It's not hopeless.
After sputtering in fury throughout the latter part of the 1990s, medical organizations are beginning to gain a foothold in the battle against niggling HMO bean counters.
As a result, draconian managed care as physicians have come to know it--and hate it--appears to be on its way out. At the very least, it's metamorphosing into something that may be more palatable to doctors and their patients.
A substantial amount of backbone is needed for providers to fight the hand that feeds them--however inadequately. But many groups are doing so because they recognize that failure to act will only put them deeper into the financial morass in which they are now engulfed. Having had it up to their eyeballs, individuals and organizations around the country are sending managed care to the woodshed.
In High Point, N.C., Cornerstone Healthcare, a multispeciality practice with about half of the city's doctors, announced plans to terminate its contracts with Blue Cross Blue Shield of North Carolina, effective Sept. 30.
Earlier, Greater Newport Physicians, based in Orange County, Calif., threatened to terminate its contracts with PacifiCare unless the insurer agreed to increase capitation rates.
In July, the California Medical Association filed a lawsuit against California's three largest for-profit health plans, accusing them of violating federal racketeering laws--the same laws that put mobsters in prison. Separately, San Francisco's largest IPA, Brown & Toland, filed suit against AetnaUSHealthcare, accusing it of breach of contract and unfair and deceptive business practices.
Hospitals in California, North Carolina and New Jersey have told insurers there to get real or get lost.
There is no better time for doctors to speak up. With employers facing double-digit percentage premium increases for 2001, and most health insurers on more financially solid ground after several difficult years, it would be unconscionable for managed care companies not to pass along more generous rates to physicians.
After all, clinical personnel are helping HMOs offer a better brand of preventive care. For example, new data from the National Committee for Quality Assurance shows progress in providing HMO enrollees basic care, such as beta blockers for those who suffer heart attacks, to reduce the chance of a future attack.
If the health plans fail to play fair with physicians, a group whose involvement is essential for their success, doctors shouldn't hesitate to make it happen.