THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Saturday, November 5, 1994 TAG: 9411050629
SECTION: BUSINESS PAGE: D1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 129 lines
Virginia doctors have taken a look at the future, and what they see worries them.
They see health maintenance organizations signing up most of their patients, then controlling which doctors those patients can use.
They fear being blacklisted by the HMOs, losing control of their own practices, having their medical decisions dictated by business people.
They're ready to apply a little health maintenance of their own. At today's meeting of the Medical Society of Virginia, a statewide doctors' group, physicians are expected to take steps to protect their independence.
The society, meeting in Northern Virginia, will decide whether to create a statewide coalition to improve doctors' clout with health maintenance organizations.
``Doctors have been, to a large extent, excluded from management decisions in the HMO managed care market. We feel a certain sense of loss of control over our own destiny,'' Dr. Russell D. Evett said. A Norfolk internal medicine specialist, Evett is the incoming president of the society, which includes doctors from around Virginia.
Because managed care companies control which doctors their members can see, the companies can force doctors to agree to unfavorable terms if they want to keep their patients, Evett contends.
The proposal would create a system of independent doctors and market their services to businesses, HMOs and insurance companies. The system would be open to any qualified physician in the state. It would start out in small, local groups, and could expand to statewide, he said.
Evett said that the system would help doctors avoid going afoul of federal regulations that restrict how much physicians can band together to discuss fees. ``We could not discuss how we would set prices,'' Evett said, but ``we can discuss in general terms the value of services.''
Before Dr. Russell D. Evett left earlier this week for a meeting of the Medical Society of Virginia, he met with staff medical writer Marie Joyce to talk about how doctors are working to protect themselves: Question and Answer with Dr. Russell D. Evett
What worries doctors about managed care?
It would be the loss of choice, I think, on both the part of the physician and the patient. We're very fortunate here because we haven't had any of our managed care systems `deselecting' doctors from the system. But just as close as Washington, there's a large group of doctors who were essentially kicked out of (a) managed care system. So suddenly they lost contact with their patients.
How much of a danger is this here?
In my own personal practice, I've had a few patients who have had to go elsewhere because their employers changed to an HMO of which I was not a member. I'm sure my experience is reflected by a sizable number of doctors in the area. But it has not been, at this point, a major problem.
Let's talk about some of the resolutions that doctors will be discussing at the convention. One calls for the General Assembly to establish a ``patient protection act'' that would guarantee doctors' input into medical policies of insurance and managed care plans. Are doctors shut out now?
Many of them have been shut out from making decisions regarding medical policy. In many of the HMOs and medical insurance carriers, you have to call the carrier and get permission for the patient to be admitted (to the hospital), and you will be told how many days you have to treat this patient. If the patient is still in need of medical services at the end of that time, the insurance carrier may or may not say there's anymore time allowed. And this may not always be, in the physician's judgment, in the best interest of the patient.
There's another one on here - companies should be prohibited from dropping doctors without ``due process,'' and they should be required to tell doctors who apply why their application has been denied.
When the large group (of doctors) in Washington were recently, as they use that euphemism, `deselected' from the plan, the physicians who were removed from the plan were given no explanation at all. They were just simply told, `You're out.' They at least need some due process if they're removed from the system, that tells them why they're removed. It seems only a modicum of fairness.
Why do doctors need this protection?
As it stands right now, a large (insurance or managed care) company comes into this area and presents to me a contract and says, `Hey, take it or leave it.' Physicians don't have any opportunity to collectively bargain, if you would.
You feel doctors are at the mercy of these companies?
Yes.
Here's a resolution asking for a law that would make health plans liable for discriminatory action when they fire a doctor for ``acting as a patient's advocate.'' Are doctors afraid they will be punished for speaking out on behalf of patients?
There's a concern that this deselection process might take place for any of a variety of reasons - that being one of them.
Retribution?
Retribution. (There) is the potential there.
Do you know of any cases where that has happened?
No, I don't.
We've talked about a lot of things that could happen. And yet most of them, as you say, apparently have not happened in Virginia. Are doctors getting overly worked up about this?
No. Let's face it: California is sort of the bellwether, and these things have very clearly happened in California. We see these tides moving from west to east. If you look at the national picture, these are, unfortunately, all-too-common events.
So this doctors' network is a kind of preemptive strike?
That's right. We're trying to position ourselves so we can continue our practice. I hate for this to come across as being totally oriented toward just parochial issues and physicians looking after themselves. I do think that we still are motivated by concerns for our patients.
How would this physician's network protect patients?
There's some restriction in patient choice of physician (under managed care) - those few patients I've had who have had to go elsewhere for their care because their employer picked a different carrier.
How would this big network change that situation?
It would be open to all physicians in the state who are willing to meet the terms of whatever contract would be offered.
But even if every doctor could join this, a patient's HMO or health care plan would have to have a contract with this network in order for the patient to choose that doctor.
That's right. It would still require that. I grant you it's not - I wish it were - the cure-all. I wish it were the answer to everything, and it's sure not. ILLUSTRATION: Photo
Dr. Russell D. Evett, incoming president of the Medical Society of
Virginia
KEYWORDS: MANAGED CARE HEALTH CARE COORDINATED CARE PHYSICIANS by CNB