San Francisco: New HMO Problems Threaten Access to Care
About 2,000 patients in the San Francisco area may have to change doctors or health plans, because of a dispute between managed-care organizations. For persons with HIV, the problem may be especially severe for those seeing doctors at the Davies medical center.This situation occurred because two HMOs, HealthNet and Blue Shield, will not renew their contract with BayCare, a relatively small IPA (independent practice association) in San Francisco. The patients affected are those with HealthNet or Blue Shield coverage, who are seeing physicians who are dependent on BayCare and cannot move their patients to another IPA. (At this time physicians cannot join the dominant IPA, Brown & Toland Medical Group, because of action against Brown & Toland by the U.S. Federal Trade Commission.)
William Owen, M.D., told AIDS Treatment News, "My office has been inudated by calls from patients who were alarmed when they received the rather curt letter from Blue Shield HMO informing them that, because BayCare was dropped as an independent practice association (IPA) by Blue Shield HMO, and because their physician (Dr. Owen) is not a member of another IPA that has a Blue Shield HMO contract, the patient would be required to select a new M.D. by February 26. This letter, unfortunately, strikes at the heart of many provider-patient relationships that have been nurtured over many years...
"I have requested that Blue Shield HMOpatients file protests with the HMO, and send copies of their letters to the Department of Corporations (which regulates HMOs in the State of California), Assemblywoman Carole Migden (who has had a long-standing interest in lesbian and gay health issues, including treatment of patients with HIV/AIDS, and has dealt with earlier problems with access by patients to their long-term providers through BayCare Medical Group), to President of the San Francisco Board of Supervisors Tom Ammiano, and to the the Federal Trade Commission (FTC), which is needlessly preventing a dozen or so former Davies Medical Center physicians from joining Brown & Toland Medical Group (an organization that consists of over 1,000 physicians) on the grounds that this addition of a miniscule number of providers would somehow constitute a 'restraint of trade'."
Dr. Owen noted that the other HMO, HealthNet, has worked out a temporary arrangement until it negotiates a contract with another IPA with which the physicians are affiliated.
For more information, see "Feud Erupts Between HMOs, Doctors' Group," San Francisco Chronicle February 11, 1999; also see "New Healthcare Economics Threaten HIV Specialization, Patient Choice, & Quality Care, AIDS Treatment News #311, January 22, 1999.
