Wage Increase Deceptive, Say Feds

Another Snow, Another Day Off In W-b Area

By CECE TODD; Times Leader Staff Writer
 Sunday, January 16, 1994 &nbsp;&nbsp;&nbsp;&nbsp;Page: 3A QUICK WORDS: BLUE CROSS DEFENDS ITS
HMO'S DOCTOR CUTS 





WILKES-BARRE -- Blue Cross, the bully? Or, Blue Cross, the misunderstood
friend, defender of choice? &nbsp;&nbsp;&nbsp; 
 When Blue Cross chose Wyoming Valley Health Services Inc. as sole provider
in Luzerne County for its Health Maintenance Organization (HMO), it sparked a
chain of events that now has Blue Cross receiving up to 30 calls a day from
concerned patients. &nbsp;&nbsp;&nbsp; The Wyoming Valley Physician Hospital Organization (PHO), the physicians
group formed by Wyoming Valley Health Services, barred doctors affiliated with
Mercy Med-Care. Now, those doctors and their HMO patients say Blue Cross took
away their choice of physician. &nbsp;&nbsp;&nbsp; 
 Downplaying the growing controversy, Blue Cross insists choice is still
there. &nbsp;&nbsp;&nbsp; 
 An executive with the non-profit giant likens the matter to buying clothes
and cars. If patients wish to stay with doctors outside the HMO, they can
switch to the traditional insurance plan -- and pay more. &nbsp;&nbsp;&nbsp; 
 "Absolutely it will cost more," said A. Paul Holdren, Blue Cross vice
president for marketing, business affairs and operational development. "But
don't we all make choices? Whether it's clothes or cars, we prioritize what
we're going to buy." &nbsp;&nbsp;&nbsp; 
 Blue Cross, he said, is trying to make things better for business and the
70,000 people enrolled in its HMO by controlling costs, expanding services and
improving care. &nbsp;&nbsp;&nbsp; 
 "The Blue Cross perspective is that we want to offer people a range of
choices through different types of health plans," Holdren said. "The HMO is
not the only choice. If people want to stay with a physician outside the
system, they can choose the traditional Blue Cross plan." &nbsp;&nbsp;&nbsp; 
 But that choice exists only for those who can afford it. Holdren calls it
economic reality. &nbsp;&nbsp;&nbsp; 
 "We all make economic decisions every day," he said. "But for a long time,
health care was outside that realm because the employer paid 100 percent of
the costs and made all the decisions. Now, employees are starting to get
involved. They're going to have to make those economic decisions." &nbsp;&nbsp;&nbsp; 
 Mercy Med-Care doctors and Mercy Hospital officials claim Blue Cross is
only considering dollars and cents, at the expense of physician-patient
relationships. They say it's hypocritical for Blue Cross to stand by a PHO
that bars them, while fighting in court an exclusive arrangement between
Geisinger Health Plan and Procter &amp; Gamble. &nbsp;&nbsp;&nbsp; 
 This month, Blue Cross filed a request for an injunction and restraining
order against P&amp;G when the company offered its employees only one health plan
-- to be administered by Geisinger. &nbsp;&nbsp;&nbsp; 
 Blue Cross, in its court filing, says P&amp;G agreed Nov. 24 to offer the Blue
Cross HMO plan as an option. The company reneged on the agreement, Blue Cross
officials said. &nbsp;&nbsp;&nbsp; 
 U.S. District Judge Richard P. Conaboy ruled against Blue Cross, saying
correspondence between Blue Cross and P&amp;G does not support the Blue Cross
claim that a contract existed. &nbsp;&nbsp;&nbsp; 
 "There is no hypocrisy," Holdren said of the company's fight with P&amp;G over
exclusivity and the exclusivity agreement it has with Wyoming Valley Health
Care. &nbsp;&nbsp;&nbsp; 
 "We want people to have a choice in health care systems, that's all,"
Holdren said. "We recognize that our system will have a set number of
physicians and providers and another system may have different providers. But
people should have a choice." &nbsp;&nbsp;&nbsp; 
 It's not fair, he said, to compare the P&amp;G/Geisinger partnership to the one
Blue Cross formed with Wyoming Valley Health Services, which operates
Wilkes-Barre General and Nesbitt Memorial hospitals. &nbsp;&nbsp;&nbsp; 
 "P&amp;G selected one system which means there will be tremendous displacement"
of patients from doctors not affiliated with Geisinger, Holdren said. He
estimated about 6,000 people are affected by the change in health plans at
P&amp;G, compared to more than 1,300 Blue Cross HMO members affected by the new
Wyoming Valley PHO. Geisinger officials say 9,000 people are being covered
under the new P&amp;G plan. &nbsp;&nbsp;&nbsp; 
 Blue Cross, Holdren said, is trying to protect P&amp;G employees' rights as
consumers to make choices. &nbsp;&nbsp;&nbsp; 
 But like Blue Cross HMO members, P&amp;G employees can also choose doctors
outside their health plan -- if they are willing to pay more. &nbsp;&nbsp;&nbsp; 
 Holdren paused. "Those are two different situations," he said. "When we
submitted our rates to P&amp;G, we were virtually the same (as Geisinger). When
you have another bona fide HMO, certified and accredited ... one that has gone
through rigorous review ... they (P&amp;G employees) should have been offered a
choice of plans." &nbsp;&nbsp;&nbsp; 
 When they chose to form an exclusive partnership with one hospital, Blue
Cross officials knew they were inviting competition and controversy. Every
hospital in the area, Holdren said, wanted to be chosen for that exclusive
arrangement. &nbsp;&nbsp;&nbsp; 
 But, he added, Blue Cross was unaware when it picked Wyoming Valley Health
Care Services that Wyoming Valley would form a PHO excluding doctors from
competing hospitals. &nbsp;&nbsp;&nbsp; 
 Still, Blue Cross supports that decision. &nbsp;&nbsp;&nbsp; 
 "We recognize that managed care controls costs," Holdren said. "Yes, we are
for choices. But that doesn't mean those choices have to include everything." &nbsp;&nbsp;&nbsp; 
 A. Paul Holdren

Blue Cross Defends 
Its Hmo's Doctor Cuts 
A Spokesman For The Giant Insurer Bristles At Claims It's Reneging On A 
Commitment To Wider Choice Of Physicians

Blue Cross Defends Its Hmo's Doctor Cuts A Spokesman For The Giant Insurer Bristles At Claims It's Reneging On A Commitment To Wider Choice Of Physicians