-sided victory for insur- here. For more information, contact Dr. Beth King at
There are proven models in states like ance companies. bking@health.fau.edu.
New York and Texas that have provided
a mechanism for insurers and health care Fraser Cobbe is Executive Director of the
providers to mitigate disputes without Dade County Medical Association.
providing perverse incentives for insur- For more information, contact the
ance carriers to further narrow their net- DCMA at (305) 324-8717.
works.

South Florida Hospital News southfloridahospitalnews.com October 2019 15