CHILDREN’S HOSPITAL: Cinci Doctors Ponder Tough Choices
Cincinnati-area insurers have long been looking for ways to reduce costs for pediatric care, but now that local pediatricians are sharing more financial risk, the move away from Children's Hospital Medical Center is gaining momentum. Telesis Physician Partners of Cincinnati LLC, a joint venture formed recently by two doctors' groups and a medical management firm, is putting the finishing touches on a contract with Choice Care/Humana under which it would assume "major financial risk" for caring for about 20,000 people. The Cincinnati Business Courier reports that the groups' pediatricians have begun discussions about cutting costs by switching some referrals from Children's to cheaper local adult hospitals -- a tough call in a community which reveres the hospital. On average, costs at Children's are higher by $500 for tonsillectomies, $725 for MRIs and $150 for ER visits. One unnamed managed care executive said, "If I came out with a plan like this, to move these procedures to another hospital, we'd absolutely be assaulted." Children's CFO Scott Hamlin defended his facility. "Yes, we have costs in our system because we're prepared to take care of the sickest children," he said, adding, "It completely skews the comparison when you lump all of the children between zero and age 12 into one average. ... We get a lot more of the younger kids (under 2 years old) and almost all of the kids who have serious complications." HMO executives, not forced to play the role of the heavy for once, are proceeding cautiously. "I'm not sure what we would do," said UnitedHealthcare's Ken Hoverman. "We don't like pediatric care compromised in any way" (Curtis, 3/22).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.