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Did California Pacific Medical Center Push UCSF Docs Out?
by Lee White
Sunday Sep 13th, 2009 9:20 PM
Thousands of HMO subscribers who receive care in San Francisco have a choice to make: Go with Hill Physicians and keep their UCSF docs or stay with Brown & Toland and lose UCSF access. The change not only places patients on the horns of a dilemma, but it could irreparably harm the Bay Area’s public health infrastructure. And Sutter Health, a corporation that wants to build a new hospital in San Francisco, may have played a role in forcing UCSF’s physicians out of Brown & Toland.
Effective January 1, thousands of HMO patients in Northern California will lose access to doctors at the University of California-San Francisco unless those patients change physician groups. Brown & Toland Medical Group has terminated its relationship with UCSF’s physicians. The UCSF doctors will become members of Hill Physicians. In order to continue seeing UCSF physicians, Brown & Toland patients will have to switch primary care providers to Hill Physicians. State regulations allow some Brown & Toland patients to continue seeing specialists at UCSF without prior insurance authorization until January 1, 2011.

This change carries with it major and unsettling implications for public health care. UCSF is a state-funded institution whose physicians also serve the most vulnerable patients in the area at San Francisco General Hospital and the Veterans Administration Medical Center. If UCSF’s hospital and clinics lose patients and revenue, painful cuts to care and tax and user fee increases will be the natural results. I’m also concerned that a decrease in patients might negatively impact charitable contributions to UCSF.

A physician I spoke with the other day told me California Pacific Medical Center (CPMC) encouraged Brown & Toland to sever ties with the UCSF physicians. I have sent letters calling on Bay Area elected officials at the national, state, and local levels to investigate what role, if any, CPMC played in forcing patients to choose between Hill Physicians and Brown & Toland.

It is worth noting that CPMC and its parent company, Sutter Health, are seeking regulatory approval to build a brand new hospital at the corner of Geary and Van Ness in San Francisco. If, indeed, CPMC engineered this attack on San Francisco’s public health infrastructure, it should not be allowed to create for itself a wide and deep revenue stream with which to line the pockets of its already-overpaid executives. Let CPMC complete earthquake retrofits on its existing campuses.

Comments  (Hide Comments)

by Lee White
Sunday Sep 13th, 2009 10:16 PM
This story from the December 12, 2008, San Francisco Business Times pretty much confirms it. How can the San Francisco Board of Supervisors seriously entertain the idea of granting CPMC a building permit? If they do, they have consigned SF General and UCSF to the dung heap. link From July 1, 2009, this release from Brown & Toland explaining that the Physician Foundation at California Pacific Medical Center (referenced in the Business Times) has joined Brown & Toland: link
by Kevin McCormack
Monday Sep 14th, 2009 11:32 AM
As usual Lee White has his facts wrong about CPMC's actions and motives. Under this agreement with CPMC patients won’t lose their access to UCSF; if those patients need that highly specialized care and it’s not available at CPMC then they can still go to UCSF. In fact, this agreement means they’ll be able to access specialty care from CPMC, UCSF, Stanford and a number of other hospitals around the Bay Area.

The physician he says he spoke with is wrong in alleging that CPMC encouraged Brown & Toland to sever ties with UCSF physicians. We did nothing of the sort. We simply reached agreement with B&T to enable their physicians to have access to our specialists for patients who need them. No one is being forced to do anything against their will.

Since when was an agreement to increase patient choice, to make it easier for patients to get access to the specialists they want to see when they need to see them an attack on the public health infrastructure.

The one fact that Mr. White did succeed in getting right is our plan to build a new, state-of-the-art hospital at Van Ness and Geary - though he conveniently neglected to mention that we are also planning on building another state-of-the-art hospital at our St. Luke's campus in the mission to replace the old facility there. We are doing this because we are required, by state law, to either retrofit or replace all our acute care hospitals in the next few years. CPMC can no more retrofit its existing facilities than SFGH or UCSF can, so, like those hospitals we are trying to rebuild, and replacement hospitals are ultimately cheaper, better, & will last longer than retrofits.

Mr. White has a personal grudge against CPMC and uses any opportunity to attack us. As usual he bends the facts to suit his purpose. Just as the national debate about health care reform is being distorted by individuals who care more about promoting their own goals, so Mr White insists on distorting our actions to promote his own, selfish, agenda.

by Lee White
Monday Sep 14th, 2009 12:07 PM
"I see a specialist at UCSF. May I continue my care with my specialist?

"If you are currently receiving care from a UCSF specialist you may continue to see your specialist at least through December 31, 2010. Brown & Toland anticipates that as a result of a new agreement between Brown & Toland and UCSF, members who need specialty care at UCSF will be able to do so beyond 2010."

Prior authorization will be required to see a specialist at UCSF. How is this increasing -- or even maintaining -- access? It's like taking a drug off the formulary and requiring the insurance company to authorize payment before the patient receives it. The insurance company won't approve every authorization request for the drug and Brown & Toland certainly won't approve every request to see a specialist at UCSF. Heck, you'll probably have a better chance of seeing a UCSF specialist by going with Kaiser.

