He’s regional president for Rochester’s largest insurance provider: Excellus Blue Cross Blue Shield. In the wake of Rochester’s steady shortage of primary care and specialty physicians, Scott Ellsworth has been answering tough questions on how to curb the crisis.
“Reimbursements are a key issue, there’s no question about it,” says Ellsworth in response to the insurance payments Excellus currently pays many area doctors, “I don’t think there’s one simple answer that we have to apply to all physicians.”
Rochester competes regularly with larger cities such as New York City and Washington D.C. for many of its physicians. Many of these more populated cities are able to offer higher reimbursements from insurance companies.
“Our reimbursements today are about 3% below the national average,” says Ellsworth.
One of the pressures on insurance companies, according to Ellsworth, is the rising cost of certain pharmaceutical drugs. In the last decade, pharmaceutical companies have developed more potent, targeted and effective drugs to treat a variety of conditions and diseases. For example, Enbrel is a newer biological drug for rheumatoid arthritis. It is given via injection and will only be covered by insurance if a rheumatologist prescribes it. Enbrel costs $12,000 per month.
“It ultimately puts pressure on the rest of the system to constrain costs,” says Ellsworth, “it ultimately puts pressure on the premium dollars.”
However, Ellsworth tells News 8 Now that this year in Rochester, there may finally be some financial relief for physicians who have typically been at the lower end of insurance reimbursement payments. Excellus recently consulted with the Monroe County Medical Society, the Rochester Independent Practice Association (RIPA), the RUMP group, the University of Rochester Medical Center and the Rochester Business Alliance to determine a long-term strategy to both retain and keep certain physicians. As of January 1st, Excellus raised the reimbursement rate to certain specialties in the area by 3.7%
“We actually think that with the 3.7% increase we’re putting in place on 1-1-08,” says Ellsworth, “that Rochester based on this data, will be at the national average when it comes to reimbursement.”
Excellus also plans to keep its “endangered specialty” program in place. The program began four years ago as a way to financially boost reimbursements for areas of medicine where Rochester faced critically low numbers to serve its population. The endangered specialty program provides an additional one million dollars a year to certain providers.
“I think the issue going forward,” says Ellsworth, “is average pay enough? When we’re talking about Upstate New York with our economic issues, tax issues, is average pay enough to continue to be able to recruit and retain high quality physicians?”