Physicians add options with OMA

A new business in town may be just what the doctor ordered.

Ozark Medical Associates LLC, established Aug. 27, is an independent practice association for physicians, according to Dan Whitney of Spectra Health- care, a management and contracting company based in Wichita, Kan.

Already about 25 area physicians have signed up, he said. There are about 500 independent physicians in a five- to seven-county area here, he added.

"In managed care contracting, typically we find there is a need and some benefit for physicians to link together in order to offer a managed care organization some significant advantages in terms of contracting with them. That's what the hospitals do. The doctors have never been as organized as the system' is. The independent physicians association can do that," Whitney said.

Spectra is a physician service organization that helps doctors "with the business of medicine," including managed care relationships, personnel, billing and collections. "Physicians certainly aren't businessmen and many times need help" with those issues, Whitney said.

When a doctor, as a health care provider, joins Ozark Medical Asso-ciates, the organization provides the chance for the doctor to gain access to additional patients that aren't available through his current network.

With OMA, he said, participating doctors who are affiliated with Cox Health Systems Inc. or St. John's Health System Inc. will only use OMA contracts for patients who are not covered in their existing network, he said. That would bring in patients outside the network and therefore doesn't directly compete with the local hospitals' networks, Whitney added.

OMA, owned and controlled by its member physicians, plans to establish contracts with health care payers in the area, providing a safety net for doctors in case their primary network affiliation suddenly ends.

OMA is "not intended to replace any of the network arrangements that are in existence," Whitney said. It acts to "piggyback" current arrangements and serves as a "mechanism so that (health care) contracts that currently aren't coming to the network can be accessed directly to OMA and the managed care network."

Whitney said OMA doesn't require the participating doctor to terminate any existing network relationship in order to join the independent practice association.

He said that the association benefits hospitals, insurance companies, doctors and patients and is a "win-win deal."

According to Whitney, the introduction of managed care to the community beginning in the early 1990s created many challenges. Hospitals and doctors fight over ownership issues as well as the management of doctors' practices and access to patients.

Some doctors who felt their options were being limited have left the area the Greene County Medical Society counted 90 in the last three years.

Eight local physicians left employment with St. John's Physicians and Clinics Inc. and sued the corporation and St. John's Health System for what they claim are monopolistic practices, citing issues including access to patients.

They have a current contract as providers in the St. John's network, but worry that the annual contract might not be renewed, leaving them no access to patients.

Whitney said the OMA could address that issue.

"As many physicians leave their hospital-employed or hospital-affiliated status or for those who have never had a formal hospital or affiliated status, the majority of managed care relationships right now are directly with one of two of the systems in town, and you have to be formally listed as an affiliated physician in order to gain access to contracts that they sign up with."

Doctors not employed by Cox or St. John's have to go through an annual reapplication process after the hospitals have performed a needs assessment, Whitney said.

"A formerly employed physician has no guarantee (of patient access) short of the annual contract that they have to sign."

He said, "Springfield is a very unusual market." The percentage of independent physicians versus employed or affiliated is at least half what he has seen in any other market he's worked in. There are far more employed and affiliated doctors.

Whitney said Spectra, which created OMA, has three or four managed care organizations that are interested in OMA.

"They like to work with an independent practice association. We do a lot of the work that the managed care organization typically does, and by signing one agreement they can gain access to a lot of physicians instead of on a onesy, twosy basis."