Doctors seek aid from AG

Meanwhile, New York probes low reimbursements from insurers

The investigation ‘‘calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members,” said Nancy Nielson, president-elect of the American Medical Association.

Cuomo’s allegations parallel those leveled by the AMA in an eight-year lawsuit against UnitedHealth, the nation’s biggest medical insurer and one of two predominant insurers in Maryland.

Meanwhile, Maryland legal officials may get involved.

Last week, Martin Wasserman, executive director of the Maryland State Medical Society, or MedChi, along with the group’s senior leaders, met with Attorney General Douglas Gansler ‘‘on things that MedChi can do without being accused of violating antitrust laws,” Wasserman said.

Gansler told Wasserman’s group he was aware of Cuomo’s investigation and will be following it, said Gansler spokeswoman Raquel Gillory.

Maryland being ‘bypassed’

Physicians in Maryland, like those in New York, are reimbursed by insurers at some of the lowest rates in the nation. Doctors complain of being powerless to negotiate because 90 percent of payments, according to the state health department, are controlled by two companies, UnitedHealth and CareFirst BlueCross BlueShield.

The problem, said Dr. Scott E. Maizel, president of the Maryland State Surgical Association, is that practicing medicine in Maryland has become ‘‘a non-sustainable financial loss. Young men and women who go into medicine today are bypassing Maryland.”

In fact, none of the 77 primary care residents now at Johns Hopkins Hospital plans to practice in Maryland, Wasserman said, and hospitals are having difficulty retaining physicians.

Meanwhile, MedChi is supporting an ongoing study by Gov. Martin O’Malley’s Health Care Access and Reimbursement Task Force, which probably won’t finish until next year.

In a show of strength Monday, a parade of physicians in starched white lab coats filed into a crowded Senate hearing room for a task force meeting. Orthopedic surgeon Stephen J. Rockower, past president of the Montgomery County Medical Society, said most of the doctors at the meeting will be retired in 10 years, indicating a graying of the physician community while a rapidly expanding patient base of baby boomers will increase demand.

Only minor reform legislation is expected this year. Wasserman said such steps ‘‘are only steps of fairness, and it is extraordinarily frustrating to have to fight so hard to just get what you are unmistakably due.”

Premiums could rise

On the other side, David D. Wolf, CareFirst executive president, has said that higher reimbursements could drive up insurance premiums.

Still, ‘‘CareFirst agrees with national health care leaders that payment and delivery models, particularly for primary care, need to change and that these changes are needed to promote better access to high quality care,” Wolf wrote to John M. Colmers, Maryland’s health secretary and task force chairman.

Some insurers now offer higher performance reimbursements. CareFirst is offering up to 7 percent higher payments to physicians who meet standards for certain procedures and it plans to expand the program.  

But the state is already in a crisis over low reimbursements, said Pegeen A. Townsend, the Maryland Hospital Association’s senior vice president for legislative policy.

‘‘If we don’t get on it, it will soon be out of our reach,” Townsend said. ‘‘Some mechanical things” can be done while waiting for major legislation. Incentives are needed for physicians to have night hours, keep blocks of expanded patient appointment times, and ‘‘to go and want to be in rural areas.”

Some specialty physicians in hospital-based practices are banding together for bargaining. With few new anesthesiologists, First Colonies Anesthesia Association of Towson, with about 110 members, was formed in 2004 to streamline their business operations, according to Daniel T. Koontz, CEO of its management services company. Two years ago, 65 percent of 26 hospitals surveyed by the state society of anesthesiologists said they had to close at least one operating room per week because of a lack of anesthesia staff. And 81 percent said they were using temporary staff to keep the remaining rooms open.

Most primary care physicians in Maryland work alone or in groups of two or three and can’t easily form such associations. Maizel, of the surgical association, said the specter of antitrust action keeps many from organizing.

‘‘Most of us are trained to take care of patients. We are not negotiators,” he said.

Laura Pimentel, director of emergency services at Upper Chesapeake Health Services, said low reimbursement rates also hurt emergency room patients.

‘‘When you go into emergency departments, you see long waiting times and harried personnel,” Pimentel said. ‘‘And many people are not necessarily an emergency services-trained person. In my experience, it is getting worse.”

Even specialists backing up emergency services are feeling pressure. Rockville ear, nose and throat specialist Seth Goldberg said he was forced to close his private practice because of an ‘‘odious” drain of time and energy for emergency room duty.

In a report this month to Colmers, task force member Joseph S. Fastow compared reimbursements paid through billing firm Reimbursement Technologies Inc. for emergency room physicians.

For a simple ER visit, Maryland and New York physicians are paid only 62 percent of what those in Virginia receive, according to the report given to Colmers. And for the most complex ER procedures, Maryland physicians are paid 86 percent of what those in Virginia receive.