Wyoming Valley West 
Performs Like Champion

Acc Struggles 
Continue For 
Sura, 'noles 
Florida State Falls To Maryland

By CECE TODD; Times Leader Staff Writer
 Thursday, January 13, 1994 &nbsp;&nbsp;&nbsp;&nbsp;Page: 1A QUICK WORDS: IT'S YOUR BODY -- AND
THEIR BIG BUSINESS 





Like chess, health care in the Wyoming Valley has become a tactical game of
strategy and survival. &nbsp;&nbsp;&nbsp; 
 To offer better care and lower costs, Procter &amp; Gamble Co. replaces its
health plans with sole coverage from Geisinger Health Plan. Blue Cross Blue
Shield calls foul and files a restraining order against Procter &amp; Gamble. &nbsp;&nbsp;&nbsp; Not to be left out, Mercy Hospital advances across the board by offering
four new health plans of its own. &nbsp;&nbsp;&nbsp; 
 In a cunning move, Blue Cross Blue Shield picks Wyoming Valley Health Care
System Inc. as sole provider in Luzerne County for its health maintenance
organization. &nbsp;&nbsp;&nbsp; 
 Then, check. Wyoming Valley Health Care System Inc., the operator of
Wilkes-Barre General and Nesbitt Memorial hospitals, forms a physicians'
network that, in effect, shuts out Mercy doctors from practicing in the Blue
Cross HMO. That means 1,388 patients have to leave their Mercy doctor or find
a new health plan. &nbsp;&nbsp;&nbsp; 
 Checkmate. &nbsp;&nbsp;&nbsp; 
 On a chessboard checkered with new health plans and exclusive contracts,
doctors and patients are the captured pawns. &nbsp;&nbsp;&nbsp; 
 Dr. James Majdic, a physician employed by Mercy Med-Care, is outraged.
"Decisions are being made by administrators in offices who know nothing about
the doctor-patient relationship, and primary care doctors are being
manipulated by whatever party sees fit. &nbsp;&nbsp;&nbsp; 
 "They treat this like a game. ... But it's the patients who get squashed." &nbsp;&nbsp;&nbsp; 
 It's all strategy designed to guarantee health-care providers a share of
the county's health-care market. &nbsp;&nbsp;&nbsp; 
 As the country moves toward health-care reform and local hospitals and
insurers try to hold on to and increase business, competition heats up. &nbsp;&nbsp;&nbsp; 
 From his administrative offices at Mercy Hospital, President and CEO Robert
Goodwin observes the fray. He nods his head slowly. "There are lots of local
market forces taking place," he said. "As lengths of hospital stays and
admissions drop and physicians struggle, networks are being formed. &nbsp;&nbsp;&nbsp; 
 "We're having our very own mini health-care reform right here in the
Wyoming Valley." &nbsp;&nbsp;&nbsp; 
 Given that health services is the third-largest industry in Luzerne County,
some might call it a health-care war -- with the players lining up on the
battlefield. &nbsp;&nbsp;&nbsp; 
 Let the games begin &nbsp;&nbsp;&nbsp; 
 This month exploded with a blitz of changes in health-care delivery:
Procter &amp; Gamble's partnership with Geisinger went into effect, as did Mercy's
new FirstCHOICE health plan. &nbsp;&nbsp;&nbsp; 
 But sparking the most controversy has been the exclusion of Mercy Med-Care
doctors -- some of whom have privileges at Wilkes-Barre General and Nesbitt
hospitals -- from the Wyoming Valley Physician Hospital Organization (PHO)
associated with those hospitals. &nbsp;&nbsp;&nbsp; 
 Because the Wilkes-Barre General/Nesbitt PHO has the exclusive contract for
Blue Cross HMO members, more than 1,300 patients who now see a Mercy doctor,
must find a new doctor, or get a new health plan. &nbsp;&nbsp;&nbsp; 
 Officials with Wyoming Valley Health Care System Inc. would not grant an
interview or directly answer why they barred some doctors from the PHO. They
simply provided The Times Leader with a list of criteria for physician
membership, which includes the statement "Must not be employed by a competing
hospital or health care system." &nbsp;&nbsp;&nbsp; 
 "I'm very unhappy," said Denise Kimmel, 37, operations manager at TNT
Management Services and a Blue Cross HMO member. For more than a year, she has
been a patient of Majdic, who is employed by Mercy Med-Care. &nbsp;&nbsp;&nbsp; 
 "Your primary care physician is one of the most important medical people in
your life," she said. "You rely on them. You develop a great rapport with
them. As a patient, it's uncomfortable to find another doctor." &nbsp;&nbsp;&nbsp; 
 Kimmel said TNT Management, which offers the Blue Cross HMO plan to its
