'Our business model would implode': Why a physician group exited a payer's network

David Kowalski, MD, a physician with Springfield (Ill.) Clinic, a physician group with ASCs that dropped out of network with Blue Cross Blue Shield of Illinois last year after a pay dispute, shed light on the details of the dispute and what lies ahead during a presentation at the Effingham (Ill.) County Chamber of Commerce last week.

The Effingham Daily News reported Dr. Kowalski addressed the chamber during a June 3 luncheon. He said Springfield Clinic refused Blue Cross and Blue Shield of Illinois' contracted rates because it would have made it more difficult for the group to recruit and retain physicians. He said it would have been "fiscally irresponsible" for the group to accept the terms of the new contract.

"We feel that if we cannot retain or recruit providers that our business model would implode, not unlike our local hardware store," he said. "We feel we owe our patients more — a future that is stable and they continue to receive great care for many generations to come."

Dr. Kowalski said Springfield Clinic has been seeing Blue Cross and Blue Shield of Illinois patients out of network. Labs and X-rays for those patients are performed at HSHS St. Anthony's Memorial Hospital in Effingham until the two sides can agree on a new in-network contract.

Springfield Clinic and Blue Cross and Blue Shield of Illinois are still in talks to renegotiate their contract, and in the meantime the clinic has a process to mitigate the financial impact to out-of-network patients.


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