A Message to Our Blue Cross Patients  ·  Kassay Family Medicine  ·  Portland, Oregon

Blue Cross raised your premiums 51% in four years.
They gave our clinic 0% of it.
So where did the money go?

Oregon's Division of Financial Regulation approved substantial premium increases for Blue Cross every single year since 2022. Blue Cross argued those increases were necessary because healthcare costs were rising. The state agreed. Employers and employees paid more.

Our clinic received none of it. Not one cent more than the 2022 rate — itself calculated using a 2016 pricing formula. If the money didn't come to the clinics providing the care, someone else got it.
The Question Every Patient Should Ask
If premiums rose 51% to cover rising medical costs, why did payments to the physicians actually delivering that care rise 0%?
This is not a rhetorical question. Oregon's insurance transparency files — required under state and federal law — contain the answer. The money didn't disappear. It went somewhere. The pattern visible in those files points to large institutional health systems: Providence, OHSU, Legacy. Small independent clinics were left out.
Annual Rate Change: BC Premiums Collected vs. Clinic Reimbursement Paid
Crimson bars show Oregon DFR-approved Blue Cross premium increases each year — what your employer and you pay more. The flat blue line at 0% is what our clinic received. Every year.
Blue Cross Premium Increases · 2022–2026
+51.1%
compounded · approved by Oregon DFR
Simple sum: +43.4%  |  State-approved each year
vs.
Clinic Reimbursement Change · 2022–2026
+0.0%
four years · zero adjustments
On a 2016 conversion factor  |  Sole insurer holdout

Following the Money

Oregon PEBB & state government are one of the largest single employer group paying Blue Cross premiums. A zero-sum game with fixed premium pools means every dollar routed to a large system is a dollar not reaching independent clinics.

Oregon State Gov't / PEBB
↑ Premiums
Largest employer bloc
paying Regence/BC premiums
→
Blue Cross / Regence
+51.1%
DFR-approved increases
2022–2026
→
Providence · OHSU · Legacy
Negotiated ↑
Leverage to renegotiate
contracts annually
Independent Primary Care (Kassay Family Medicine)
+0.0%
No negotiating leverage. Rate frozen at a 2016 formula since 2022. Practice absorbs the gap.
←
Premium Increase Allocation
$0.00
Not a single dollar rate increase in 4 years. In fact, 2022 the contract was pushed back to 2016 Contract Factor.
This is a government sized reimbursement pool. In theory, it won't run out. Oregon state government employees and retirees are the dominant premium-paying bloc for Regence Blue Cross. When Oregon pays ever rising premiums to Blue Cross, the available public data appears consistent with larger systems obtaining materially better reimbursement. So if premiums are going up, and only a few institutions are getting increased reimbursements, it is plausable THOSE institutions should be present at the State table. If they are the only ones participating in the higher premiums, they are the cause and only they are the benefactors. Anyone reviewing Oregon APAC data or the federal MRF transparency files can trace the flow. We are helping funnel what appears to be public-employee premium growth being captured disproportionately by larger institutions. Not because we want to. Because we have no choice.
Why This Is a Policy Problem, Not Just Our Problem
🏛️
Oregon's largest employer is funding this directly The Oregon PEBB program covers state employees, teachers, and retirees — one of the largest single pools of Regence Blue Cross premium payers in the state. Every year Oregon approves higher PEBB contributions, it increases the premium pool Blue Cross collects. Independent clinics see none of it.
⚖️
The DFR approval process has a blind spot Oregon regulators approve premium increases by reviewing Blue Cross's aggregate cost justifications. What they do not require: evidence of how those increases are distributed among providers. Large systems with negotiating leverage get more. Small independent practices with no leverage get zero. The regulator sees the input (costs rising) and the output (premiums approved) but not the distribution in between.
🔍
The transparency files make this traceable Under the ACA and the Consolidated Appropriations Act, insurers must publish machine-readable files disclosing in-network provider rates. Oregon APAC adds all-payer all-claims data. A researcher willing to parse these files could quickly quantify how much Oregon state government premium dollars flow through Regence to Providence, OHSU, and Legacy versus independent practices. We already know our number: $0.00 increase over four years.
🌀
Consolidation accelerates itself When independent clinics cannot survive on frozen reimbursements, they close or sell to large health systems. This gives large systems more patients — and more leverage to negotiate higher rates next cycle. Blue Cross's refusal to adjust independent clinic contracts does not just harm small practices. It accelerates the consolidation that ultimately costs patients access, choice, and years-long waitlists.
📂
This can be verified using public data. The federal Transparency in Coverage rule requires Blue Cross to publish machine-readable files (MRF) listing all in-network negotiated rates by provider. Oregon's All Payer All Claims (APAC) database, maintained by OHA, provides aggregate provider payment context. A journalist, researcher, or policymaker willing to cross-reference Oregon PEBB premium data with MRF provider payment rates could quickly see how much of the state's premium increase passed through to Providence, OHSU, and Legacy — and how much reached independent primary care. We already know our share. It is in this document.
What This Means for Our Practice  ·  Page 2 of 2
The Practice Impact  ·  Kassay Family Medicine  ·  January 2022 – March 2026

We Are Not Asking for a Raise.
We Are Asking Not to Go Backwards.

