THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Saturday, December 31, 1994 TAG: 9412310324
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 177 lines
SENTATRA takes another step toward a complete health system that it hopes will save money.
DOCTORS maintain stability and control in a market that discourages small, independent practices.
PATIENTS will see few changes now but may be more likely to be covered by a managed-care plan in the future.
Sentara Health System announced Friday that it had acquired seven local doctors' practices, including NDC Medical Center, Hampton Roads' largest independent group practice.
The company mailed letters Friday explaining the changes to the more than 180,000 patients on the doctors' rolls.
For Sentara, the marriage is a step in building a complete health-care company that provides health insurance, hospitals and doctors.
For the doctors, it means an acknowledgment of market forces that are making it increasingly hard for small, independent practices to survive.
For the patients of the 63 doctors involved, it means very few changes in the short run. But the willingness of some of the biggest doctors' groups to align themselves with an insurance company may signal a long-term change in how doctors, patients and insurers do business.
When the paperwork was signed at Sentara's offices Thursday night, the doctors and all their staffs became employees of Sentara. Sentara also bought the practices' equipment. Company officials declined to reveal financial details of the merger, which takes effect Sunday.
For now, the doctors involved will stay at their offices,although some may move over the next few years. Some of the smaller groups eventually may merge their offices with others.
The doctors will continue seeing all the patients they currently treat, regardless of whether those patients belong to a Sentara insurance plan.
The immediate changes will be behind the scenes, as the offices consolidate billing and paperwork. Sentara may decided to combine duplicated services like labs or X-ray.
The core reason for the marriage is simple: Sentara believes that they can save money by streamlining the practices, especially if the doctors are part of that process.
``Across the country, we've found that groups of five or eight or 10 physicians are much more efficient than three,'' said Donald Jellig, a Sentara vice president.
The doctors will join the 60 or so physicians who already work for Sentara in 19 regional health-care and urgent-care clinics, and in centers for treating families of military people.
The deal with Sentara offered the doctors some stability in a time of great uncertainty for the medical profession.
``Even we can see the handwriting on the wall,'' said Dr. Russell D. Evett with a laugh. ``These changes are coming, and the way to deal with them is to be able to manage them rather than just react to them.''
Evett, a member of Consultants in Internal Medicine, has been in private practice for 30 years. As president of the Medical Society of Virginia, a statewide doctors group, he has spoken out about doctors' fears of managed care.
Their greatest worry, he said, is that a health-plan bureaucrat will arbitrarily drop them from the company's list of approved doctors, cutting them off from patients.
The Sentara deal , said Evett, offered them control.
One physician from NDC has joined Sentara as a vice president and administrator of the new doctors group. Some Sentara doctors have seats on the company's board and the new executive council.
The doctors will make the crucial decision to approve independent practices who want to do business with Sentara's two HMOs. The physicians also will have a say in how the company cuts costs.
``Doctors in this setting will have some chance - if not to control our destiny - to have some voice in it,'' said Evett. ``Rather than having someone a hundred miles away with a protocol and a telephone telling you, `You shouldn't do this and you shouldn't do that.' ''
Right now, only about 20 percent of people with health insurance in Hampton Roads are part of a managed-care plan, but the percentage could be as high as 85 by the end of the decade, Sentara officials said.
By that time, each general practice doctor may be aligned with a particular health care company, seeing patients only from that company, said Karen Corrigan, a Sentara vice president.
Corrigan says that trend has played out in markets in California and Minnesota, where far greater percentages of the population get insurance from managed-care companies.
``It's too early to say now'' whether this will happen in Hampton Roads, Corrigan said.
Almost all the doctors who joined Sentara this week are general practitioners. Generalists are the backbone of managed care, since they act as ``gatekeepers,'' controlling whether and when a patient sees a specialist.
Dr. William P. Edmondson Jr., a member of NDC and spokesman for the doctors, said they are feeling a little anxiety.
``They're all very uptight at this point,'' he said. ``(But) we're all in the same boat, and we're moving forward.'' MEMO: THE DOCTORS
Ghent Medical Associates, Ltd.
Harvey H. Bercowitz, M.D.
Barry C. Lubin, M.D.
Stuart L. Shepheard, M.D.
The Group for Internal Medicine, Inc.
Alan M. Cohen, M.D., Ph.D.
Charles J. Goldman, M.D.
Howard C. Steier, M.D.
Consultants in Internal Medicine, Ltd.
William M. Bethea Jr., M.D.
Gregg R. Clifford, M.D.
Julie L. Damman, M.D.
Oscar E. Edwards, M.D.
Russell D. Evett, M.D.
David C. Grulke, M.D., Ph.D.
Charles A. Kessler, M.D.
Edward L. Lilly, M.D.
William L. Oelrich, M.D.
Ciccone, Sokol & Snider
Alvin J. Ciccone, M.D.
Gary B. Snider, M.D.
Richard A. Sokol, M.D.
Bayside Family Practice
Allison D. Byrd, M.D.
Karen Martin Hart, M.D.
Clarence A. Holland, M.D.
Kirsten A. Santianni, D.O.
William B. Warden, M.D.
George S. Wong, M.D.
Providence Road Family Practice
Garrett M. Kelly, D.O.
Katherine P. Law, M.D.
David R. Maizel, M.D.
Meredith B. Rose, M.D.
NDC+ Medical Center
William D. Atchley Jr., M.D.
Robert L. Bademian, M.D.
Stuart B. Baker, M.D.
David P. Blais, M.D.
John T. Bowers III, M.D.
Thomas D. Brown, M.D.
Gene H. Burke, M.D.
James W. Carty Jr., M.D.
H. Steven Choi, M.D.
Paul R. Conkling, M.D.
Richard L. Cullen Jr., M.D.
David M. Cundiff, M.D.
Jeanne C. Dillon, M.D.
John G. Duckett, M.D.
William P. Edmondson Jr., M.D.
T. David Elder, M.D.
Craig B. Froede, M.D.
A. Randolph Garnett Jr., M.D.
William W. Gough, M.D.
Jeffrey M. Graves, M.D.
Reginald B. Henry III, M.D.
Eric C. Hodeen, M.D.
E. Beaumont Hodge Jr., M.D.
Francois E. Holder, M.D.
J.R. Howard Jr., D.O.
Albert H. Lee, M.D.
Scott A. Miller, M.D.
Jonathan W. Miller, M.D.
Zarine Mistry, M.D.
Martha L. Mooney, M.D.
David M. Persson, M.D.
William L. Robinett, M.D.
Ghandi M. Saadeh, M.D.
Carol S. Scatarige, M.D.
James R. Tomlinson, M.D.
KEYWORDS: MEDICAL INSURANCE HEALTH INSURANCE HEALTH CARE
MANAGED CARE MERGER DOCTORS by CNB