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Physicians Organizations are springing up across the continent either to bargain with HMOs for better terms or to offer their own health plans to employers. Last October, Primary Care LCC, a group of 170 physicians in the suburbs south of Boston, won a contract with Secure Horizons, a managed-care plan, to treat some of the plan's 40,000 Massachusetts Medicare patients. In Los Angeles, UCLA Medical Group, which began in 1992 with just two physicians, expects to have 80 by midsummer. It already has two full-time vans carrying patients from suburban doctors' offices to the star-studded UCLA School of Medicine. In Washington, Doctors Care Plan has signed up 900 physicians and 17 hospitals in the capital and its suburbs.
Cynics may contend that doctors mainly want to protect their incomes by preventing HMOs from lowering capitation (per patient) payments. In California, where HMOs are most dominant, the average earnings of a primary-care physician dropped from $172,100 in 1993 to $146,000 in 1995.
But doctors say they also want to take better care of patients. Prying more money out of HMOs for treatment is one way. Another is to insist that HMO contracts let doctors make all the decisions on treatment rather than allowing "M.B.A.s phoning from the back of their limos to cancel bone-marrow transplants for breast-cancer patients," as one medical researcher puts it.
The doctors face some obstacles. One is the formation of organizations big enough to force HMOs to deal with them--or even to raise enough money to get going. Still, the doctors potentially have mighty muscle: without them, HMOs can't exist.
UNIONS
They too have bargaining power, since their contracts with employers often specify what medical insurance is to be provided for members. Some unions are exploring ways to put a greater percentage of their premiums into care. The United Automobile Workers and General Motors have launched pilot projects to work with hospitals and doctor groups to bring down the proportion of premium dollars going to administrative costs. In Flint, Michigan, they got hospitals to eliminate 450 unneeded beds so that more money from HMOs will go to care for patients in the beds that will be kept.
Unions of health-care workers, who witness firsthand the treatment managed-care patients are getting, have been especially active. Local 1199 of the National Health and Human Service Employees Union, whose members staff hospitals, clinics and doctors' offices in New York City, is starting its own health plan. The aim, says local president Dennis Rivera, is to "take for-profit out of the equation" and lower costs--not for care but for overhead and salaries. Eleanor Tilson, executive director of 1199's 320,000-member plan, makes $175,000 a year--peanuts compared with nearly any other HMO chief.