HNF Stories
8:00 pm
Wed December 11, 2013

Doctor-Dropping for Quality or Profits?

On Jan. 1, hundreds of Florida doctors who now treat UnitedHealthcare's Medicare patients will be dropped. A host of patients have been affected nationwide. (See update: FMA Protests Doctor-Dropping)

Gail Gallagher.
Gail Gallagher.
Credit Carol Gentry

Ever since United started sending out letters to doctors, telling them they won’t be on United’s Medicare network next year, it’s been a big story.
   
Here it is on Fox: “United Health, which is one of the largest  health-care providers in this country, has dropped thousands of doctors from their insurance plan. The reason? Obamacare.”

WINK TV, the CBS affiliate in Fort Myers, offered a different view:

“New at 6, there’s a big change coming to some United Healthcare subscribers, and it has nothing to do with the Affordable Care Act.”

So who’s right? Did the health law trigger all this? Not really, says John Petrila, chairman of Health Policy & Management at University of South Florida.

He says the narrowing of doctor networks isn’t new.

“I think there are certain trends in health care   that the Affordable Care Act to some degree has made more visible, to some degree maybe has  accelerated, but ever since the introduction of managed care  and efforts at controlling costs into health care, and  that dates back at least 25 years or more, there have been efforts by payers to reduce their panels.”
 
But it used to fly under the radar, Petrila says.

“What I think is new is the effort to use this as one of the proxies for what people are arguing is the failure of the Affordable Care Act.”
 
Because of the health law, insurers can’t outright deny coverage to patients who’ve been sick the way they used to.  But Petrila says they can drop the doctors who treat them – like the ones who practice at Moffitt Cancer Center.   

“No insurer wants to deal with sick people, that’s the bottom line. At some level, this is a strategy to decrease access.”

If sick people can’t keep their doctors, insurers know, they’ll move to a different plan. That’s what happened with Gail Gallagher, who moved with  her husband to Tarpon Springs three years ago when she retired from the Broward School system. She was so attached to her gynecologist that she drove back to Boca every year for her annual exam.

For eye care, her doctor in Boca recommended St. Luke’s Cataract and Laser Institute in Tarpon Springs.    

She says she got really good care there, and it was just 10 minutes from her house. But then she found out United was dropping St. Luke’s doctors; she’s one of 5,000 United patients who use St. Luke’s and were told they’d have to go elsewhere.

“How could United let this happen? This is a huge amount of people.”

United offered alternatives. She didn’t like them.

“When you’ve had three torn retinas, you want to make sure should there ever be a problem, you’re  not  told ‘We’ll see you in a month.’  St Luke’s always has someone on duty. “  

Over at St. Luke’s, administrator Brad Houser says the United Medicare Advantage contract accounts for 10% of their business.

“The contract’s pretty straightforward. You have the right to terminate us without cause, giving us notice. We acknowledge that’s what you did. ”

The most frustrating thing, Houser said, is the mystery. United won’t say why it’s dropping them, as he told me on a recent visit.

“Is there a financial advantage to them? My guess is they think there’s a financial advantage or else  they wouldn’t be doing this.

“Is it a way of getting rid of people who have eye diseases? One could construe that there’s a backdoor rationing of care.“
He’s not so much angry as mystified, he said.

“It’s frustrating because we can’t get any answers from anybody about what’s going on. We just know there’s a bad thing coming at us and bad thing coming at our patients. They’re in here everyday saying what am I going to do about my eye care next year, doctor? And our doctors are as dumbfounded as I am.”

So I called UnitedHealthcare to ask why they’re doing this. Jessica Pappas  was the PR person assigned to me. She said, essentially, everybody’s doing it.

“Many Medicare Advantage plans including United Healthcare are making these changes;  it’s really to improve the quality and affordability of health care coverage for our Medicare members. "

"Okay, well it seems to me that if you have fewer doctors they’ll either be super-busy and people will have trouble getting in to see them, or else you’ll have to have fewer patients."

"We’re working to insure that our network is adequate to meet the needs of our members. Historically United has had a larger network than other insurers in many markets." 
 
Doctors are not taking it lying down. Last week, as Kaiser Health News reported, a federal judge in Connecticut temporarily blocked United from dropping 2,200 doctors in that state from its Medicare Advantage network.

Florida Medical Association has asked federal Medicare authorities to investigate the terminations to make sure United is following the law and that it is not harming patients.

--Health News Florida is part of WUSF Public Media. Contact Editor Carol Gentry at 813-974-8629 (desk) or e-mail at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.