Tuesday, May 21, 2002
Insurers deny doctor drain
By Tim Bonfield email@example.com
The Cincinnati Enquirer
The Tristate's biggest insurers say they do not believe that Greater Cincinnati is suffering from a medical brain drain. Even if some medical specialties are in short supply, the insurers say the problem isn't unique to Cincinnati and isn't caused by unusually low pay from private health insurers.
We have seen no objective data to support an overall shortage of physicians in the Cincinnati area. And, we have not had members complaining about being denied access to specialists or not getting appointments in a timely manner, said Paul Beckman, chief executive of Paragon Health System, the local arm of Anthem Blue Cross and Blue Shield that handles physician contracting.
He was among a dozen insurance executives, hospital administrators, doctors and others who spoke Monday at Mercy Franciscan Hospital Western Hills during the second of three public hearings about the quality of health care in Greater Cincinnati.
The hearings are being held by a legislative subcommittee formed by state Rep. Greg Jolivette, R-Hamilton.
Doctors have been contending for months that colleagues are leaving town, retiring early or refusing to move here because reimbursement rates are unusually low.
They say patients are suffering as a result, from longer waiting times for specialty appointments, to hospitals unable to recruit doctors to staff emergency departments and operating rooms.
But insurers say whatever physician supply problems that might exist reflect national trends more than anything unique to Cincinnati.
Our fee schedules in the Cincinnati are equivalent to those offered in other metropolitan areas in Ohio, and very similar to those in Kentucky, Mr. Beckman said.
UnitedHealthcare, which covers about 300,000 local residents, also uses a consistent fee schedule to pay doctors throughout Ohio, said Linda Cullen, United's director of compliance for southwest Ohio.
In addition, its internal satisfaction survey results indicate that Greater Cincinnati consumers are more satisfied with access to specialty care than United customers nationwide.
However, insurers also told committee members that they recently increased payment rates for some Cincinnati hospitals and doctors, including neurosurgeons.
Over the past year, I have proactively negotiated with hospitals and physician groups alike to increase reimbursements when market conditions and data supported the action, said Larry Savage, president and chief executive of Humana Health Plan of Ohio, which runs the local Humana-ChoiceCare plans.
Doctors and others who spoke Monday said they still see sharp differences in pay between Cincinnati and other cities.
For example, from 1998 to this month, when the service was returned to the hospital's control, the Bethesda North Ambulatory Surgery Center was run by Johnson & Johnson Health Care Systems Ambulatory Group.
When taken as a group, insurers paid the Bethesda North center an average of $861 per case, but paid more at four other centers in Ohio, including $1,233 per case at one. In California, known by many as the capital of managed care, insurers pay an average of $2,350 per case, said Robyn Gavin, a senior consultant for the J&J group.
Insurers and doctors agreed that a more sophisticated study is needed to sort out the pay disputes and other factors that may be involved in chasing physicians away. However, there was sharp disagreement over whether a reliable study would cost less than $35,000 or 10 times as much.
A third and final subcommittee hearing is expected to be held in late June or July. The subcommittee's recommendations would be issued several weeks after that.
Hamilton County braces for terrorism
County offers break on home fix-up loans
Erpenbeck strands condo associations
Legislator seeks title reform
Erpenbeck to plead not guilty
City schools set to start building
Officer loses police powers
Police review panel has openings
Report backs police search
Teen drug use declining, survey says
Young crowd dance night away
Spanish emerges in hospitals
Insurers deny doctor drain
Killer caught in Columbus 31 years after her escape
Ohio lawmakers close to budget deal
Planners seeking public feedback
Search continues for two men in Ohio River
Silverton tax hike 1 vote short
Trial starts for cemetery operator
UC professor claims gender discrimination
Volunteer charged with molestation
Boehner covers bases in re-election bid
Butler County Digest
Choir sets poems to music
Family accuses officer of brutality
Lebanon mulls raising utilities
Life Success Seminars moves
Petitions address airport name
Schools focus budget cuts
Homeless sue over camp razing
Displaced miss their possessions, 'family'
School chief will hear Fort Thomas fear
Airport security case goes to federal court
Cop outlines case against Huiett
GOP primary pits two ex-Democrats
Louisville archdiocese faces 75 lawsuits
Teaching programs subjected to review