Thousands In Missouri May Need New Doctors

Date 2014/6/20 4:42:22 | Topic: News

ST. LOUIS (AP) - UnitedHealthcare has notified more physicians in Missouri that they will be removed from the company’s Medicare Advantage plan on Sept. 1.
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This is the second round of cuts to UnitedHealthcare’s Medicare Advantage physician ranks, following reductions in April. The provider is the largest carrier of Medicare Advantage plans for seniors in the nation, with about 95,000 plan members in Missouri.

Dr. Joseph Craft III, a cardiologist and president of the St. Louis Metropolitan Medical Society, said his organization was hearing every day from doctors who have received a termination notice.

While the society is not aware yet how many of its members have been terminated, “we know ultimately this is going to affect thousands of patients in the St. Louis area,” Craft said.

UnitedHealthcare terminated almost 100 Missouri physicians from its Medicare Advantage plan in April, which prompted a scathing letter from the Missouri State Medical Association. The provider said then that eventually 5 percent to 7 percent of the more than 10,000 physicians in the state would be eliminated this year.

In an email Wednesday, UnitedHealthcare said the cuts affected less than 10 percent of the state’s physicians, which would translate to fewer than 1,000 physicians. While the company manages its network on an ongoing basis, UnitedHealthcare does not expect to make any more changes to its size in Missouri this year.

While Craft said he thinks physicians of all specialties have been affected, this month’s cut seems to target dermatologists, ophthalmologists, gastroenterologists and orthopedic surgeons.

Dr. George Hruza, a Chesterfield dermatologist and president-elect of the American Society for Dermatologic Surgery, received the network termination on June 2. After contacting St. Louis area dermatologists, he learned at least 36 had also been terminated. That amounts to almost half of the skin specialists in the area.

In St. Charles County, for example, he said three dermatologists had been cut from the network. Those three are the only specialists in the county who perform Mohs surgery, which has a 99 percent cure rate for the most common type of skin cancer.

“This area has a lot of farmers, so a lot of people who have sun damage — these patients are now asked to find another doctor,” Hruza said.

Most of the dermatologists who stayed in network, he said, are in the center of St. Louis, and many belong to a larger health care group, such as a university.

This is a problem because universities already have about a three-month waiting list for patients, Hruza said.

“They’re gonna put thousands and thousands of patients into such a small group of physicians.”

Craft said he thought UnitedHealthcare might be trying to push patients into service delays or toward doctors affiliated with bigger medical groups. He doesn’t see how that would save money for the provider, though.

“But again we’re only speculating ... because they haven’t offered anyone an explanation,” he said.

In the physician notices, UnitedHealthcare cites a no-cause termination. Hruza says the insurer’s contract states it is not required to give a reason for termination.

This makes it harder for physicians to appeal the termination because they don’t know what aspect of their practices they need to defend.

UnitedHealthcare said in an email Wednesday that the main factors for the change were the health industry’s move toward quality over quantity and a closer collaboration between insurers and doctors. With a smaller group of doctors, patient data could be shared better as well.

Missouri is not alone in the cuts. Last year, UnitedHealthcare began making terminations in several states. By the end of the year, the company expects to be 10 percent to 15 percent smaller than it was at the beginning of 2013.

These changes are being made in the middle of the policy year, so patients cannot switch to plans that include their doctor.

“The relationships (doctors) have with their patients is being disrupted arbitrarily, mid-contract term, with no explanation,” Craft said. “It’s not reasonable. It’s not fair to patients to do that.”

Jessica Kostner, spokeswoman for UnitedHealthcare, said these changes could be unsettling.

“We are working to make transitions to new doctors as smooth as possible and will do all that we can to prevent interruptions in care,” she said.



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