Aetna to Provide Greater Support to Physician Groups
One day after unveiling a major restructuring effort, Aetna Inc. announced yesterday that it will assume risk from California physician groups for prescription drug costs and some medical costs and possibly may raise payments, the San Diego Union-Tribune reports. This "olive branch" was part of a "wide-ranging 'blueprint'" announced yesterday by Aetna in conjunction with the California Medical Association. Aetna, which has one million members in California, will take on risk for prescription drug costs and the "administration of recommended childhood vaccinations," risks that it had been "passing on" to physician groups (Fong, San Diego Union-Tribune, 12/20). In addition, Aetna said it will no longer require "pre-approval for many surgical procedures and certain hospital stays"; will pay for "expensive new technologies for at least the first year they are used"; and "will pay a monthly fee to medical groups starting on the first day that a patient signs up, even if the patient doesn't choose a doctor or seek treatment for months or years after that" (Bernstein, Los Angeles Times, 12/20). Although it did not promise to raise payments to physician groups, Aetna said it would "commit" to a payment system that is "actuarially sound."
Although much of the blueprint is still in the planning stages, the concessions "represent a significant change as physician groups throughout the state struggle to stay afloat," the Union-Tribune reports. CMA Executive Director Jack Lewin said that vaccination costs, prescription drug risks and low payments "are all things that are forcing doctors into bankruptcy." According to a CMA report released last year, as many as 90% of California physician groups are in "dire fiancial straits," as monthly rates paid by health plans declined 35% from 1993 to 1999. CMA President Marie Kuffner said, "I can't predict that doctors will be paid more. What I'm hoping for is that doctors will have less risks and less hassles" (San Diego Union-Tribune, 12/20). She added, however, "Is this going to stabilize the system? I don't think it's going to be enough. The whole system is crumbling." In addition, Aetna members may not like the changes: the health plans announced Monday that premiums for employers and consumers will rise by as much as 13% next year (Los Angeles Times, 12/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.