employees at group rates, might find a new plan. "We've heard that Aetna
insurance is looking at this area and might set up an HMO," she said. "Our
contract (with Blue Cross) is up in April and we are definitely discussing
other options." &nbsp;&nbsp;&nbsp; 
 For another Majdic patient, Harold Woodburn, 52, there is no other option. &nbsp;&nbsp;&nbsp; 
 "I have to stay (with Blue Cross HMO) because I get it through work," said
the Newtown Manufacturing &amp; Building Supply Corp. employee. "But I hate
looking for another doctor." He will miss his relationship with Majdic.
"Nobody likes to go to the doctor, but he treats you good. He talks to you in
English. I hate to go to anyone else." &nbsp;&nbsp;&nbsp; 
 Majdic, who stands to lose about 100 patients, is steamed. "This is not a
money issue for us (the Mercy Med-Care doctors). Our interest is in preserving
the doctor-patient relationship, which is the equivalent of going to a priest
and baring your soul." &nbsp;&nbsp;&nbsp; 
 Blue Cross spokeswoman Jill Carey said the creation of an exclusive network
of caregivers is not unusual. "In any market across the country, this is how
it works." &nbsp;&nbsp;&nbsp; 
 After studying local hospitals, Blue Cross determined that Wilkes-Barre
General and Nesbitt could best meet the needs of its members. "The data we
looked at ranked them the highest," Carey said. "They were also chosen for
their willingness to expand departments and increase the care they provide." &nbsp;&nbsp;&nbsp; 
 After Wilkes-Barre General and Nesbitt were selected, Wyoming Valley Health
Care System Inc. formed the PHO, "which is really Blue Cross's PHO," Carey
said, adding that the Mercy doctors "were aware for over a year that this was
happening and that they would be forced to choose." &nbsp;&nbsp;&nbsp; 
 But for Majdic, 34, there has been little choice. As a young physician with
medical school debts to pay and a family to support, he joined Mercy Med-Care
for the financial security it offered. &nbsp;&nbsp;&nbsp; 
 "And now, I'm being penalized for my financial situation," he said. He
points out that while he was denied admission to the Wyoming Valley PHO, he
still has privileges at Wilkes-Barre General. "I can see the day coming when
I'm making rounds and in one bed is my patient. In the next bed is a former
patient I can't touch because they have Blue Cross HMO. &nbsp;&nbsp;&nbsp; 
 "I'm good enough to be on their staff. I have privileges there.
Essentially, they're saying I'm good enough to touch one patient, but not the
other." &nbsp;&nbsp;&nbsp; 
 A different story &nbsp;&nbsp;&nbsp; 
 While Blue Cross HMO defends its exclusive arrangement with the Wyoming
Valley PHO, it is fighting in court an exclusive arrangement between Procter &amp;
Gamble and Geisinger Health Plan. &nbsp;&nbsp;&nbsp; 
 In January, P&amp;G replaced its three health insurance options with a new
point-of-service plan administered by Geisinger. About 9,000 people are being
covered by the plan that was developed by P&amp;G. &nbsp;&nbsp;&nbsp; 
 Geisinger spokeswoman Lisa Hartman said the plan is an HMO-type product,
but does not exclude physicians. Patients can see a doctor outside the
network, although it will cost more. &nbsp;&nbsp;&nbsp; 
 Blue Cross HMO has filed for a temporary restraining order and injunction,
claiming P&amp;G employees should have choices in health-care coverage. &nbsp;&nbsp;&nbsp; 
 Mercy officials say Blue Cross is being hypocritical: How can Blue Cross
deny its HMO members a choice of doctors and then complain that P&amp;G employees
are being denied a choice of health plans? &nbsp;&nbsp;&nbsp; 
 "Tough question," Carey said. But she pointed out that the Blue Cross HMO
offers its members a choice of more than 300 physicians, and that Geisinger
employs its own doctors. "We're essentially doing the same thing, but we're
getting the resistance." &nbsp;&nbsp;&nbsp; 
 In regard to Blue Cross HMO members finding new doctors, she said, "I don't
agree with members who feel they won't be taken care of. ... We have over
seven years' experience in quality assessment. We've been here a long time and
we've proven ourselves. &nbsp;&nbsp;&nbsp; 
 "We have always been open arms to everyone. We do not turn anyone away." &nbsp;&nbsp;&nbsp; 
 Mom and pop in trouble &nbsp;&nbsp;&nbsp; 
 In another move, officials of Wyoming Valley Alcohol and Drug Services,
