HMO CONTRACTS: Rather Than Renew, Many Docs Eschew
Disillusioned with managed care, an increasing number of "Southern California physicians are bolting from the fold of managed care organizations and going on their own," the Journal of Commerce reports. "Definitely, I see this as a trend," said Orange County physician Jamie Lewis, a member of Memorial Prompt Care, an eight-doctor group that recently informed its patients that it will sever all HMO ties, representing about 10% of its business or 1,000 patients. He added, "I see more and more physicians registering the same types of complaints as we are, and others are doing what I'm doing. California is usually the state that sets the trend nationally, and I would anticipate that physicians in other states would follow suit." Many doctors fleeing HMOs cite unacceptably low reimbursements for an industry which took in $50 billion last year. Lewis said, "[T]heir compensation doesn't provide us with a fair profit, let alone cover the cost of the kind of quality care patients should expect." Dr. Susan Hutchinson, who is also abandoning managed care contracts, said, "[W]e tried to hang in there, but it got so frustrating because many patients who are being covered by their employers want the same type of choice to go to specialists as they had with doctors who operate on a fee- for-service basis."
HMOs Hope They'll Balk
Many HMO representatives are downplaying such moves as insignificant. "I don't see this as presaging a trend," said Maureen O'Haren, executive vice president of the California Association of Health Plans. She added, "There are doctors that don't want to contract with HMOs; there always have been and there always will be. These are small isolated cases. Frankly, with so many people in HMOs not many doctors can sustain a viable practice without contracting with HMOs." Memorial Prompt Care "is gambling" that some patients are willing to pay more for more attentive care. Indeed, Hutchinson said "about 50% of her former practice are trying to switch to non-HMO plans," while others are paying out-of-pocket. "Many of my patients are voluntarily paying cash because they feel the quality of service that I provide is worth it," she said (Lent, 12/22).