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Doctors Say HMO Tried to Reroute Clients

TIMES STAFF WRITER

A Ventura physicians group charged Friday morning that a large HMO is trying to destroy the doctors’ relationship with hundreds of longtime patients--and they saw greed as the motive.

Physicians at Brent Street Family Practice said Blue Cross’ California Care HMO had sent letters directing 380 of their patients to go to other doctors.

“The outrage is that they are destroying established doctor-patient relationships,” said Robert Dodge, a physician.

But by Friday afternoon, a Blue Cross spokeswoman said the problem--brewing all week as patient after patient complained--had been resolved: All 380 patients were now free to go back to Dodge and his four partners, all well-known Ventura family doctors, and notification letters were being mailed Friday afternoon.

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“The fix is in,” said Blue Cross’ Elise Anderson, a few hours after The Times asked her about the issue. “And this had nothing to do with finances.”

Dodge said that was the first he had heard of it.

“We’ve not been notified,” he said. “Sometimes it helps to bring a little pressure to bear. But if our patients are back, then we’re satisfied.”

The fleeting controversy is the latest skirmish in an increasingly contentious relationship between those who provide medical care and the HMOs that control the flow of patients to them--especially Blue Cross.

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For example, earlier this month, operators of St. John’s and Pleasant Valley hospitals threatened to stop accepting Blue Cross patients because the insurer’s new contract paid so little for patient care. A compromise was reached.

Two years ago, Ventura’s Community Memorial Hospital refused a new Blue Cross contract because of a proposed cut in fees.

And this week, Dodge said the situation reinforced all his worst feelings about HMOs.

Dodge and his four partners were furious not only because they felt patients were being mistreated, but also because a Blue Cross notification letter sent to patients last week implies that the change was driven partly by the quality of care.

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The July 13 Blue Cross letter says that the most important reason for the HMO changing doctors was “to ensure the quality of all our members’ care.” It says the HMO was acting to ensure “the right kind of care from the right kind of provider.”

“Fortunately,” Dodge said Friday, “our patients are calling and they’re irate. We’re hearing from them literally by the hour. These are relationships we’ve had for years. We’re talking about women with babies due and patients whose surgeries are being canceled.”

One patient, Sharon Velasquez, said she and her son, Brandon, have seen Dodge for 15 years.

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“I don’t like this,” said Velasquez, child support officer in the district attorney’s office. “All we want to do is go to our doctor. We trust his judgment.”

Blue Cross spokeswoman Anderson said the Brent Street patients will get what they want. That they were ever switched was an anomaly that is easily corrected.

And it never would have happened if a large San Diego-based physicians management group had not declared bankruptcy last weekend.

Dodge’s group subcontracts with bankrupt FPA Medical Management Inc., one of the biggest U.S. managers of physician practices. FPA-contract doctors deliver medical services to about 1.4 million people in 29 states.

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In Ventura County, acting on behalf of large HMOs, FPA had contracted with hundreds of local physicians to provide care for about 30,000 residents. The company’s bankruptcy has left those doctors with stacks of bills that the FPA may never pay, although the company is attempting to reorganize.

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As for local patients, the bankruptcy has forced HMOs to choose other physician groups to provide care. In most cases, this has not been a large problem, say HMO representatives, since local doctors such as Dodge contract with a number of physician management groups and can continue to provide care for FPA patients through another group.

For example, Health Net, which had 13,318 local members with FPA, immediately reassigned 93% of them to their doctor through other physician groups with Health Net contracts. Health Net representatives are notifying the other 1,000 patients by phone to help them pick a new doctor, said spokesman Ron Yukelson.

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That is just the way all HMOs should have handled it, Dodge said.

“It’s a mess, but some of the insurances--like Health Net and Blue Shield--are very doctor friendly,” he said. “They’re putting the patients’ interests first.”

Then there is Blue Cross’ HMO, he said.

Dodge said his practice has a contract with Valley Care, which cares for Blue Cross. So he could have seamlessly continued to provide care for Blue Cross patients. The only change would have been the group name on their enrollment card, he said.

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Instead, Blue Cross transferred Dodge’s patients to a physicians group in Simi Valley that demands less money for each patient than does Valley Care, Dodge said.

“They’re trying to punish Valley Care for not taking lower fees,” Dodge said. “They’re hoping that 25% of our patients won’t take the time to call and stay with us. And they’ll end up going to doctors who work for a lesser rate.

Blue Cross says Dodge had it all wrong.

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Of the 50,000 Blue Cross enrollees who received care through FPA, 78% were able to keep their primary doctors, Anderson said.

“We’re trying to make this switch as transparent as possible by moving our patients to other [physician groups] and doctors,” Anderson said.

But in the case of the Brent Street practice, there were complicating circumstances, she said.

It is true that Brent Street Family Practice is a member of the Valley Care physicians group that contracts with Blue Cross to provide care, she said. However, Blue Cross had not listed Brent Street as a provider on its computer because the practice only joined Valley Care in March.

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And Blue Cross had accepted no new physicians from Valley Care since last December because of ongoing contract negotiations.

“So they did not show up on our network [of member physicians]” she said. “Now all five of those doctors are in our system.”

Actually they were placed on the Blue Cross roster on Monday or Tuesday, after a Brent Street manager called to complain about the 380 lost patients, Anderson said. So patients who called to complain have been returned to the Ventura practice all week, she said.

Now all 380 will be notified by letter that they are eligible to still be treated by Dodge and his partners--Robert Garrison, Fran Larsen, Geoffrey Loman and Robert Moffatt.

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“We’re fixing this by making exceptions to our rules,” she said. “We’re doing a lot of this with a lot of doctors because of the FPA situation. . . . We are very concerned that our members get the highest quality care.”


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