We love caring for our Blue Cross patients. This section is not a complaint — it is an accounting. Since January 2022, Blue Cross has frozen our reimbursement at exactly $500,000 per year. Not one cent more. Meanwhile the cost of running a medical practice — staff wages, supplies, equipment, rent — has risen every year with inflation.

We have never asked for more than we were paid before. We have only asked that Blue Cross adjust our contract so that the same dollar we received in 2022 still covers the same costs in 2026. That is the definition of breaking even. Blue Cross has refused. Dr. Kassay has quietly absorbed that growing gap herself — subsidizing your care out of her own practice's margin — so your access and your co-pay could stay the same.
⚠️
Important context the chart below does not fully capture: The $500,000 baseline frozen in 2022 was itself calculated using Blue Cross's 2016 conversion factor — meaning reimbursement rates already six years out of date when the freeze began. This analysis measures only the inflation since 2022. The full underreimbursement going back to 2016 is substantially larger.
Annual Reimbursement: Paid vs. What Breaking Even Requires
Blue = what Blue Cross has paid each year (unchanged). Red = inflation our practice has absorbed on your behalf. Dashed line = cumulative inflation absorbed (right axis).
2023
$32,051
Absorbed by practice,
not reimbursed by BC
2024
$48,496
Absorbed by practice,
not reimbursed by BC
2025
$64,953
Absorbed by practice,
not reimbursed by BC
2026 (Q1)
$19,609
Jan – Mar, absorbed
by practice
BC Rate Frozen Since
January 2022
Using a 2016 conversion factor
What Breaking Even Costs
$578,436 / yr
CPI-U · not a raise, just even
BC Still Pays
$500,000 / yr
$78,436 below break-even today
Every Other Insurer
Has adjusted ✓
Blue Cross is the sole holdout
Cumulative Inflation Absorbed · January 2023 – March 2026
Total Absorbed by Dr. Kassay
on Behalf of Blue Cross Patients
Based on U.S. Bureau of Labor Statistics CPI-U All Items index.
This understates the true amount — it excludes the 2016–2022 gap
and the fact that medical cost inflation consistently exceeds general CPI.
$165,109
covered by the practice so your
access and co-pay stayed the same
✅
Every other insurer we work with has made annual adjustments to keep pace with inflation. This is standard practice in healthcare contracting. Blue Cross of Oregon is the only insurer that has refused since 2022, leaving our practice to absorb costs that every other insurer has acknowledged and addressed.
Why This Matters to You Personally
🏥
Same-day & next-day appointments Dr. Kassay is one of the very few remaining independent primary care physicians in Portland still offering same-day access. That is not the norm — it is the result of a practice that has chosen patients over profit.
👩‍⚕️
One of Portland's last independent female MDs in primary care Dr. Kassay has remained independent specifically to give patients unhurried, relationship-based care that large health systems cannot. That independence has a real financial cost.
📅
The alternative: 4 to 9 months to see a new provider If this practice closes or joins a large health system, patients seeking a new primary care physician in Portland face waiting lists measured in months, not days. Emergency rooms absorb the overflow.
🤝
Nobody wins if this clinic closes Not patients, not the community, not even Blue Cross — whose members would face dramatically worse access and higher total healthcare costs downstream. Keeping this practice open is in everyone's interest.
Page 1 methodology: DFR-approved rate increases sourced from Oregon Division of Financial Regulation approved rate filings, small group market, Regence BlueCross BlueShield of Oregon: 2022 +3.4%, 2023 +7.4%, 2024 +6.0%, 2025 +13.5%, 2026 +13.1%. Compounded: 1.034 × 1.074 × 1.060 × 1.135 × 1.131 = 1.511 (+51.1%). Clinic reimbursement from practice contract records. Oregon APAC and OHA data may provide aggregate provider context. Federal MRF transparency files available at cms.gov.

Page 2 methodology: Base contract of $500,000 established January 2022. Annual CPI-U step adjustments per BLS data. Break-even values: Jan 2023 $532,051 · Jan 2024 $548,496 · Jan 2025 $564,953 · Jan 2026 $578,436. Cumulative totals: end of 2023 $32,051 · end of 2024 $80,547 · end of 2025 $145,500 · through March 2026 $165,109. Medical care inflation (MCPI) consistently exceeds general CPI, so actual underreimbursement is greater. The $500,000 baseline reflects a BC conversion factor dating to 2016.