Inc. are upset because their agency has been dropped from Blue Cross HMO. &nbsp;&nbsp;&nbsp; 
 John Plucenik, the agency's community outreach coordinator, said the move
will be harmful to patients' continuity of care. "It's not like signing up
with a doctor and then going there when needed. Patients see therapists on a
regular basis. They divulge things, bare their souls. It takes time to build
up trust." &nbsp;&nbsp;&nbsp; 
 Executive Director Carmen Ambrosino said Blue Cross dropped his agency
because of the insurance company's tie to Wyoming Valley PHO and Nesbitt
Memorial Hospital, which operates its own drug and alcohol treatment agency. &nbsp;&nbsp;&nbsp; 
 Carey confirmed that, adding that as part of an arrangement, Wyoming Valley
PHO had agreed to develop and expand its services. "Their program will
accommodate the needs of our members," she said. &nbsp;&nbsp;&nbsp; 
 Wyoming Valley Alcohol and Drug Services is talking with Mercy officials
about a possible arrangement with that hospital. &nbsp;&nbsp;&nbsp; 
 "We need someone that we can align with," Ambrosino said. "Mom and Pop
operations are in trouble. The big guys are eating up the little guys." &nbsp;&nbsp;&nbsp; 
 Running scared? &nbsp;&nbsp;&nbsp; 
 Mercy officials point to Blue Cross as the instigator. &nbsp;&nbsp;&nbsp; 
 "They were running scared. They were reacting to Geisinger's growth," Terry
Conrad, vice president and chief financial officer at Mercy, said of Blue
Cross HMO's exclusive arrangement with the Wyoming Valley PHO. &nbsp;&nbsp;&nbsp; 
 Mark Stephens, Mercy vice president for marketing and planning, said, "They
(Blue Cross) were aware that in developing that exclusive relationship, they
would create competition." &nbsp;&nbsp;&nbsp; 
 Goodwin agreed. "It was a clear signal. But I think they were surprised by
how fast we responded." &nbsp;&nbsp;&nbsp; 
 The FirstCHOICE health plan that Mercy began offering this month provides
four options: an indemnity plan, a preferred provider network, a
point-of-service plan, and an HMO. Stephens said Mercy is in the final stages
of negotiating a partnership with national insurance companies. &nbsp;&nbsp;&nbsp; 
 Goodwin laughed, "Unfortunately for the gang over at the Blues (Blue
Cross), we're doing all the right things." &nbsp;&nbsp;&nbsp; 
 Carey said Blue Cross is simply following a trend toward national care and
considering what's best for its HMO members. "What we're doing all relates
back to quality care and cost-containment," she said. "Blue Cross is a staple
in the home. I don't think Blue Cross has ever run scared." &nbsp;&nbsp;&nbsp; 
 But all the strategy and tough talk mean little to patients and the doctors
who care for them. &nbsp;&nbsp;&nbsp; 
 Physician Majdic sees the doctor-patient relationship as the loser. &nbsp;&nbsp;&nbsp; 
 "Who will survive and who will not remains to be seen," he said. "If this
is health-care reform, I want no part of it." &nbsp;&nbsp;&nbsp; 
 T &nbsp;&nbsp;&nbsp; 
 HE &nbsp;&nbsp;&nbsp; 
 P &nbsp;&nbsp;&nbsp; 
 LAYERS &nbsp;&nbsp;&nbsp; 
 This month, Procter &amp; Gamble replaced its health plans with a
point-of-service plan to be administered exclusively by Geisinger Health Plan &nbsp;&nbsp;&nbsp; 
 Mercy Hospital is negotiating with national insurance companies to offer
four new health plans &nbsp;&nbsp;&nbsp; 
 Wyoming Valley Health Care System Inc., which operates Wilkes-Barre General
and Nesbitt Memorial hospitals, established a physician hospital organization
that shut out Mercy doctors &nbsp;&nbsp;&nbsp; 
 Blue Cross chose Wyoming Valley Health Care System Inc. as the sole Luzerne
County provider of services to its HMO members this caption for 1a &nbsp;&nbsp;&nbsp; 
 TIMES LEADER/LEWIS GEYER &nbsp;&nbsp;&nbsp; 
 Dr. Joseph Anistranski, a physician for Mercy Med-Care, checks the ear of
2-year-old Brittany McFadden of Hanover Township. Because of his affiliation
with Mercy Med-Care, Anistranski cannot treat Blue Cross HMO members.

It's Your Body -- And Their Big Business 
It's A Simple Strategy: Exclusion Can Ensure Success. But Traditional 
Relationships Between 
Doctors And Patients 
Are In Jeopardy In The 
Wyoming Valley -- And That's A Gamble

It's Your Body -- And Their Big Business It's A Simple Strategy: Exclusion Can Ensure Success. But Traditional Relationships Between Doctors And Patients Are In Jeopardy In The Wyoming Valley -- And That's A Gamble