HIV/AIDS: Docs Struggle Against Managed Care to Provide Care
Despite the "strength of the AIDS community" in San Francisco, changes in managed care "have forced many of the leading HIV physicians to spend much of their time in non-HIV care in order to support their HIV practices," according to a recent AIDS Treatment News article. Many HMOs "claim that HIV disease treatment is part of primary care ... and then pay only the healthy adult capitated rate," usually about $8 per month. In effect, doctors are penalized for seeing expensive HIV patients and thus often wind up seeing fewer of them. But in some instances, doctors have been able to "restrain managed care abuses by organizing into" independent practice associations, AIDS Treatment News reports, citing the example of San Francisco's largest IPA, Brown & Toland Medical Group. Brown & Toland "has been a leader in defining protocols for high quality and cost-effective HIV care," because it has enough "clout to negotiate contracts which can force health insurance plans to provide ... viable reimbursement for HIV care." However, some HIV specialists who wish to join Brown & Toland cannot because of federal antitrust action pending against the IPA which prohibits it from accepting new doctors. While many private health insurance plans are reluctant to accept HIV specialists, AIDS Treatment News reports that the problem has been compounded as many of the area's PPOs -- which allow greater physician choice than HMOs -- "have suddenly been discontinued" (James, 1/22 issue).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.