BY TIM BONFIELD
The Cincinnati Enquirer
It's too early to tell how a new physician union will change health care in Greater Cincinnati. But one thing is clear: the intensity of conflict between doctors and managed care health plans has increased.
Contract battles. Legislative battles. Courtroom battles. The overriding theme of a health care round- table Friday was the growing tug of war between insurers and physicians over control of the future of health care.
"There's no question that physicians are frustrated," said Russell Dean, executive director of the Academy of Medicine of Cincinnati. "They're concerned about loss of autonomy . . . the hassles of jumping through hoops" for managed care plans.
"And many physicians have experienced a leveling off or a decline in revenue," Mr. Dean said. "Yet they are working harder than ever and spending less time per patient."
The breakfast meeting, sponsored by the Physician Practice Management Forum, featured Mr. Dean and Jack Seddon, executive director of the Federation of Physicians and Dentists. Several managed care executives declined the group's invitation to speak. In the ultimate statement of frustration, more than 80 local orthopedic physicians decided in July to form the Tristate's first physician union. The union claims to represent about 90 percent of the orthopedists in town, but has been slow to add other speciality groups.
Locally, some health plans have refused to talk with the union agents. Nationally, the union faces a legal challenge from the U.S. Department of Justice over whether its activities violate the Sherman Antitrust Act.
But Mr. Seddon said Friday that even when plans won't negotiate directly with the union, they are still agreeing doctor-by-doctor to contract changes demanded by physicians after the union analyzed the details.
Some doctors have won changes in proposed payment rates, in the wording of grievance policies and other business issues, he said.
Still, many at the roundtable were concerned about the prospect of a doctor's strike - even though Mr. Seddon said there is no likelihood that unionized doctors would call a strike.
"I'm trying to be a little more open minded about the subject," Mr. Dean said. "But I've had bad experiences with unions. As a hospital administrator in Kentucky some years ago, we endured a 107-day strike" involving LPNs and other hospital staff, but not doctors. The concern that forming unions may be one step over the top has opened a door for other ideas about organizing doctors, or at least addressing their concerns.
Dr. Daniel Gregorie, former ChoiceCare chief executive, has attracted two large physician groups to a venture called Telesis Medical Management of Ohio, which seeks to negotiate with health plans on members' behalf. Other physicians are talking about forming specialty groups large enough to force concessions from managed care health plans.
Meanwhile, the Academy of Medicine is emphasizing its political role: supporting lobbyists to push a pro-doctor legislative agenda. For example, Mr. Dean said he expects doctors to be deeply involved next year when Ohio lawmakers resume debate over allowing patients to sue HMOs for malpractice.
