HCFA said it will review a campaign by a Long Island, N.Y., physician organization that urges Medicare beneficiaries to avoid HMOs.
The North Shore Physician Organization, a 1,000-member network in Nassau County, N.Y., last week launched what it called a "public service campaign" to educate Medicare beneficiaries about differences between traditional Medicare and HMOs. The campaign, which uses newspaper ads and tabletop displays in physician offices, includes charts comparing traditional Medicare with managed care.
The physicians are on the medical staff of 958-bed North Shore University Hospital in Manhasset, N.Y., which is part of the North Shore-Long Island Jewish Health System, based in Great Neck, N.Y.
This is at least the second time this year that a provider organization has attempted to influence Medicare choices through marketing. Last month, a HCFA regional administrator reprimanded a North Dakota hospital for conveying misinformation about Medicare to consumers (Dec. 14, p. 12).
Nassau organization Chairman Stephen LaSala, M.D., said the campaign is designed to allay confusion about recent changes in the Medicare market. He denied an economic motive, even though Medicare HMOs are reducing reimbursement rates to local doctors.
Two plans, NYLCare Health Plans and Vytra Healthcare Long Island, will shutter their Medicare HMOs as of Jan. 1. They cover 7,600 beneficiaries, or 3% of Nassau County's Medicare market of 224,000, according to HCFA. Nine other HMOs will continue to serve the market, the agency said.
"We just thought it would be very good for the patients to discuss their options with their physicians," LaSala said. "I think that's part of our obligation."
LaSala declined to say how much the network is spending on the campaign.
HCFA Region 2 Administrator Judith Berek said the material "raises enough issues so that HCFA will investigate." She said she would check the accuracy and "appropriateness" of the information and determine whether HCFA has legal authority to take action, if required. "This is new territory," Berek said.
LaSala said traditional Medicare "doesn't get as much play" as managed care, which is aggressively marketed. At the same time, he said, patients have been calling their physicians' offices asking for assistance with Medicare options.
Berek acknowledged that HCFA was caught off guard by sudden changes in the Medicare market, which were spurred at least in part by lower reimbursement rates for HMOs. She said her office launched an unprecedented effort to contact beneficiaries at community meetings and by phone and has "never before reached so many people in such a short period of time."
Some members of Congress have accused HCFA of siding with traditional Medicare over HMOs, Berek noted. "This is one of those, `we're damned if we do, we're damned if we don't,' situations," she said.
To stem losses, Nassau County's largest Medicare HMO, Oxford Health Plans, recently signed a risk contract with the 13-hospital North Shore-Long Island Jewish system, which selected a network of physicians to participate.
Carol Hauptman, a spokeswoman for North Shore-Long Island Jewish, said some physicians are fighting the risk contract because it pays less than traditional Medicare. "Across the board, HMOs have lowered their rates for hospital and physician services," Hauptman said.
Meanwhile, there is low public awareness about Medicare options, even in affluent Long Island, she said.
"If (physicians) can bring awareness and put pressure on insurers and the government, that's a big plus," she said. "If, however, their goal is to protect their incomes, that's a questionable goal as far as consumers are concerned."