Tuesday, May 21, 2002

Insurers deny doctor drain

By Tim Bonfield tbonfield@enquirer.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.


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