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Managed Care And Mangled Careers?


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MANAGED CARE--AND MANGLED CAREERS?

The health-care plan conceived by Bill Clinton is months, maybe years away from becoming anything more than a dense stack of papers. But that's not stopping some health-care providers from launching guerrilla assaults on the cornerstone of the President's plan: managed competition.

Indeed, lawsuits challenging managed care are surfacing nationwide. In a little noticed suit in December, for instance, about 50 chiropractors in and around Suffolk County, N.Y., sued about a dozen health-maintenance organizations and their trade associations for antitrust violations. In other areas, antitrust suits have been brought by radiologists, podiatrists, allergists, and specialized hospitals excluded from health networks. And as relationships between networks and physicians solidify, and the Clinton health-care plan creeps closer to reality, more groups are expected to head to court. Among the likely complainants: psychiatrists and osteopaths.

What's the beef against managed care? The New York chiropractors are pretty typical. They argue that the defendants, including U.S. Healthcare,

Aetna Health Plan of New York, and Health Insurance Plan of Greater New York Inc., have "conspired to boycott and otherwise exclude" chiropractors from their plans--thereby preventing them from effectively competing in the marketplace. The chiropractors feel this alleged anticompetitive behavior is so harmful that they are seeking at least $10 million in damages.

UPHILL BATTLE. Consider the case of 51- year-old Dr. Phillip J. Solla. For the past 30 years, Solla has had a thriving chiropractic practice in Lindenhurst, N.Y. Not long ago, he noticed some of his patients were having difficulty getting insurance coverage for his services. So Solla tried to join his patients' preferred-provider networks--formal associations of health-care providers that sell their services jointly through HMOs and PPOs. That's when his troubles began.

Along with several colleagues, Solla sent 30 registered letters last July to carriers seeking inclusion in their health- care plans. One by one, the doctors were told that quotas for chiropractors were already filled or, in some cases, that chiropractors weren't allowed in the plan at all. Unable to infiltrate any of the local health-care networks, the chiropractors say their business is off by as much as 50%. "Managed-care programs are single-handedly decimating the chiropractic profession," fumes Solla.

These plaintiffs, however, face an uphill battle. That's because antitrust law is designed to protect consumers from harm, not competitors. Sure, defense lawyers acknowledge, managed-care organizations may not always seem fair--especially when the doctors some patients want cannot participate in their health plans. But, says William G. Kopit, an expert in health-care and antitrust law who represents two defendants in the chiropractors' suit: "It's also unfair that I wasn't born with the athletic ability of Michael Jordan or the money of Donald Trump." Provided your care is good, Kopit asks, "are you really willing to pay 10% more for care to ensure every competitor is treated fairly?"

In several cases, courts have basically agreed with Kopit's line of reasoning. In one suit decided last year, a radiology group claimed that it was illegally barred from an association that provided exclusive services to an HMO in upstate New York. An appellate court found that although the radiologists might have been harmed, consumers still got the quality medical care they needed.

To avoid more such defeats, health-care providers are trying to prove that HMOs actually hurt patients by limiting their choices of care. The chiropractors, for example, are relying on the woeful tales of patients such as Kathleen Kelly, an unemployed clerical worker in North Babylon, N.Y. A sufferer of chronic back pain, Kelly had been seeing her chiropractor for years. But when her husband's insurance was changed, she found that the only chiropractor in her plan was more than 20 miles away. Kelly says she didn't have the money to pay her former chiropractor and that the trip to the one in the plan was simply too long. Today, she says flatly, "I am suffering for it."

Sounds like Kelly may have a point, doesn't it? As the Administration tries to put its health plan into effect, such sounds may reverberate across the land.Linda Himelstein in New York


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