Although I most definitely have a grudge against the upper management of CPMC for reasons stated in the link, below, I absolutely adore my wife's Brown & Toland physicians, particularly Dr. Amy Akers and Dr. Stuart Rosenberg. We also like and respect Dr. Doug Goodin, of the UCSF Multiple Sclerosis Center. This inept move on the part of million-dollar-a-year wunderkind Gloria Austin and her toadies at B&T has indeed forced us to make a painful choice. Quite frankly, Mr. McCormack's behavior is beginning to tip the scales in favor of Hill Physicians.

by Gloria Austin
Wednesday Sep 16th, 2009 11:27 AM
I have never met Lee White nor has he requested to talk to me or any official at Brown & Toland to get the correct facts about this issue. He states, “Subscribers have to choose Hill Physicians and keep UCSF docs or stay with Brown & Toland and lose UCSF access.” This is completely false. Patients who are currently receiving treatment at UCSF will continue to do so until the end of 2010. If a patient requires treatment from a UCSF physician, Brown & Toland has a referral process and there is no intent to deny referrals unless the specialty requested is already available in the community. Brown & Toland also has several hospitals other than UCSF in its network for specialized care. In addition to CPMC, Brown & Toland has Stanford in its network and Brown & Toland also contracts with Children’s Hospital of Oakland.

Referral processes are used in all medical groups with HMO contracts. The Permanente Group (Kaiser) requires a referral for services outside of their employed physicians. Hill Physicians has a referral process for their HMO patients to be seen at UCSF. Hill's new relationship with UCSF for unrestricted access to UCSF physicians only applies to patients in their San Francisco plan. It does not apply to the 300,000 Hill HMO patients who are currently in other geographies.

Brown & Toland will ensure access to UCSF for patients who need to be seen by a UCSF physician. I encourage Mr. White to obtain accurate facts before irresponsibly reporting his own interpretation.
by Lee White
Wednesday Sep 16th, 2009 12:57 PM
OK, so what's so inaccurate about my original post? Here's how it works now using my wife, Sherri's, case as an example: Sherri's primary care physician refers her to Dr. Amy Akers, a neurologist who's part of Brown & Toland's network. Amy's very bright and has an impeccable academic background, but she does not consider herself an expert in the treatment of multiple sclerosis particularly when the disease course is rather aggressive as it has been for Sherri. Amy, therefore, refers Sherri to Dr. Doug Goodin, director of the UCSF Multiple Sclerosis Center for twice-yearly examinations. Dr. Goodin and his team are known worldwide for their research and expertise in the treatment of MS. Doug has provided and continues to provide Sherri and Dr. Akers with valuable advice. Mr. McCormack and Ms. Austin would have us believe that the current seamless referral process will continue past December 31, 2010. Sorry, but I don't buy that. It is likely that Sherri will have to choose a Hill Physicians primary care doctor and give up the excellent relationship she has with her Brown & Toland docs in order to continue seeing Dr. Goodin in 2011 and beyond. If Mr. McCormack and Ms. Austin were truly concerned about how the health care consumer views their respective organizations in light of this development, they and their management would have worked harder to keep the UCSF physicians in the fold. As it is, they are working mighty hard to "spin" this story in a favorable direction for CPMC and Brown & Toland.
by Jay Harris
Wednesday Sep 16th, 2009 4:10 PM
In an open, public letter to Brown & Toland Physicians dated February 5, 2009 and signed by four Brown and Toland Board members it was stated: "We are seeking to negotiate an appropriate vendor contract. similar to those that other IPAs have with UCSF, for needed services that are uniquely available there." Under this standard, many referrals from Brown & Toland community primary care physicians (that would have traditionally been sent to UCSF) will be re-directed to non-UCSF specialists.

There will now be two, distinct, high quality IPAs in San Francisco with restricted access between the two. UCSF will be in the Hill Physicians network. Referrals from a Hill primary care physician to UCSF specialists will be accomplished simply by e mailing the UCSF specialist. If you want unrestricted access to UCSF specialists, choose a primary care doctor in Hill Physicians.
by Gloria Austin
Thursday Sep 17th, 2009 8:06 PM
What is so inaccurate is that Mr. White assumes that his wife and other patients will not have access to UCSF. That is simply untrue. Brown & Toland is currently in negotiation with UCSF for an agreement. Regardless of whether a formal agreement is reached or not, Brown & Toland will ensure that patients have access to UCSF when it is in the patient's best interest.

This is not just my position as CEO but it is the position of the Brown & Toland Board of Directors.

by Lee White
Thursday Sep 17th, 2009 9:59 PM
I'll take you at your word, Ms. Austin, but I think the key phrase is: "...when it is in the patient's best interest." Of course, the gatekeepers at Brown & Toland, not physicians, will ultimately be the ones deciding when it is in the patient's best interest. Currently, a B&T physician can make a referral in much the same way Mr. Harris described the process at Hill Physicians. I think that's an important difference and one that patients should be aware of. If I could find someone in Vegas to take my bet, I would wager that many of the B&T patients seeing UCSF specialists will eventually have to switch to Hill Physicians to keep seeing them. Maybe I'm wrong, but I'd put $500 on it tonight.
by Lee White
Tuesday Sep 22nd, 2009 4:03 PM
KPIX-TV, CBS 5, just called and will air a story on its 6 o'clock cast tonight ( click on "Health"). Chronicle did a story (link below). I'm glad this important issue is finally getting covered.
by Lee White
Tuesday Sep 22nd, 2009 4:06 PM
KPIX-TV, CBS 5, just called and will air a story on its 6 o'clock cast tonight ( click on "Health"). Chronicle did a story (link below). I'm glad this important issue is finally getting covered.
by Lee White
Tuesday Sep 22nd, 2009 4:12 PM
KPIX-TV, CBS 5, is set to air a story about this on its 6 o'clock cast tonight ( click on "Health"). The Chronicle did a story (link below). I'm glad this important information is finally getting wider distribution.