AETNA: More Texas Doctors Threaten To Bolt

      "About 750 physicians affiliated with Presbyterian Healthcare System" have given Aetna U.S. Healthcare 30 days to comply with their contract or face a walkout from its North Texas HMO. The Dallas Morning News reports that the doctors, members of the Presbyterian-affiliated Genesis Physicians Practice Association, "are accusing Aetna of failing to pay claims on time, withholding financial information and refusing to provide data on doctor referral and prescription patterns." Dr. Ralph Turner, Genesis chair, said, "We've had these problems for a long period of time, and we finally said, 'Enough is enough.'" About 8,000 patients would have to find new doctors or pay for their own care should the walkout occur. However, the walkout would not affect the 300,000 patients enrolled in Aetna's PPO or POS plans whom the doctors also treat. "Individual physicians [would] also have the option of contracting individually with Aetna's HMO." The threat by the Genesis doctors amounts to the third physician dispute that Aetna's Texas unit has faced in the last year. Doctors associated with Baylor University Medical Center and Methodist Hospitals of Dallas both threatened to quit because of underpayment. Both disputes were ultimately resolved.

Did Not/Did Too
      "The current dispute involving Genesis does not revolve around reimbursement rates," but rather an alleged failure by Aetna to provide required information about the doctors' own financial performance or efficiencies. "As an organization dedicated to patient care, we would be irresponsible to continue to operate in this manner," said Turner. Aetna said it has provided all necessary information, and it accused the doctors "of manufacturing the situation for publicity." C. Timothy Brown, manager of Aetna's West Central region, said, "We're giving them what's in the contract. We're even giving them more than what's in the contract. But this is a data business, and they want more and more and more." Some Genesis doctors share Brown's assessment. "This has got to be the first time that a contract is going to be terminated, not based on contractual terms or fees, but rather on perceived failure to deliver administrative data by the insurance company," said one doctor who asked not to be named. Presbyterian Hospital officials said they back the physicians' claims and "will attempt to mediate the dispute." Hospital executive Bill Haire said, "We firmly believe that under the terms of the agreement, Aetna should be supplying data and information to our physicians so that they can appropriately care for their patients in an effective manner."

Other Doctors Too
      The Dallas Morning News also reports that doctors in the Baylor University Medical Center-affiliated MedProvider group "sent out letters [last] week warning 3,500 patients of Aetna's problems retaining specialists and hinting at the group's possible departure from the network." However, an Aetna spokesperson denied that the HMO's network has had problems keeping specialists (Ornstein, 6/13).

Focus Of The AMA
      Today's Dallas Morning News reports that "leaders of the American Medical Association said Sunday that they will begin publicizing the success of 250 Dallas-area doctors who threatened to quit Aetna U.S. Healthcare's network last fall to protest fee cuts of as much as 40%." AMA President-Elect Dr. Nancy Dickey said, "We want to be able to say, 'Here's what you need to do.' In fact, if you're a very small group and don't think you can do what Baylor did, maybe we can send a person or two in and help you do that" (Ornstein, 6/15).