Doctors Revolting Against HMO
By PHIL GALEWITZ - AP
NEW YORK (AP) - For years, heath maintenance organizations
have been telling you to see your primary-care doctor for nearly all of your medical
needs. Now, some of the nation's biggest HMOs are restricting the primary-care
doctor's role in one of the most sensitive places - the hospital.
Over the past two years, HMOs have been hiring doctors called hospitalists, who
work full time in hospitals coordinating care, replacing the role traditionally held by
the patient's regular physician.
Insurers say patients tend to get more attention from hospitalists since the
doctors aren't splitting their time between the hospital and an office. As a result, tests
are scheduled faster and patients often go home sooner without care being
compromised. Shorter hospital stays mean HMOs can save money, which some critics
suspect is the real reason behind the effort.
At first, health plans offered the hospitalists as an option, and the reaction
was mixed. But now that some plans such as Prudential Health Care and Humana have all but
mandated the use of hospitalists, some doctors and consumer groups are outraged.
``There is incredible irony in this,'' said Ron Pollack, executive director of Families
USA, a national consumer health group. ``HMOs have for the last few years talked about the
virtue of having a primary-care physician who coordinates the care for a patient, and yet
at a point when the patient most is in need of health care, they are withdrawing the
central feature ... by the doctor who knows the patient best.''
A coalition of 24 medical groups, including the American College of Physicians,
last month appealed to the HMO industry asking for an end to mandatory hospitalist
programs. ``This is a direct attack on our profession,'' said Dr. Cornel Lupu, a
Miami internist and Prudential primary-care doctor. ``It's a horrible idea.''
Prudential started its hospitalist program in March in the South Florida and
Tampa areas. Humana began implementing its program in 1997 in a dozen major markets,
including Chicago, South Florida, Louisville, Ky., Kansas City, Mo., Las Vegas and San
Antonio. Cigna and some Blue Cross and Blue Shield plans proposed mandatory
hospitalist programs in certain markets, but decided to keep it voluntary after
primary-care doctors raised concerns. Humana spokesman Greg Donaldson said a study
of the company's use of hospitalists in Kansas City found that they shortened some
hospital stays by half, and increased the likelihood that patients were prescribed
appropriate medications. And about 85 percent of Humana's members nationally who had
been cared for by a hospitalist said they would want the same hospital-based doctor if
they were hospitalized again, the company says.
Neither Prudential nor Humana considers its hospitalist programs mandatory
because doctors can continue caring for their own patients in the hospital if they meet
certain criteria, such as keeping the patient in the hospital for a shorter-than-average
period. Prudential says fewer than 20 percent of its Tampa and South Florida doctors
meet the standard. A Humana official did not know what proportion of its doctors met the
tests. ``We are trying to improve efficiency in the hospital and improve quality and
as a result hopefully save some costs, said Dr. Kirk Cianciolo, Prudential's senior
medical director for South Florida and Tampa.
HMO industry experts say more health plans will require the use of hospitalists
because they reduce hospital stays. ``More and more plans are considering making it
a mandatory program, '' said Brett Turner, a health care consultant with Hamilton-HMC,
based in Minneapolis. ``It's a major trend, a much more efficient way to practice quality
medicine,'' he said. ``But making the transition is a difficult process for some.''
