Practice Management Alert

Plus, BCBS in Michigan faces DOJ scrutiny and class-action lawsuit.

If you bill for a variety of treatments for patients with breast, colon, and lung cancers and you contract with United Healthcare, take note. The payer is testing a new program that pays oncologists upfront and bundles reimbursement -- which is based on the expected cost of a standard treatment program for the specific disease the patient has -- for the entire treatment program.

The drug the physician uses will not affect payment. Oncologists will receive the same fee whether they use standard chemotherapy with generic drugs or higher-cost brandname treatments, such as Herceptin or Avastin.

UHC is testing the program in five clinics in Georgia, Missouri, Ohio, Tennessee, and Texas.

In other news: Blue Cross Blue Shield in Michigan was slapped with a class-action lawsuit earlier this month. This suit follows one filed in October by the Justice Department and the Michigan attorney general.

According to the Michigan Business Review, both cases deal with agreements BCBS signed with around 70 Michigan hospitals. The contracts allegedly stipulate the hospitals must charge BCBS competitors equal or higher prices for procedures. The allegation is that BCBS took this practice -- known as most-favored-nation (MFN) clauses -- too far with the payer using its dominant market position in Michigan to basically force hospitals to agree to the MFNs.

MFN clauses are "a legitimate part of the procurement process and trying to exact the best price," Jeffrey Rumley, BCBS's general counsel, told the Michigan Business Review. "Our position is the use of MFN clauses is a perfectly acceptable practice," he explained.