Physicians Plus threatens to sue UW doctors [The Wisconsin State Journal]

Nov. 29--Physicians Plus is threatening to sue UW-Madison's doctor group, saying the group might cut off members' access to UW doctors because the insurance company rejected a contract it deemed too expensive.

The threat of legal action, made in a Physicians Plus news release Monday, comes less than three weeks after UW's doctor group sued Meriter Health Services, which owns Physicians Plus. The lawsuit claims Meriter Hospital wouldn't provide night coverage for UW's family medicine patients or allow more UW doctors to provide the coverage.

The new conflict, according to Physicians Plus, involves an "ultimatum" from the doctor group, UW Medical Foundation.

If Physicians Plus doesn't meet the doctor group's deadline of Tuesday for accepting a new contract with the group, the insurance company said, UW doctors will no longer be available to most of the insurance company's 114,000 members beginning Jan. 1, 2013.

Access to the doctors for next year is not in question.

Physicians Plus said it would continue negotiations and vow "to take all necessary actions to ensure its members' access to UW physicians, including legal remedies."

Dr. Jeff Grossman, president of UW Medical Foundation, said Monday that today was set as a "milestone date," not a deadline.

The doctor group "has attempted to bridge the gap between the parties and further meetings have been scheduled," Grossman said.

Physicians Plus and UW Medical Foundation negotiate access to UW doctors every two years and reimbursement rates every year, Linda Hoff, Physicians Plus president, said in an interview.

The doctor group usually commits another two years of access to its doctors before requiring the next agreement on reimbursements, Hoff said. This year, for the first time, the group asked the insurance company to sign the reimbursement contract before extending the commitment to its doctors, she said.

Grossman said a multi-year contract for access to the UW doctors expired in 2008, and the doctor group twice extended it two years.

Hoff said Physicians Plus didn't accept the reimbursement contract this year because it didn't adequately control costs.

"Physicians Plus and the people we serve were never previously threatened with UWMF turning its back on more than 100,000 community members," Hoff said in the news release.

State law requires the doctor group to continue the current agreement unless the parties agree to new terms, Hoff said. If UW Medical Foundation takes away access to the UW doctors, Physicians Plus will sue, she said.

The UW Medical Foundation's 1,200 doctors care for many patients at UW Hospital and at Meriter Hospital, which has a small but growing group of its own doctors. The latest count in October was 116 doctors.

UW Health and Meriter Health Services, which collaborate on services such as maternity care, have competed against each more in the past year since talks of a merger broke down.

A chief element of UW Health's merger proposal was combining Physicians Plus and Unity, UW Health's insurance company, which has about 100,000 members.

A June 22 memo from Physicians Plus to UW Medical Foundation said the insurance company would "redirect" patients from UW Hospital to Meriter Hospital for some services starting Sept. 1 and require approval to see UW's specialists beginning Jan. 1.

After a State Journal article in July mentioned the changes, Physicians Plus said it wouldn't implement them.

The UW Medical Foundation's lawsuit Nov. 11 against Meriter alleges unfair competition and other charges. On July 1, Meriter stopped providing doctors at night to oversee patients seen by UW doctors during the day.

___

(c)2011 The Wisconsin State Journal (Madison, Wis.)

Visit The Wisconsin State Journal (Madison, Wis.) at www.wisconsinstatejournal.com

Distributed by MCT Information Services