Which Way To Go On Hmo?

Premier has both advantages and drawbacks


In Payson, more than 400 senior citizens have switched in recent weeks from Intergroup to Premier Healthcare of Arizona because they believe the new HMO to be a better deal.

But a switch in HMOs has its drawbacks.
Negotiations continue between Premier and Payson Regional Medical Center. Until a contract is signed, Rim country seniors who belong to Premier will have to go to either Mesa Lutheran Hospital or Valley Lutheran Hospital in Mesa for their non-emergency hospital care.

PRMC's CEO Russell Judd said that although the hospital agrees with Premier on fees for patient care, there are concerns about a local doctors' group -- Central Arizona Independent Providers Association -- taking on the responsibility for paying the bills for its Premier patients.

In Gila County, Premier passes the responsibility of paying members' health care costs on to Central Arizona IPA, which has an exclusive contract with the HMO. The IPA will pay Premier for accounting and marketing services.

Payments for those services and for health care costs for senior citizen members will come from "per member per month" allotments from Medicare, which will go to the IPA.

This differs from Intergroup, which pays its associated doctors fees for their services and which can draw on a larger financial base to cover total health care costs --such as hospital bills.

Although those signing up with Premier are apparently willing to go to the Mesa hospitals, Central Arizona IPA doctors would prefer to keep all health care local.

"We have no desire to have care anywhere but in Payson," said Dr. Mark Ivey of the Central Arizona IPA.

Members of Intergroup, who have to pay $750 for each of two hospital stays in a year, have complained about the co-payments since the HMO gave notice of the co-payment changes last January. Before that, Intergroup had no co-payments for hospital visits. PRMC has a contract with Intergroup, but not Premier.

Ivey said hospital officials here need to realize that the $1,500 a year co-payment required per year by Intergroup is a hardship for many patients.

Judd said PRMC has set up a hotline to answer questions about the current HMO situation. Interested persons can call 472-1269.

Enough local doctors?
Another concern with the current set up between Premier and the doctors' group is that not all physicians in Payson have signed on with the group.

Dave Stewart, vice president in charge of marketing and sales for Premier, said he is concerned about the limited number of doctors in Payson who have signed on with the HMO. "Maybe the fees are not acceptable to the other docs," he said.

As of last week, Central Arizona IPA had five primary care physicians who have received their credentials with Premier. Three physician assistants have also gone through the credentialing process.

Ivey said more primary care providers are going through the contracting process with Premier . "Most of our local specialists are already credentialed or are in the process," he said. "Samaritan Family Health Center doctors want to come on and we're currently negotiating."

Dr. David Cluff, with Samaritan Family Health, concurred with Ivey, saying the door is still open for negotiations and that his group is waiting to hear back from the IPA.

Ivey said Central Arizona IPA has an open-arms policy to all providers in town. "There's not a primary care provider in this town we wouldn't love to have in our IPA," he said.

Ivey said there is no fee for a doctor to contract with Central Arizona IPA, but there are requirements doctors have to meet regarding "quality of care, certification (when applicable), record keeping and other important quality indicators."

More patients per doctor
Doctors who belong to Premier have also opened up their offices to more patients. He said another 200 physicians in the Valley will treat Payson residents who belong to Premier.

Ivey said there are no limits set on the number of patients a doctor can take, but there are policies regarding appointment availability and office wait-time that meet Medicare guidelines.

"We will work closely with our members and physicians to ensure access to care," he said. "Right now, if we see we need more providers, we'll bring some other docs."

Ivey said the advantage to Premier members is that doctors in the Central Arizona IPA know the area and its people.

"We are physicians that have served the Payson area for many years," Ivey said. "We know this area, its people and health care issues. This gives us a strategic advantage over any large insurance company."

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