TUFTS: Contract Spat Spurs Docs to Refuse New Patients
Nearly 500 doctors under contract with Tufts Health Plan, angered by "what they see as inadequate payments," are refusing to accept most new patients from the HMO. The Boston Globe calls the public dispute "a rare glimpse into the world of managed care" as an "increasingly brutal economic environment threatens to unmask the veneer of gentility." More than half of the 915 doctors in Partners HealthCare System Inc. -- affiliated with Massachusetts General and Brigham and Women's hospitals -- sent an "angry" letter to Tufts officials Friday in a display of "contractual brinksmanship." The agreement between Partners and Tufts expired Jan. 1.
It's All About Money
Ellen Zane, president of Partners Community Health Inc., a managing subsidiary of the group, said the roughly $100 per month per patient that Tufts pays physicians is insufficient to cover costs, noting that "Partners doctors lost $7 million on the contract, despite doing an 'above average' job at managing resources": patient hospital stays have dropped 10%, and prescription drug spending has increased at a rate far below the New England average. Zane said, "We know we're performing well, so why are we losing money? The answer has got to be that the medical budget Tufts gives to us is fundamentally too low." Tufts Vice President Jon Kingsdale countered, "I can guarantee you, given their clout, Partners is not below average for what they get. They get better than average. We're all losing money." With Tufts, Harvard Pilgrim Health Care and Partners' flagship hospitals all deep in the red, consultant Ellen Lutch Trager of Brown Rudnick Freed & Gesmer said, "This is only the beginning of a very divisive period. It's a very scary time." Kingsdale "tried to downplay" the dispute, saying, "This is a friendly spat between organizations that normally get along quite well" (Pham, 5/4).