THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, May 4, 1995 TAG: 9505040363
SECTION: BUSINESS PAGE: D1 EDITION: FINAL
SOURCE: BY MARIE JOYCE AND ROBERT LITTLE, STAFF WRITERS
LENGTH: Medium: 76 lines
Dr. Thomas Berenguer said goodbye to some of his patients, and he didn't like it.
Three health maintenance organizations don't include him on their lists of approved doctors. When his patients sign on with one of those HMOs, they have to pick a new physician.
``I have lost patients to those networks, and I want them back,'' said the Norfolk obstetrician and gynecologist.
That's why Berenguer and other members of the Medical Society of Virginia have created PHP Virginia - a new HMO partially controlled by the state's doctors.
The society, the state's largest doctors' group, has been talking about the proposal for months. On Wednesday, they announced a partnership with a similar organization in North Carolina and provided the first details of how the HMO will operate.
The partner, Physicians Health Plan of North Carolina, is an HMO owned by doctors in the state and by a Greensboro hospital and a surgery center.
The new Virginia HMO won't be available in Hampton Roads for another year or two, said Dr. Randolph Gould, a Norfolk surgeon who is the medical society's first vice president. When it starts up, probably at the end of this year or the beginning of 1996, it will focus on central Virginia.
Doctors see it as a way to regain some control over their practices.
``We can recover some of the ground we've lost over the last several years to . . . faceless bureaucrats in managed care,'' Berenguer said.
It's a trend repeating itself around the country. Doctors are revolutionizing the structure of health care, banding together to gain leverage in their dealings with managed care companies. In Florida, some doctors have even started unionizing.
When PHP Virginia becomes licensed and begins providing services - so far no doctors or patients are enrolled - it will operate like any other health maintenance organization.
The company will assume the insurance risk for a population, manage members' health care and negotiate directly with employers for contracts.
But the people running it say there would be a difference: Doctors make the decisions, not business managers.
``We're not looking for big business profits, we're looking for adequate reimbursement and quality care,'' said Gould, a Norfolk surgeon. ``Our patients are our friends, not our enemies. And we've both been victims of the business climate.''
Gould said they want to ``maintain the sanctity of the physician-patient relationship.''
The HMO will be open to all qualified Virginia doctors, who can buy shares at $1,500 apiece. Even those who don't want to sign on to treat PHP patients can become shareholders, and doctors don't have to be medical society members to take part. Those who treat PHP patients can continue relationships with other HMOs.
The medical society has about 6,400 members; there are more than 14,000 physicians in Virginia, about 10,000 in private practice.
The group decided to put off coming into Hampton Roads and Northern Virginia immediately, Gould said, because there are so many competing managed care companies in those areas.
While planning PHP Virginia, the medical society took a close look at attempts in other states. In some case, the doctors' networks have run afoul of antitrust laws.
The trend has become so common that in September, the Federal Trade Commission and the Justice Department issued guidelines for these types of medical alliances.
PHP's founders say they consulted extensively with legal experts when forming the company.
``Our lawyers, if we are to believe them tell us . . . we do not have a risk,'' Bereguer said.
KEYWORDS: MEDICAL INSURANCE by CNB