“If there was any question as to who is running the health care system, this should give us a hint. It’s not physicians, and it’s not patients.”
as and other states. Harris County Medi- cal Society (HCMS) President Elizabeth Torres, MD, a Sugar Land internist, says approximately 1,100 Houston physicians have been terminated by United from its Medicare Advantage plans. HCMS learned of the terminations in August and contacted TMA.
“The impact to affected doctors and patients is huge. HCMS has been track- ing terminations, and more than 50 percent affect solo practices and small groups in Houston,” said Dr. Torres, a former member of the TMA Council on Science and Public Health. Dr. Torres adds that she thinks Unit- ed’s decision is risky.
“I think United’s actions will ultimate- ly hurt patient care and the company fi- nancially,” he said.
The matter has garnered national at-
tention. Connecticut’s Fairfield County Medical Association and Hartford Coun- ty Medical Association sued United after the organizations learned the insurer be- gan removing physicians from its Medi- care Advantage network in October. In December, a federal appeals court granted the medical associations a pre- liminary injunction, preventing United from kicking physicians out of its Medi- care Advantage plans until doctors could arbitrate their cases against United. The Court of Appeals for the Second Circuit declined United’s request to stop the injunction pending the insurer’s appeal and referred the case to a three-judge panel.
The same month, the Texas Medi- cal Association and the state medical associations of Connecticut, California, Florida, New York, New Jersey, and Tennessee, along with several county and specialty medical societies and the Physicians Advocacy Institute, filed a friend-of-the-court brief in the Second Circuit opposing United’s motion to stop the preliminary injunction. Shortly thereafter, TMA, the American Medical Association, the AMA Litigation Cen-
40 TEXAS MEDICINE March 2014
ter, the state medical societies of Con- necticut, Florida, Georgia, Indiana, New Jersey, New York, North Carolina, Ohio, and Tennessee, and other organizations from across the country filed a separate friend-of-the-court brief.
The briefs filed by TMA and the other associations argue that the appeals court should maintain the injunction because it “temporarily keeps in place the ar- rangements between United and phy- sicians that have functioned for years.” Terminating the physicians will cause them “irreparable harm,” but keeping the injunction in place will not hurt United, they wrote. United contends the injunction interferes with its right to manage its physician networks. In January, the three-judge panel of the Court of Appeals of the Second Cir- cuit ordered UnitedHealthcare, the Fair- field County Medical Association, and the Hartford County Medical Association to resolve the dispute over United’s net- work terminations through arbitration. The injunction entered in Fairfield County Medical Association v. United HealthCare of New England, Inc. originat- ed in and currently applies only to Con- necticut. Attorneys for TMA and other medical societies, however, are trying to expand the case nationally because United’s actions affect physicians in Tex-
“If each Houston physician terminat- ed had a minimum of 10 to 15 patients on their panel, that would translate to 11,000 to 16,500 patients being affected. United is taking a risk assuming that the remaining specialists will be willing or able to take on additional patients or that patients will be happy to change physicians,” she said. Dr. Lin says he’s grateful to TMA for working through the courts in the best interest of physicians and patients. “I’m an independent, solo physician, and I don’t have the resources to sway a big insurance company. TMA is good at evaluating situations like this and look- ing out for physicians and their patients. Physicians will benefit from having TMA on their side,” Dr. Lin said.
United responds In response to the Connecticut lawsuit, United spokesperson Jessica Pappas wrote: “We firmly believe the changes to our network will encourage better health outcomes and the affordability of health care coverage for our Medicare members and are in keeping with our contractual commitments with physicians.” When asked why United terminated some physicians from its Medicare Ad- vantage plans, Ms. Pappas wrote: “Medi- care, like all aspects of health care, is go- ing through a transformation that will test the ability of doctors, hospitals, and insurers to find new and better ways to provide for the health care of a rapidly growing senior population. As a result, many health plans are making changes
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