DENVER: Doc Group Bans FFS Medicare in Favor of HMOs
In "a rare endorsement of managed care" that may be the first of its kind, a 52-doctor Denver-area medical practice has notified its patients that it will no longer provide care under traditional fee-for-service Medicare. Instead, New West's 6,000 senior fee-for-service patients must now pay cash or enroll in Medicare HMOs operated by PacifiCare or Blue Cross Blue Shield. The move is surprising in light of some Denver-area HMOs' recent abandonment of the Medicare managed care market, citing lower reimbursement rates for Medicare HMOs than for traditional fee-for-service Medicare. The Denver Post traces the physicians' decision to HCFA's war against Medicare fraud -- additional paperwork requirements may have convinced the doctors that HMOs are "so much easier to deal with than the federal government ... that the savings in time and hassle" concerning Medicaid claims are worth reduced reimbursement rates. In fact, the Post notes that several physicians' groups participating in PacifiCare's Secure Horizons HMO "actually make more money than they would accepting fee-for-service Medicare." A pleased Dr. Val Dean, COO of PacifiCare's Colorado division, said that New West physicians "believe in [HMOs] for lots of reasons, not the least of which is they believe their physicians can be reimbursed better than straight Medicare" (Hubler, 2/12).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.