Doctors’ representative
calls HMSA’s handling of
concerns ‘really sleazy’

By Helen Altonn
Star-Bulletin

Final amendments to the Hawaii Medical Service Association contract with physicians don't satisfy concerns of the Hawaii Coalition for Health, which says some "are pretty bad."

Dr. Arleen Jouxson-Meyers, coalition president, said HMSA deleted two amendments, which is an improvement, but others that were troubling are still there. Instead of negotiating a new contract with doctors, she said, "They're proceeding to enforce an existing contract by amendments.

"In terms of contract principles and good faith, this is really, really sleazy because doctors have to put food on their table and they don't have the option not to participate, and no possibility here of negotiating better terms.".

Cliff Cisco, HMSA senior vice president, said most of the amendments are of a housekeeping nature and based on input from physicians. "They shouldn't have any impact at all on the physician-patient relationship," he said.

He said the changes were discussed with physicians at meetings throughout the state and with physician groups. "Our amendments to the original submittal is a reflection of those meetings. The changes aren't that significant."

Meyers said the only choice the doctors have regarding the contract is to ask for terms of two or five years instead of three years as HMSA proposes.

"We have some real concerns. We're wondering if they're trying to split the physician population," she said.

HMSA said it is offering two, three or five-year terms to give doctors greater flexibility and choices since some wanted shorter terms and others longer ones.

"If some people are due in two years, others are not going to be interested in what's going on with that contract, and vice versa," Meyers said. "If they always have a certain number of provider under contract, they don't care if others don't sign. It's another scheme."

When the amendments were first proposed without correcting contract problems identified by the coalition, it asked Insurance Commissioner Wayne Metcalf to order the state's largest medical insurer "to cease and desist from engaging in unfair practices," to impose fines and to suspend or revoke HMSA's license.

The amended agreement takes effect Jan. 31. HMSA sent doctors the final amendments Nov. 30, saying in a letter that it had "engaged in an extensive process of conferring and consulting with participating physicians about the proposed amendments to the individual HMSA Participating Physician Agreement."

The letter, from Jim Walsh, vice president, provider services, said HMSA had received 260 written comments and input from more than 135 physicians. All the comments were considered in fine-tuning the amendments, he said. He said changes were made to certain amendments as a result of feedback from physicians.

Among objectionable amendments is one giving HMSA total control over setting reimbursements, Meyers said.