Brown & Toland Mixes It Up With UCSF

A few months ago, we picked up a story from the San Francisco Chronicle about the nasty fight going on between two Bay Area IPAs, Hill Physicians and Brown & Toland, over access to the specialists at the University of California San Francisco (USCF) academic medical center. At that point, it looked as if UCSF, which had switched its affiliation to Hill, would allow patients with primary-care physicians in Brown & Toland to continue seeing UCSF specialists. But according to UCSF ads now running on local TV, only HMO patients who switch to physicians in the Hill network will have access to those specialists. (For those not clued into the bizarre world of California healthcare, HMOs in that state delegate care management and financial risk to physician groups and IPAs, which can choose the specialists they want to use outside of their group.) Brown & Toland claims that the $600,000 ad campaign is misleading, and it has sent patients letters saying so. It has also protested to the California Board of Regents, which governs UCSF. The university has denied Brown & Toland’s charge that it is engaging in scare tactics and is disseminating “incorrect and disruptive” messages.

Nevertheless, there’s no doubt that many doctor-patient relationships are being disrupted by the bare-knuckled fight, which is essentially over money. Last year, Brown & Toland accused the UCSF physician organization of not wanting to participate in its PPO or adopt the electronic health record system that the IPA has asked its members to use. That reportedly led to the breakup between the two organizations.

As I pointed out in my earlier post, this kind of battle is not unusual in the highly competitive managed care environment of California. It also occurs routinely across the country when hospitals and health plans cannot agree on terms. And in more competitive markets, some health plans shunt patients to hospitals or labs that may not be conveniently located but are willing to meet the plans’ terms.

What is concerning about this-aside from the inconvenience to patients-is that the healthcare industry is moving toward a system of hospital castles surrounded by physician practices that are linked to them. This is occurring partly because of economics and partly because many hospital leaders believe that in the future, Medicare payments will be bundled or apportioned to “accountable healthcare organizations.” If this does occur-and it should not be ruled out, considering the demonstration projects that the government is launching-it is likely that patients will be whipsawed even further between competing business entities.

ACOs make a lot of sense from the viewpoint of cost control. But it would be better if some entity other than hospitals were in control of them, or if hospitals had only a share of their governance. Unfortunately, however, hospitals are the dominant business organizations in most medical communities. So there’s a good chance that patient choice of physicians will again be severely limited, as it was in the ’90s heyday of managed care.