Phelps County Regional Medical Center is terminating the contract it has with Premier/Mercy health-insurance providers beginning Jan. 1.

The decision will affect 1,212 Mercy Health Plan members in Rolla and an additional 670 members throughout Phelps County, according to statistics provided by Mercy Health in St. Louis.

Having already notified Premier/Mercy of its intent to terminate the contract, PCRMC hospital administrators announced near the end of June they were concerned Premier/Mercy had not yet notified employers and members of the change. PCRMC also is planning an advertising campaign geared toward notifying current Premier/Mercy customers of the change.

The director of marketing for Mercy Health Plan in St. Louis, Kimberly Mernovage, disagreed and said insurance brokers already were notified.

“Technically, members should be notified 30 days before the termination,” Mernovage said. “However, we already have begun communicating these changes to our customers.”

Mernovage said it is her understanding that Mercy Health Plan administrators still were in discussions with PCRMC to negotiate a new contract.

However, PCRMC Chief Executive Officer John Denbo denied the implication that any further discussions with Premier/Mercy would occur.

“We want to have no relationship with the St. John’s health system,” Denbo said. “We made this decision six months ago, and unless they have started to notify their customers within the last week, we don’t know about it.

“We want to make sure people out there know there’s an issue with their plan.”

Denbo said the decision to terminate the Premier/Mercy contract was based upon the current competitive situation that exists between St. John’s and PCRMC and also because of years of unsuccessful negotiations with Premier to allow other community physicians to be included on its provider list, with a few exceptions.

St. John’s is slated to open its new medical facility in Rolla in September.

The local Mercy Health Plan, in partnership with the St. John’s Health-Care System, is described by some as a “fully integrated health system,” with hospitals, physicians and its health plan embedded within the St. Johns’ health-care system.

Denbo agreed, but described it differently.

“St. John’s has an extreme conflict of interest, in that its system owns its own insurance company.
“They profit off the underwriting, and they use it as a channel to funnel business to themselves. It’s an exclusionary practice,” Denbo said.

Using an analogy to explain his claim of a clear conflict of interest, Denbo said, “(For instance) Blue Cross doesn’t own a surgery center in town.

“We had a network-affiliated agreement. We don’t want to be listed as part of their network, because they don’t own this hospital,” Denbo said.

Phelps County Regional Medical Center is a non-profit entity, which is deeded to Phelps County, and the hospital is governed by a Board of Trustees.

Although the decision to terminate the contract with Premier/Mercy was made by hospital management, Denbo said, the Board of Trustees supported the decision to end the affiliation.

“We’re concerned about those people and employers,” Denbo said of Mercy members. “We regret the inconvenience to employers and members, but it’s important we get this in the open so they can look at alternatives.”

Additionally, Denbo said, the upcoming opening of St. John’s new Rolla facility imposes an even greater competitive relationship between PCRMC and St. John’s.

“Although they have every right to open new imaging and surgery centers (the more profitable services offered by health-care providers), you don’t notice them opening psychiatric or maternity centers (less profitable services),” Denbo said, alluding to the fact the hospital will, more than likely, lose some of the more lucrative patient business that helps support the less lucrative and wide range of services the hospital currently provides.

Dr. Randall D. Huss, president of St. John’s Clinic, the Rolla Division, said he was disappointed the hospital chose to terminate its contract with Mercy.

“To my knowledge, PCRMC would be the only hospital in the state, or any area where Mercy Health Plan is sold, that limits choices of patients and employers,” Huss said.

Huss also refuted PCRMC’s claim that St. John’s did not include physicians not employed by St. John’s onto its provider list.

“Over the years, we have been engaged in discussions with a number of physicians not in the St. John’s system, and many have been included in the network. There are a number of physicians in the Mercy Health Plan that are not in the St. John’s system,” Huss said.

According to Huss, 32 non-St. John’s-employed physicians who have offices in Rolla are on the MHP provider panel, compared to 29 St. John’s-employed physicians. Additionally, counting non-St. John’s employed physicians in the surrounding counties of Crawford, Pulaski, Maries and Texas, a total of 64 non-St. John’s employed physicians are approved Mercy providers.

Moreover, Huss said, the numbers of other non-St. John’s-employed health-care providers are too numerous to count. These include nurse anesthetists, psychologists, licensed clinical social workers, chiropractors, and physical and occupational therapists.

Huss said a total of 3,000 Mercy members reside within a six-county area that includes Phelps, Pulaski, Dent, Texas, Crawford and Maries.

“A lot of happy Mercy clients are upset that PCRMC would decline MHP,” Huss said.

Noting the opening of the new St. John’s Health-Care facility in Rolla, Huss said, “We will be able to accommodate patients  who need services that were only available at the hospital, previously.”

Huss also explained the Mercy Health Plan, which operates in Missouri, Arkansas and Texas, is a not-for-profit health-care plan that is a part of the Sisters of Mercy Health System.

Mernovage, with MHP in St. Louis, also wanted to assure Mercy members they would continue to receive their full benefits through the end of the year.

Additionally, Mernovage said, plan administrators are working on some options to minimize the impact of the contract termination to its consumers. Members would be notified shortly of the available options, she said.

PCRMC advised consumers to direct any questions regarding the termination of the Mercy contract to its director of Public Relations, Suzanne Paule, at 458-7605.