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provide cost-effective, efficient care. He included physician assessment reports from United that rate him as a cost-ef- ficient provider and information from Medicare that shows he participates in the Physician Quality Reporting System (PQRS) and the electronic prescribing incentive programs and meets quality measures.
“I think I was able to show that I take good care of patients. I showed on sev- eral United Medicare Advantage patients that I prescribe generic medications when appropriate, take a team approach to coordinated care, and don’t repeat re- cently performed labs or tests,” he said. “I genuinely care about my patients, and most of them wanted to stay with me after hearing about the termination. I don’t want their care to be disrupted.” Dr. Lin’s appeal hearing panel includ- ed two physicians (an obstetrician-gyne- cologist and an internist), a moderator, and a United administrator. “My feeling is that the appeal process was perfunctory. In September, prior to my hearing, I checked the Medicare Ad- vantage network directory, and I had al- ready been removed. During the appeal hearing, I explained that unlike a lot of ophthalmologists who provide general care and cataract surgery, I specialize in glaucoma treatment and surgery,” Dr. Lin said.
In the end, Dr. Lin says it didn’t mat-
ter. Effective Jan. 1, he was no longer in United’s Medicare Advantage network, and his 60 affected patients had to sign up for another plan to continue seeing him or find another doctor. “I understand that Medicare allows
United to manage its network to ensure good geographic coverage, but I got the impression the company just decided to narrow the network and provide an obligatory appeal process. It was pain- fully obvious to me United made this decision without doing appropriate re- search first. I think this will hurt patients and the company in the long run,” Dr. Lin said.
Patients reassigned new physicians
42 TEXAS MEDICINE March 2014 1/3 v 2.25 x 9.75
Connect with Community
You and your community benefit when you support TMA’s Healthy Now and Healthy Future initiatives.
These award-winning programs connect medicine’s trusted leadership to thousands of Texans. A tax- deductible donation to TMA Foundation to honor or remember a family member, friend or colleague is a thoughtful way to make your gift!
It’s easy and safe to donate online. Start giving — and connecting — today at
www.tmaf.org or call (800) 880-1300, ext. 1664.
1/4 V (3 7/16 x 4 7/8)
they were being kicked out of its Phy- sicians Health Choice Medicare Advan- tage plan in September, after the insurer stopped offering that particular plan to patients. By the time the letter arrived, Parkway’s three physicians — Travis Bias, DO; Tina Philip, DO; and Shane Keller, MD — suspected something was amiss. “We learned directly from our Physi- cians Health Choice patients that United had assigned them to a new primary care physician effective Oct. 1,” Dr. Bias said. “These patients hadn’t selected the new physician, and we received zero notice. Our Medicare patients, the most vulnerable and complex of all, were ex- tremely confused and called us.” United spokesperson Ms. Pappas stat- ed in writing that United is “approaching member notices in a deliberate manner to make sure the information our mem- bers receive is accurate and provides clear direction. This includes suggesting in-network physicians when a primary care physician assignment is required for their benefit plan. Our members have the ability to either move forward with this suggestion or select a participating physician of their choice.” Ms. Pappas adds that “members with specific concerns may contact us and request to continue care with an out-of- network physician, and UnitedHealth- care will review such requests consistent with continuity-of-care requirements.” Parkway contacted United and per-
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United formally notified physicians at Parkway Primary Care in Pflugerville
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www.tmaf.org or call (800) 880-1300, ext. 1664.
You and your community benefit when you support TMA’s Healthy Now and Healthy Future initiatives.
These award-winning programs connect medicine’s trusted leadership to thousands of Texans. A tax-deductible donation to TMA Foundation to honor or remember a family member, friend or colleague is a thoughtful way to make your gift!
suaded the insurer to allow the physi- cians to continue seeing their 250 Physi- cians Health Choice patients through the end of 2013. Dr. Bias says United’s actions speak volumes about the state of health care in the United States. “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,” he said. Like Dr. Lin, Parkway’s physicians
were out of network by Jan. 1. Dr. Bias says some affected patients signed up for a different Medicare Advantage plan to continue seeing him and his partners. He says United’s termination of him and thousands of other Texas doctors is dis- heartening.
Connect with Community
You and your community benefit when you support TMA’s Healthy Now and Healthy Future initiatives.
These award-winning programs connect medicine’s trusted leadership to thousands of Texans. A tax-deductible donation to TMA Foundation to honor or remember a family member, friend or colleague is a thoughtful way to make your gift!
It’s easy and safe to donate online. Start giving — and connecting — today at
www.tmaf.org or call (800) 880-1300, ext. 1664.
1/6 V: 2 1/4 x 4 13/16
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