NJ hospital group asks for delay of new referral list

By Mary Jo Layton Bergen Record

A group representing Catholic hospitals in New Jersey is asking the state to delay the rollout of a plan by New Jersey's largest insurer, saying it excludes nearly 90 percent of Catholic hospitals.

The president of Catholic HealthCare Partnership of New Jersey said Catholic hospitals could be forced to close their doors – resulting in the loss of health care access for uninsured residents – if the proposal by Horizon Blue Cross and Blue Shield goes into effect.

The concerns raised Tuesday by the group and by Assemblywoman Valerie Vainieri Huttle, D-Englewood, add to the backlash over a plan to create a tier system that would funnel patients to select hospitals.

Patients could use other hospitals, but their out-of-pocket costs would be higher.

"Insurance companies should not be able to dictate which of our state's hospitals succeed and which ones fail," said Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey, whose members include nine acute health care systems, specialty hospitals and other facilities.

"Horizon's decision will undoubtedly make it more difficult for Catholic hospitals to continue our mission of providing access to health care for New Jersey's poor and underinsured citizens," Codey said.

After the plan was made public this month, executives at hospitals left off the list of the select group known as "Tier One" questioned how the list was formed.

The list of Tier One hospitals includes 22 that are members of the newly formed Omnia Health Alliance, along with 12 others. Hackensack University Medical Center, HackensackUMC at Pascack Valley in Westwood, and Englewood Hospital and Medical Center made the Tier One list in Bergen County. In Passaic County, two Catholic hospitals, St. Joseph's Regional Medical Center in Paterson and St. Joseph's Wayne Hospital, made the list. Among those left off the Tier One list were The Valley Hospital in Ridgewood, Holy Name Medical Center in Teaneck and St. Mary's General Hospital in Passaic.

"I sincerely hope that Horizon did not intentionally keep Catholic hospitals out of its Tier One plan," said Huttle, chairwoman of the Assembly Human Services Committee. "If Horizon wants to quickly dispel this claim, it should be transparent with the criteria it used to select the elite group of hospitals that would participate in this new alliance."

'Deliberate process'

Tom Vincz, a spokesman for Horizon, said the insurer "engaged in a thoughtful and deliberate process in choosing the Omnia Health Alliance based upon an understanding of the desire, ability and demonstrated commitment by those health systems to move from fee-for-service to fee-for-value health care."

Horizon did not consider in the criteria "the health systems' tax status, religious affiliation or governance structure," he said.

The tier structure is not a view of the quality of care provided, he said.