In another round in the battle between physicians and payers, the California Medical Association has sent letters to 19 health plans that operate in the state, asking them to stop terminating physicians from networks without cause.
"Numerous health plans have terminated physicians from the plans' provider panels without stating any reason for the terminations or affording the affected physicians any right to a hearing on the matter," stated the Oct. 23 letter signed by CMA President Jack E. McCleary, M.D.
McCleary declared that such terminations violate state law and adversely affect physician-patient relationships.
"This can seriously disrupt and delay a patient's course of medical treatment, particularly if the patient requires the special expertise of the physician who was dropped," he said in a statement.
McCleary's letter concluded by urging the health plans to confirm that their provider agreements "do not allow for terminations without cause," either on an individual basis or through contracting medical groups or independent practice associations. It has asked the recipients to respond within 30 days.
However, CMA officials did not immediately provide specific numbers of physicians terminated, or whether such cases had increased in recent months.
"We're acting on input we have received from our members," said CMA spokesman Ron Lopp, who added that the letter was meant to encourage dialogue between physicians and providers on the issue.
The CMA's relationship has become frostier with the state's managed-care plans in recent months. Last summer it launched California Advantage, a health plan intended to give more decisionmaking power to physicians and compete directly with HMOs. In August a CMA subsidiary, the Institute for Medical Quality, was named by the state's Department of Corporations to help evaluate HMOs seeking licenses (Aug. 19, p. 3). The decision was sharply criticized by the California Association of HMOs, a CMA adversary.
Myra Snyder, executive director of the HMO group, said the health plans perceived the letter as hostile and threatening.
"This is a nationwide strategy on the part of physicians to install an `any-willing-provider' hiring policy within HMOs," said Snyder, who cited the CMA's forwarding of a copy of the letter to the American Medical Association as proof of its intentions. "What we do have is an oversupply of specialists in the marketplace that cannot be accommodated."
As for terminating physicians without cause, Snyder said that only happens when an expired provider contract is not renewed. "Otherwise we must give cause," she added.
Snyder said she was also puzzled as to the timing of the letter, just a couple of weeks before a scheduled meeting between the HMO group and CMA officials.
"The CMA said this was going to be the year of cooperation," she said. "We'll still meet with them, but this will definitely be on the agenda."