A California Association of Health Plans report on medical group closures has led to a new round in the schoolyard brawl that is the healthcare environment in the nation's most populous state.
CAHP officials say the March 16 Fact Check was meant to help clarify for legislators how many medical groups have closed in what time frame and whether they've filed for bankruptcy. Instead, the report has resulted in more name calling, finger pointing and insult hurling.
The report outlines medical groups that have either filed for bankruptcy or closed for other financial reasons since 1998. CAHP research shows that 19 of 361 medical groups in the state have filed for bankruptcy since January of that year. That's about a 2%-per-year bankruptcy rate using the 361 medical groups as a base, the association says.
In the same time frame, its research shows another 13 medical groups and IPAs closed due to financial problems. These are groups that closed or no longer operate under their initial business names but for which researchers were unable to verify any bankruptcy filing. CAHP researchers say that number represents an annual closure rate of about 1%.
These statistics stand in stark contrast to California Medical Association numbers. CMA executives often say in testimony and interviews that upward of 160 physician groups and IPAs have gone bankrupt in recent years. But a March report from the CMA shows 154 medical groups have filed for bankruptcy or have closed or merged for financial reasons since 1996.
The CAHP report doesn't count mergers and only dates to 1998. Subtracting the mergers and using data from 1998 on, CMA records show 41 medical groups have filed for bankruptcy or closed due to financial reasons.
CAHP officials say their research demonstrates CMA statistics are overblown.
"The greater concern is if we're not speaking from a point of reality and accuracy, then the CMA is trying to set political posturing based on exaggeration," says Bobby Pena, spokesperson for the health plan group.
"I can come up with different solutions based on 40 groups closing or 160 groups closing. The problem is the solution could be worse than the problem we're dealing with now."
CMA chief executive Jack Lewin, M.D., says the study shows that the health plans are out of touch with reality.
"The report reflects (CAHP's) inability to understand the environment or a desire to deceive the public," Lewin says. "Physicians in California are taking care of patients with 30% fewer dollars than they would have if they worked in most other parts of the country. That's the bottom line."
CAHP officials cite a discrepancy in CMA statements regarding the number of medical groups that have closed and in what time frame. Several different quotes from the medical association's executives put the number of closures between 38 and 160 in a time period that ranges from two to five years.
The medical association says those numbers came from self-reporting by physician groups, bankruptcy records, media reports and monitoring by county medical societies.
Regardless of the source, it was the discrepancy that sent the health plans scurrying for accurate data, says John Schneider, CAHP's director of research.
Schneider says the CMA's list doesn't account for other, nonfinancial reasons that cause all types of entities to close and open in the normal course of business, he says. CMA officials say they include only those groups with financial problems.
But even Schneider says he's not sure CAHP has the correct numbers. "All we wanted to do is point out the fact that given the seriousness of the problems . . . this is something we don't think should be trifled with," he says. "We think CMA's trifling with this."
CAHP's assertions are unfounded, says medical association spokesperson Peter Warren. "Their charges are false about CMA. The data doesn't add up."
It doesn't matter in which category physician group closings fall, Lewin counters. The point, he says, is that they are closing.
"Rolling medical blackouts will be happening in one or two years if we can't get the health plans to somehow make contact with physicians once again," Lewin says.