Imagine a pediatrician's waiting room on a winter day: Coughing, wheezing children sneeze on one another while working parents attempt to reschedule their days. The first thought that comes to mind probably is not "cash cow" -- unless you are a crafty medical organization.
Physicians from Brown & Toland Medical Group, San Francisco's largest network of independent physicians, recently opened a day-care center for children with mild illnesses, such as stomach flus and colds. Day-care centers generally ban such children, but Helping Hands Day Care Center for Mildly Ill Children offers parents an alternative to missing work.
Helping Hands is staffed by pediatric nurses and specially trained child-care providers. Children at the center are grouped by illness (stomach flu in one room, colds in another), toys are washed after a child plays with them, and a pediatrician visits the center daily.
Fees are $85 per day, or $50 for a half day. Jake Sinclair, M.D., executive vice president and founder of Pediatric Partners, which runs the center, says demand for alternative child care is enormous, and the profit margin is high, especially because employers are sometimes willing to foot the bill.
"Parents," he adds, "are more comfortable knowing that the child is with a professional who can monitor the illness and call a physician if necessary."
The other side. It's not all bad news for HMOs, however. After being pummeled for months by consumer backlash, health plans finally have found someone who is sticking up for them. Last month, Washington Post columnist Howard Kurtz blasted the media for fixating on a few tear-jerking HMO horror stories. After doing some investigating of his own, Kurtz says he found the stories were not always substantiated and the mistreatment by HMOs was not as draconian as reported.
"The marketing of personal tragedy has become a cottage industry," Kurtz wrote.
He quoted an HMO official as saying: "The problem is that medical situations are complicated. They don't just fit into a sound bite."
A few days later, the Wall Street Journal decried the media for acting "as the Clinton echo chamber. . . . For weeks the press has been repeating the President's tear-jerking anecdotes about patients suffering at the hands of evil managed-care providers."
My HMO had an affair with Bruce Willis. What do Tom Cruise, Demi Moore, the Kennedys and your HMO have in common?
They're the cover subjects of the Aug. 4 National Enquirer, showing that the HMO backlash is resonating beyond policy wonks to a publication whose other front-page health story was "Tina Turner Breast Surgery Disaster."
Opposite a story on 1980s TV afterthought Todd Bridges is a tale subtly titled "HMOs Can Kill You." The Enquirer is asking readers to send HMO horror stories for discussion in future issues by Alan Steinberg, M.D., a Marina Del Rey, Calif., internist and author of The Insider's Guide to HMOs.
Steinberg, whose book was released in September 1997, says he's not a fan of theEnquirer. On the other hand, he says he wants to make all patients aware that HMOs might be putting their doctors in financial conflicts of interest. Plus, by agreeing to participate, he got to edit the Aug. 4 story to make it less sensational, believe it or not.
"You sort of have to get in bed with the devil to get your message across," Steinberg says.
Dying Young. "Marcus Welby is dead" is no longer just a hoary euphemism for the alleged coldness of managed care (see Notebook, August 1997).
In late July, Robert Young, who played the kindly doctor on the highly rated
ABC-TV show from 1969 to 1976, died of heart failure at his Westlake Village, Calif., home. He was 91.
To hear many consultants and doctors tell it, Young's Welby, with his house calls and lack of worry about managed care, these days would be a less realistic TV doctor than Dick Van Dyke as a physician solving crime in his spare time on "Diagnosis: Murder."
The other shoe. Following the January blowup of the proposed MedPartners-PhyCor merger and MedPartners' subsequent stock-price dive, other PPMs tried to distance themselves from MedPartners' problems. Now it's MedPartners' turn to feel it's suffering for others' sins.
MedPartners sent a statement to its investors and the media after the stock market closed July 23, distancing itself from problems at FPA Medical Management and PhyCor. FPA a few days earlier had declared Chapter 11 bankruptcy; PhyCor's second-quarter earnings report sent its stock down $5.28 to $14.06, dragging almost every PPM's shares along with it.
MedPartners' move didn't work: By Aug. 10, its stock had fallen more than $2 to an all-time low of $3.06.