SPECIALISTS: Ignore ER Calls in ‘Rebellion’ Against HMOs
In an "increasingly rancorous rebellion," specialists angered by low managed care reimbursements are refusing to care for emergency room patients, a move that threatens to collapse some California trauma networks. The Los Angeles Times reports that with specialists -- particularly plastic surgeons, ear, nose and throat doctors and neurosurgeons -- no longer beholden to ER patients to build their practices, they are hesitant to accept the "low fees and late payments" they encounter under managed care -- "even if they are contracted to do so." And while the trend is a problem nationally, it is especially acute in California, with its high managed care penetration. Dr. Loren Johnson, co-chair of an industrywide task force on the problem, said, "It happens every day in California hospitals. I've had patients lose their limbs and lose their lives over failure to respond." California Healthcare Association Executive Vice President Dr. Bruce Spurlock said most "refusals involve indigent patients or those who are on Medicaid," but "specialists are increasingly turning away from insured patients as well." For example, San Mateo County physicians "resigned en masse from a large physicians group and will now come to the emergency room only if they are paid their full fees, not discounted, managed care rates."
Just Say No
Specialists -- who can turn down ER calls with "relative impunity ... because hospitals cannot afford to alienate them" -- argue that by "saying no ... they are putting managed care companies on notice." West Hills Hospital's Dr. Lawrence Pleet, a plastic surgeon, said, "If we go out and work for free, the HMOs will continue to take advantage of us." The Times reports that Pleet and three other doctors refused to care for a four-year-old boy who was bitten by a dog. He says he "was not obligated to come in because he was not on call and was not contracted with [the boy's] managed care company." The boy's parents finally offered to pay $2,000 in cash for an operation that costs a few hundred dollars in order to secure a surgeon. Jim Lott, executive vice president of the Healthcare Association of Southern California, said, "The physicians have a moral dilemma": They must see more patients to make up for lowered managed care reimbursements, but a trip to the ER "takes up valuable time." The Times reports that the conflict may have far-reaching implications, as the "failure of specialists to respond to emergency room calls strikes at the heart of the emergency system, a delicately patched together network that relies as much on relationships and the cultural history of the practice of medicine as it does on high-tech equipment and hospitals" (Bernstein, 6/1).