LABOR DISPUTE. Without admitting fault, a Chicago-area hospital settled charges filed with the National Labor Relations Board that it threatened residents who wanted to form a union.
Advocate-Lutheran General Hospital in Park Ridge, Ill., agreed not to intimidate residents or other employees who want to form unions. Hospital officials also agreed to post a notice to that effect throughout the hospital.
Physicians for Responsible Negotiation, the union arm of the AMA, filed charges last year against Lutheran General for allegedly intimidating residents who were interested in forming a union. PRN, which was chosen by residents to represent them, alleged hospital officials threatened residents and refused to leave a union-organizing meeting in December.
Residents voted in December on whether to form a union; however, hospital officials are challenging the vote, which remains impounded before the NLRB.
Hospital officials say they were "pleased to resolve the matter" but stressed they believe they did nothing wrong.
ACCESS SURVEY. Only 30% of consumers can correctly identify four basic health plan features regarding provider choice and access to specialists, according to a recent study by the Center for Studying Health System Change.
Based on interviews with almost 11,000 privately insured people, HSC found many of them believe their health plans are more restrictive than they actually are, especially regarding access to specialists. The four basic features researchers asked consumers about were: whether they must choose from a provider network; whether the plan pays any costs for out-of-network care; whether they must choose a primary care provider; and whether they must get a referral for specialists.
About 56% of respondents correctly identified whether their plan had a provider network and whether it pays any out-of-network costs. About 49% correctly reported whether their plan requires them to choose a primary care provider and get referrals for care.
ONLINE CONSULTS. Back in January, First Health Group began a pilot program to compensate physicians for online consultations with patients. Three months later, the effort is progressing very slowly, says Jim Smith, president and CEO of the Downers Grove, Ill.-based payer.
As is the case with many technology-based initiatives, "the real difficulty we've faced is getting physicians to participate," Smith says. But, he says, the first-of-its-kind payment plan is in its infancy and for now is limited to doctors who serve the 300,000 enrollees and their dependents in First Health's Care Support program for chronic diabetics, asthmatics and hypertensives. Under the plan, physicians receive $25 per consultation episode.
"It's very desirable, and it's going to go very well," Smith says.
GROUP TO DISBAND. The largest physician group in central Florida will disband by the end of May because a majority of doctors refused to pay annual dues after joint-venture partner HCA-The Healthcare Co. sold off its largest Orlando-area hospitals, a group official says.
"Once the HCA facilities pulled out (of the joint venture) at the end of 2000, we could not get enough doctors to pay the annual fees, so the board of directors voted to disband," says Elena Hunter, president of Winter Park, Fla.-based OneSource Physician Healthcare Network. She says only 40% to 50% of the group's 800 physicians were willing to spend $500 to $1,000 each to continue membership once HCA departed.
OneSource officials gave the doctors until May 31 to negotiate independent contracts with healthcare payers before the IPA shuts down.
HCA, based in Nashville, Tenn., sold Lucerne Medical Center in 1999 and Winter Park Memorial Hospital last year, leaving it without any facilities in Orange County, Fla., where Orlando is located.
The for-profit hospital chain now owns just two smaller facilities in the region.
FEE-BASED BUSINESS GROWS. Major health insurers are confirming what has been expected all along: The negative publicity in recent years about managed care in general and HMOs in particular has accelerated a return to fee-for-service and point-of-service healthcare coverage.
For one, UnitedHealth Group derived just one-quarter of its 2000 profits from commercial risk health insurance, down from 75% in 1994, says John Penshorn, United's director of capital markets, communications and strategy. "Our fee-based business is growing faster than our risk-based business," he said at a March 28 Banc of America Securities healthcare investment conference in Las Vegas.
Competitor Cigna Corp. has 9 million HMO and PPO enrollees compared with 5 million in point-of-service or other indemnity-type plans, but only 20% of the 14 million total health insurance enrollees are under risk-based HMO contracts.
And, says President and CEO Edward Hanway, risk-based contracts are responsible for a paltry 10% of Cigna's earnings.