LONG BEACH: Doctors Group Drops Aetna U.S. Healthcare
Long Beach Memorial Medical Group Inc., which negotiates insurance contracts for 550 physicians and other health care providers, such as psychologists and physical therapists, "has terminated its fee-for-service contract with Aetna U.S. Healthcare," the Long Beach Press-Telegram reports. While the group's medical director, Dr. Robert Pinder, said yesterday that doctors may continue contract with Aetna on an individual basis, the group contract termination essentially will leave "thousands of patients looking for a new doctor." Aetna spokesperson Bob Pina said, "[a]nyone who is currently undergoing a medical course of treatment will be allowed to complete that treatment with the same physician."
According to Dr. Pinder, negotiations for a new contract began more than three months ago, but resulted in a unanimous board decision to terminate the contract. Among the changes protested by the group were Aetna's proposal to reimburse doctors "at the same rate as nurses" for some procedures. Aetna proposed a $45 reimbursement rate for follow-up consultations involving "moderately complex medical decision-making, regardless of who makes the decision -- a doctor specializing in internal medicine or a nurse practitioner." That $45 rate undercuts Medicare's $51.04 reimbursement rate by 12% for the same procedure. Dr. Douglas McConnell, a Long Beach thoracic surgeon and member of the physician group's board, commented, "Aetna is not willing to pay for quality care, and its clients ought to know it." He added, "I think we've probably hit the breaking point" on proposed cuts. He said the cuts come on the heels of "enormous erosion in income over the last four years" for physicians, despite "substantial increases in property leases, employee wages and benefit packages."
Another local medical group, Los Alamitos-based Private Pediatrix Inc., also terminated its fee-for-service contract with Aetna. According to group president Dr. Robert Kaplan, the organization was alarmed by Aetna's "lowered reimbursement rates for childhood immunizations." Private Pediatrix negotiates contracts for 28 pediatricians who treat patients at Miller Children's Hospital, St. Mary Medical Center, Long Beach Community Medical Center and Los Alamitos Medical Center (Heald, 3/19).