HMOs: Pacificare Loses Two St. John’s Seniors’ Contracts
The St. John's Hospitals in Oxnard and Camarillo are canceling their contracts with Pacificare, citing a "long history of payment problems," the Ventura County Star reports. The cancellation affects a sizable portion of Pacificare's 15,700 Ventura County enrollees in both the regular managed care plan and the Medicare HMO, Secure Horizons, who will now have to travel at least 20 miles for medical services. Physicians are being instructed to transfer patients currently hospitalized at the two facilities to Community Memorial Hospital in Ventura, but "so far, the physicians are resisting that pressure," said St. John's hospital spokesperson Rita O'Connor. She noted that "[St. John's is] continuing discussions with [Pacificare], and we've asked them for three things: sufficient payment to treat patients, payments for all services rendered as ordered by doctors, and reduction of the hospital's responsibility for the paperwork and duties involving Pacificare's authorization procedures," but added, "we have had a history of payment problems with Pacificare, and this is out of our hands." Meghan Crowley, spokesperson for Pacificare, disputed St. John's version of the issue, contending that Pacificare attempted to increase payments to the hospital while in negotiations -- an "olive branch" that was rejected. She added, " ... we are not aware of any payment issues. Our goal was to come to an agreement. Unfortunately, we were not able to, and now our priority is to provide continued access to medical care for our members."
A Blow to the Community
Patients still may visit any hospital in case of an emergency, according to Pacificare's cancellation notice, which also stated that members can "disenroll" and return to original Medicare, as long as they request to do so by Jan. 31. Also, patients who have already scheduled to see St. John's specialists may continue to see them until Feb. 15. Medical groups that contract with Pacificare and St. John's hospitals are unhappy with the situation. Randy Farber, CEO of Family Health Care Medical Group, which serves 4,000 Pacificare patients, said, "We are very disappointed that Pacificare and St. John's weren't able to reach an agreement, because we're committed to keeping patients in the community." He added that the cancellation is a "reflection of the turmoil in the fast-paced health-care system, where reimbursements from HMOs are not keeping pace with the cost of care." He believes that a major portion of the troubles in California stem from the low premiums that the MCOs charge employers -- premiums that are among the lowest in the nation (Koehler, 1/21).