Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, March 7, 1990 TAG: 9003071986
SECTION: VIRGINIA PAGE: C1 EDITION: EVENING
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
"We're not real satisfied with the way things are going in Roanoke," says Richardson Grinnan, senior vice president for the insurance company.
"It's been a difficult sell and we're quite frankly trying to reassess how we can pull it together and get community support to make it happen," Grinnan says of the program, called KeyCare.
In August, Blue Cross announced it had signed Roanoke Memorial Hospital and six other hospitals in the Carilion Health System to be the exclusive providers of hospital care in the KeyCare program. Blue Cross officials hoped to have a physician network for KeyCare within a couple of months.
About 90 physicians in Roanoke have joined KeyCare, but "it's just not the level we need," says KeyCare director Edward C. Peple Jr. Many medical specialities "are conspicuous by their absence," Peple says.
"It seems there is a sort of mutual `waiting-for-somebody-else-to-make-the-first-move' kind of situation right now," Peple says of doctors' response to KeyCare. More than 400 physicians practice in the Roanoke area.
While only one company in Roanoke has joined KeyCare, Blue Cross officials believe that many other businesses are interested. But companies are reluctant to sign until they see a physician network in place that their employees will accept, these officials add.
KeyCare is a preferred provider organization or PPO. Under this type of health insurance, hospitals and doctors cut prices to businesses that encourage employees to use their services. In return, the hospitals and doctors expect to get more patients. Employees in a PPO are allowed to go to other hospitals and doctors, but they pay more when they do.
The reluctance of Roanoke doctors to join KeyCare frustrates Blue Cross officials, who recently signed about 1,200 doctors to the program in Northern Virginia in a few weeks.
"It was an interesting contrast to what we found in Roanoke," Peple says. The physicians in Northern Virginia "understood the dynamics of the marketplace and the forces of competition. Docs were easier to get in to see, they didn't take as much explaining and we just had amazing results."
Physician interest in KeyCare has been much stronger in the New River Valley, Blue Cross officials say.
Blue Cross wants to make KeyCare a statewide program so it will be able to offer a uniform health insurance benefit option to large businesses and corporations with employees working in different areas of Virginia. The KeyCare network includes about 70 hospitals and nearly 6,000 doctors statewide.
Blue Cross is the health insurer for 105,000 state employees for the next three years. Included will be employees of Virginia Tech and Radford University. Beginning in July, Virginia teachers and local government employees will have the option to join the group.
The business community needs to be more active in letting physicians know they are interested in a health care program like KeyCare, Blue Cross officials say.
"We hope the community, quite frankly, takes an interest in the larger issue," Grinnan says. "Where we find the chemistry is right, things happen. That's the piece we're really looking at. Does the community really want something like this? Are they concerned enough about health care costs to help support something of this nature?"
The answer to those questions is yes, says Tom Jones, president of the Blue Ridge Regional Health Care Coalition.
Without the groundwork laid by the business community over the past few years, Blue Cross wouldn't be interested in bringing PPO to the Roanoke Valley, Jones says.
Last year, the coalition began a PPO with Community and Lewis-Gale hospitals. About 8 of the 30 companies in the coalition are participating in the PPO, Jones says.
The process of signing companies is going much slower than the coalition anticipated. So far, the coalition has no physicians participating in its program, which is managed by a California company called Community Care Network. Jones says the physician network will come after a few more companies are involved and the hospital network is firmly established.
One reason doctors haven't shown much interest in PPOs is that many are philosophically opposed to the restrictions they bring for patients and physicians, says Dr. Hayden Hollingsworth, a Roanoke cardiologist.
"Patients ought to have total freedom of choice of physicians," says Hollingsworth, who several years ago was one of the leaders of a local doctors' group exploring various health insurance programs.
"You should not have employers who say you must go to a particular physician or a particular hospital or be penalized," Hollingsworth said.
A PPO like KeyCare also could restrict a doctor's ability to refer a patient to another specialist, Hollingsworth says. A specialist who has not joined the PPO would be less likely to get referrals from doctors in the PPO.
Doctors in his cardiology group have built good relationships with certain specialists and other colleagues and would be opposed to stop using them simply because of an insurance guideline, Hollingsworth says.
Although KeyCare would cut physicians' fees as much as 15 percent, the reluctance to join KeyCare is "not a financial issue with us" and many other doctors in Roanoke, Hollingsworth insists.
While KeyCare says it will bring doctors more patients in return for the reduced fees, that's not much of an incentive for doctors who are already swamped with patients, Hollingsworth says.
"There are probably some physicians here who are not as busy as they would like to be," Hollingsworth says. But most practitioners in Roanoke are "as busy as they want to be and in some cases a lot busier than they would like to be. . . . It's not like Richmond or Northern Virginia where there are doctors falling all over each other and guys hanging around to get new patients."
Concern about "polarization between hospital and medical staffs" in the region could be another reason that physicians aren't signing up with KeyCare, says Dr. Samuel Williams, a surgeon who is president of the Roanoke Valley Academy of Medicine.
That issue was raised in a lawsuit filed against Blue Cross late last year by Lewis-Gale Hospital in Salem, Montgomery Regional Hospital and Pulaski Community Hospital.
The three hospitals claimed Blue Cross unfairly excluded them from participating in KeyCare and expressed fears that doctors at their facilities might switch to hospitals included in the KeyCare program. The suit has yet to come to trial.
Williams also points out that a survey by the academy last year showed that physician fees in Roanoke were the lowest of five regions in the state, including far Southwest Virginia.
"We think our fees are low now," says Dr. Gerald Roller, a Roanoke internist. "There's no reason to accept a lower fee just to work harder."
Most health insurance costs can be saved by going after hospital charges and charges for expensive medical procedures, not physician fees, Roller says. "We feel Blue Cross is trying to penalize the people who are taking care of patients."
by CNB