York County doctors ousted under WellSpan, Geisinger collaboration

Oct. 20--A collaboration between WellSpan and one of the state's top health insurance providers could separate local seniors from their longtime doctors at facilities including Memorial Hospital, Orthopaedic & Spine Specialists and about 300 other health care providers in York and Adams counties.

Geisinger Gold announced its collaboration with WellSpan in the York-Adams area in November 2014, but the efforts of that partnership take effect Jan. 1, 2016.

Geisinger Gold is a Medicare Advantage plan, intended to create additional benefits for those on Medicare by administering the coverage through a private company instead of through the government.

Earlier this month, nearly 120 medical provider groups representing about 300 individual providers received a letter from Geisinger Health Plans notifying them that their participation in the Geisinger Gold plan was being terminated, according to Geisinger spokeswoman Amy Bowen.

The letter states that Geisinger made its evaluations "to support this collaboration" with WellSpan. The collaboration does not affect the providers' participation in Geisinger's commercial (such as non-Medicare) plans, the letter states.

Breaking ties: OSS Orthopaedic Hospital in York Township is one of two hospitals -- along with Memorial Hospital in Spring Garden Township -- being removed from Geisinger Gold's network.

Angie Hartman, a spokeswoman for OSS, said the hospital's main concern after receiving the termination letter was alerting its patients on the plan. The hospital sent letters to about 800 patients, Hartman said.

Paul Walker, a 78-year-old Dover resident, was one of the patients to receive the hospital's letter.

Walker has been on the Geisinger Gold plan along with his wife since his real estate business went under in 2008, he said.

To learn about the network changes and a potentially increased deductible, Walker attended a Geisinger Gold "neighborhood meeting" last Wednesday at the Wyndham Garden hotel in West Manchester Township.

He was among 17 senior citizens to attend the Geisinger recruitment meeting, which Bowen said was scheduled for people who are not enrolled in the plan.

During the hourlong meeting, a promotional video featured satisfied customers. "I can have my own doctors," one senior woman said in the video, "and that's really important to me."

The Geisinger representative leading the meeting made no mention of the company's collaboration with WellSpan or the decreased network size for the coming year.

Bowen said Geisinger encourages all potential members to research whether their doctors are part of its Gold network before joining, and that information is easily accessible through its website or its phone line.

At the meeting, the Geisinger representative handed out applications to join immediately and said enrollment time was limited -- the annual period to switch is Oct. 15-Dec. 7.

The providers that will be removed from the plan starting Jan. 1 were still listed on the company's website as of Monday, unless the Internet user clicks a special disclaimer to search through a PDF document that's more than 900 pages.

Walker might be converting to a different Medicare Advantage plan, he said, because his wife doesn't want to leave her OSS doctor.

Currently on Geisinger Gold's Classic HMO plan, Walker was told his wife might be able to continue seeing her doctor if they switched to the Preferred PPO plan, which covers participants' use of out-of-network providers if approved.

"It's all very confusing looking at stuff like this," Walker said. "All the ins and outs, you really need someone to sit down and talk with you about everything."

Walker, who will be automatically re-enrolled in Geisinger Gold if he doesn't make a change before the Dec. 7 deadline, said he would like to take a chance on the basic Medicare plan, but it's risky because he and his wife are on a fixed income.

Appealing decision: Geisinger Gold's resulting network includes 1,200 providers in York and Adams counties, 850 of which are a part of WellSpan's local network, according to Bowen.

Rebecca Bruce, senior practice administrator at Leader Surgical Center -- another provider terminated from the plan -- said her facility's Geisinger account representative expressed frustration with the decision and didn't think it was fair.

Leader is one of several providers currently appealing the decision, as the option was given in the termination letter, Bruce said.

"We don't get the feeling this was something Geisinger wanted ... It just feels like it's WellSpan trying to squash competition," Bruce said. "People are going to get upset; a lot of older people want to see the same doctor they've been seeing for years."

WellSpan spokesman Rick Ayers said the agreement "emphasizes our shared desire to create a healthier community and better management of patients with chronic conditions."

Limiting choice: Those facilities being removed from the plan's network said Geisinger Gold -- which has about 4,500 members in York and Adams counties -- represented a very small percentage of their business.

But the terminated providers expressed concern that Geisinger Gold could continue to recruit members from government-issued Medicare, capturing more customers.

"(Geisinger is) making a big push, which could limit our ability to see patients we've had for years," said Bruce, adding that about 40 percent of Leader's patients are on Medicare. "We're not getting clear responses from Geisinger and have a feeling a lot of patients will convert."

Also among those to receive the termination letter was Gastro Associates of York.

"Our costs are nearly half of what it costs in the hospital, and this removes patient choice almost completely," said chief operating officer Jim Gill. "It makes no sense to exclude high-quality practices that can provide services for less money."

Bowen said the collaboration and decreased network were about "improving health outcomes" with a focus on those with chronic medical conditions.

When asked whether removing the providers improved health outcomes, she said, "No."

-- Reach David Weissman at [email protected].

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