Northwest Arkansas Doctors out in Cold and Upset

Fourteen Benton County physicians have found themselves managed right out of two popular managed care networks, and they’re not happy.

The doctors say it’s a metter of who is in control — the physicians and their patients, or the hospitals and the insurance companies — as well as the quality of care delivered to patients.

“What’s happening is not in the best interest of the patients. It’s not in the best interest of the hospital,” says Dr. Jan T. Turley, a Rogers urologist who learned recently that he was being dropped from Arkansas Blue Cross and Blue Shield’s Health Advantage and Arkansas’ FirstSource networks in Benton County.

Susan Barrett, president and CEO of Mercy Health System of Northwest Arkansas, disagrees. She says that the revamped network of providers, which was prepared by Mercy and submitted to Blue Cross, is a response to community concerns about the rapidly changing health care industry.

“[The network] was designed to be really responsive to what the people are saying,” she says. “They want choice, they want good geographic coverage … and they want us to attend to issues of cost and quantity.”

She adds, “We’re in this for our community and the people that we serve.”

The cancellations don’t take effect until the new year, but the doctors have wasted no time in trying to see whether they have any options.

“We see this [de-selection] as antitrust and restraint of trade,” says Dr. Bernard L. Fioravanti, a radiologist who organized what he’s jokingly termed the “council of war.”

“We are not going to just lay down and let them roll over us.”

Skills Not at Issue

The physicians who were dropped are aggrieved not only by concern for their patients but also by the way they were de-selected.

Fioravanti says he’s been a Blue Cross and Blue Shield provider for more than 10 years, while Turley has practiced in Rogers for 26 years. Both say the decision had nothing to do with their skills, the quality of care they deliver to patients or to cost. Rather, they say, it was because they aren’t employees of Mercy Health System.

David Wroten, assistant executive director of the Arkansas Medical Society, agrees.

“The message is clear: If you want to practice medicine in Northwest Arkansas hospitals, you have to be an employee of the Mercy Health System.”

Wroten wades cautiously into the subject of de-selection, noting the medical society represents doctors on both sides of the issue. But he quickly warms to the subject.

The survival of independent practitioners is threatened, he says, “when you have a climate … where one or two major health insurance companies are calling the shots.”

Wroten adds, “You’ve got one dominant insurer in the state of Arkansas — Blue Cross and Blue Shield — and a lot of also-rans.”

It’s the Mercy system’s dominance in Benton County that concerns the physicians. St. Louis-based Sisters of Mercy entered the Northwest Arkansas market in 1995 with the purchase of St. Mary’s Hospital. In the past two years, the system has bought about a dozen clinics in Rogers and Bentonville, effectively making the physicians in those clinics employees of Mercy.

That in itself is a sticking point in Benton County. Not all physicians wanted to sell nor were all offered the opportunity.

Many of those who remained independent are critical of what they say were Mercy’s heavy-handed approach to buying those physician practices. They are less willing to criticize their colleagues who sold, however, and indicate many of those doctors now privately regret their decisions to sell.

“I’ve been on the Rogers hospital staff as long as any active physician … since 1973,” Turley says, “so I’ve watched the hospital over the years. … In the early years, the hospital and insurance [companies] were there to benefit and serve the patients through the physicians. Our employer is the patient and we’re the patient advocate, and the hospital insurance companies were there to serve us.”

Gradually, he continues, that’s changed.

“By purchasing the doctors’ [practices] and buying in to Blue Cross, what has happened now is patients are there as a commodity to be used to serve the hospital and the insurance company.”

Fioravanti left St. Mary’s more than two years ago. At the time he was chief radiologist. His former firm split over the question of whether to sell to Mercy. Fioravanti and the other dissenting partner left.

Soon after, Fioravanti opened his own clinic, MRI Specialists, in Lowell. There, he performs magnetic resonance imaging, ultrasound, X-rays and CT heart scans. He believes his prices compare favorably to every other facility in the region. His office recently surveyed six area facilities, including the four major hospitals, on the cost for an MRI scan of the lower back. The results: Washington Regional was the highest at $1,775; Fioravanti’s came in the lowest at $1,200.

Fioravanti says that’s typical of his prices for other procedures. MRI procedures support the facility. He added the other types of scans to better serve his patients and referring physicians, Fioravanti says.

Health Advantage and FirstSource patients make up about 20 percent of his caseload, Fioravanti says.

Turley expects to be less seriously affected economically with only about 2 percent to 3 percent of his patients on those plans. He’s more worried that patients won’t have adequate choices.

As an example, Turley notes that he uses radioactive “seeds” to treat some patients with prostate cancer. The urologist on Mercy’s staff doesn’t. “He’s a nice guy, but one guy can’t do everything,” Turley says.

Network Includes Others

The new network consists of 151 physicians, 61 of whom work for Mercy, Barrett says. It does not affect Blue Cross’ indemnity plan or Medicare reimbursement.

Development of the network is the latest in Mercy’s integrated model, a plan it developed with community input to help stabilize the region’s health care network, she says.

“This is a very important strategy, from our perspective, in meeting what we have heard the community say is their concern about the rising cost of health care.”

Barrett says the system tried to establish a network to give patients “a great deal of choice” as well as numerous access points throughout Benton County.

She notes that Blue Cross has had a similar contracting arrangement in Washington County for the past several years with Health Partners, a physician-hospital organization.

As for the question of control raised by the physicians, Barrett says that issue has been discussed across the country.

“It’s not unique to northwest Arkansas, and I think it’s a reflection of significant changes in environment for health care. I think, generally speaking, there are good people in health care trying to deal with realities.”

The physicians plan to launch a public campaign. Fioravanti says they were advised by private legal counsel as well as the state attorney general’s office that they had no legal recourse.

“We are going to get the word out to the public through letters from our own offices to our patients. We are going to contact key personnel in the companies that have these insurance plans, including Wal-Mart, RTW, Superior [Industries], Bekaert and Emerson,” Fioravanti.

He says patients are being told that the doctors quit the plans.

“So now we’ve got to fight a misinformation campaign,” Fioravanti says. “There’s nothing we can do legally but there’s certainly much we can do in public relations, politically. We are not going to lie still and let the lies be propagated without shedding some truth on the real situation.”