THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, January 29, 1995 TAG: 9501280188
SECTION: BUSINESS PAGE: D2 EDITION: FINAL
SOURCE: BY LON WAGNER, STAFF WRITER
LENGTH: Medium: 71 lines
The wave of penny-pinching that crashed onto hospitals during the past half-dozen years now appears to be rolling toward doctors.
Sentara's purchase last month of NDC Medical Center - until then the largest independent group medical practice in Hampton Roads - doubled to about 125 the number of physicians getting paychecks from Sentara.
Even doctors who don't directly join Sentara's payroll will be increasing their reliance on HMOs for business. The managed-care companies have something the doctors need: patients with a way to pay their bills. And the companies say they can't truly control costs without the doctors' help.
The companies make sure the doctors save money by withholding a percentage of their pay until the end of the year. That ``withhold,'' as Independent Physicians Association member William May put it, took some of the risk of insuring people away from the HMOs and laid it at the feet of the doctors.
Each time May refers a patient to a specialist or sends a patient to a hospital, he uses some of the withheld money - and gets less money at the end of the year.
``In the old days, the more you did in the office, the more patients you saw, the more labs you did, the more money you got,'' May says.
``The new philosophy is, the less you do, the more you get. The fewer labs you do, the fewer hospitalizations, the more money you'll have left over at the end of the year and the more money you'll get,'' he says.
That leaves some doctors wondering: What about the patient? What about quality?
``It's something we worry about a tremendous amount,'' said Bobby Garrison, a pediatrician who sits on the IPA board. ``It often feels as though we're being put in the position of trying to maintain the quality of care at the lowest possible cost.
``I'm often reminded of what one of the astronauts said: `How would you like to be sitting on top of a huge rocket knowing every piece went to the lowest possible bidder?' ''
The doctors set up the Independent Physicians Association in the early 1980s when Sentara was about to launch its first HMO, Optima Health Plan. Doctors sign contracts and own stock with the IPA, a partial owner of Optima. With that setup, the physicians have a voice in the direction of managed care under the Optima plan.
Most doctors, even members of the IPA, now accept patients insured through the spectrum of health plans. A doctor, for instance, might treat an Optima member during one appointment, a Trigon policyholder during the next and an Aetna patient next.
But if health care continues in its current direction, administrators and doctors say most physicians in the near future will be affiliated with just one company. That way managed-care companies can better monitor the efficiency of their doctors to help control costs.
Measuring costs is easy - dollars saved is the yardstick - compared to tracking quality. But Jack McNamara, president of managed care at Sentara, said in the future patients will be able to compare the quality of doctors' care just as today they can compare the costs of health plans.
Quality will be addressed soon, McNamara said. Within the next few years the managed-care companies will be charging similar fees. Business will be won and lost on the quality of care.
The integration of doctors into Sentara's system boosts cost efficiencies, but it also fortifies Sentara against the competition. Sentara thinks its staff physicians will serve as a deterrent to deep-pocketed companies like U.S. Healthcare.
``Other companies are coming in and saying, `How do I buy the doctors?' '' McNamara said. ``Because if we have the primary-care physicians, you can't have managed care.'' by CNB