Health Care
9:13 am
Fri December 13, 2013

Dropping Doctors: About Quality or Profits?

Credit Fotos GOVBA

Ever since United started sending out letters to doctors, telling them they won’t be on United’s Medicare network next year, it’s been a big story.  

Here it is on Fox: “United Health, which is one of the largest health-care providers in this country, has dropped thousands of doctors from their insurance plan. The reason? Obamacare.”

WINK TV, the CBS affiliate in Fort Myers, offered a different view: “New at 6, there’s a big change coming to some United Healthcare subscribers, and it has nothing to do with the Affordable Care Act.”

So who’s right? Did the health law trigger all this? Not really, says John Petrila, chairman of Health Policy & Management at University of South Florida. He says the narrowing of doctor networks isn’t new.

“I think there are certain trends in health care that the Affordable Care Act to some degree has made more visible, to some degree maybe has accelerated, but ever since the introduction of managed care and efforts at controlling costs into health care, and that dates back at least 25 years or more, there have been efforts by payers to reduce their panels”, said Petrila.

But it used to fly under the radar, Petrila says.

“What I think is new is the effort to use this as one of the proxies for what people are arguing is the failure of the Affordable Care Act”, Petrila said.

Because of the health law, insurers can’t outright deny coverage to patients who’ve been sick the way they used to. But Petrila says they can drop the doctors who treat them – like the ones who practice at Moffitt Cancer Center.

“No insurer wants to deal with sick people, that’s the bottom line", said Petrila. "At some level, this is a strategy to decrease access.”

If sick people can’t keep their doctors, insurers know, they’ll move to a different plan. That’s what happened with Gail Gallagher, who moved with her husband to Tarpon Springs three years ago when she retired from the Broward School system. She was so attached to her gynecologist that she drove back to Boca every year for her annual exam.

For eye care, her doctor in Boca recommended St. Luke’s Cataract and Laser Institute in Tarpon Springs. She says she got really good care there, and it was just 10 minutes from her house. But then she found out United was dropping St. Luke’s doctors. She’s one of 5,000 United patients who use St. Luke’s and were told they’d have to go elsewhere.

“How could United let this happen", asked Gallagher. "This is a huge amount of people.”

United offered alternatives. She didn’t like them.

“When you’ve had three torn retinas, you want to make sure should there ever be a problem, you’re not told ‘We’ll see you in a month.’ St Luke’s always has someone on duty", Gallagher said.

Over at St. Luke’s, administrator Brad Houser says the United Medicare Advantage contract accounts for 10% of their business.

“The contract’s pretty straightforward. You have the right to terminate us without cause, giving us notice", Houser explained. "We acknowledge that’s what you did. ”

The most frustrating thing, Houser said, is the mystery. United won’t say why it’s dropping them, as he told me on a recent visit. He’s not so much angry as mystified, he said.

“It’s frustrating because we can’t get any answers from anybody about what’s going on", Houser said. "We just know there’s a bad thing coming at us and bad thing coming at our patients. They’re in here everyday saying what am I going to do about my eye care next year, doctor? And our doctors are as dumbfounded as I am.”

When asked why they're doing this, Jessica Pappas, the PR person from United Healthcare said, essentially, everybody’s doing it.

“Many Medicare Advantage plans including United Healthcare are making these changes; it’s really to improve the quality and affordability of health care coverage for our medicare members", Pappas said. "We’re working to insure that our network is adequate to meet the needs of our members. Historically United has had larger network in many markets.

Doctors are not taking it lying down. Last week, a federal judge in Connecticut temporarily blocked United from dropping 2,200 doctors in that state from its Medicare Advantage network.

Florida Medical Association has asked federal Medicare authorities to investigate the terminations to make sure United is following the law and that it is not harming patients.