exit in Providence.
Medical Society questions motives; criticism rejected as ridiculous
When the exhaustive “SHAPE” health-care study was released last November, Blue Cross & Blue Shield of Rhode Island officials vowed that it would not sit idle on the shelf.
Two months later, the report is doing anything but collecting dust.
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As of last week, a billboard on Interstate 95 at Thurbers Avenue has been informing Rhode Island drivers that they “visit doctors 43 percent more than average” – one key finding from the study. Spots on local radio and TV stations that ran over a three-week stretch in December trumpeted the state’s “ample supply” of doctors, which exceeds the U.S. average by 25 percent, the study says.
The ad campaign has some doctors wondering what message Blue Cross is trying to send. Others, including mental-health providers, say they’re concerned that the report will serve as a blueprint for Gov. Don Carcieri’s administration when crafting new health-care initiatives, even though they say some critical issues weren’t examined in the study.
Blue Cross spent $3 million on the “Statewide Health Assessment Planning and Evaluation” study, compiled during 2002 by two national research firms. The report is an effort to gauge the future supply and demand for health-care services in Rhode Island, and is to be used as a planning tool for providers, insurers, lawmakers and regulators.
The study did conclude that Rhode Island appears to have plenty of doctors to meet the state’s medical needs through 2006. But it also notes that gauging physician supply is slippery, because many doctors do not work full time or work in narrow specialties.
“Rhode Island does not have a good understanding of how many of its licensed physicians work in patient care and what percentage of their time is spent seeing patients,” the study reads. The report warns of “potential access issues” in some parts of the state and recommends further study of the doctor-supply issue.
Based on the unknowns – which weren’t mentioned in the ads – the Rhode Island Medical Society says the ads are “misleading,” and last month the society issued a press release calling on Blue Cross to pull them. (Blue Cross says the ads ended three days before the society issued the release).
“I think the numbers are very inflated regarding the physicians available to deliver primary care to our population,” said Dr. Fred Procopio, a pediatrician who served on the SHAPE study’s advisory committee. “For the most part it’s a good study, but I think Blue Cross’s advertising campaign is selecting parts of it to advance their agenda.”
So what is the reason for Blue Cross’s ad campaign?
Scott Fraser, spokesman for Blue Cross, said the ads simply were meant to spark interest in the study.
“It was just a three-week flight of ads to highlight bullet points of interest that came out of the SHAPE study,” Fraser said. “We wanted to draw people in to learn more about it and draw them to the SHAPE Web site. To call (the ads) misleading is simply wrong.”
Dr. David B. Ettensohn, president of the medical society, sees a different motive. He said he thinks the campaign is a pre-emptive measure by Blue Cross to deflect criticism over the insurer cutting reimbursement rates to physicians by an average 7 percent for 2003, which he says could prompt some doctors to leave the Blue Cross network.
“I think they’re looking to address the backlash that will come from patients when doctors begin dropping out of Blue Cross,” Ettensohn said. “(Blue Cross) can say ‘We don’t really care if some doctors leave in response to cutting fees, because there are too many of them anyway.’”
Fraser called that theory “absolutely ridiculous.”
“The medical society is looking for monsters under the bed, and they just don’t exist,” Fraser said. He said the rate reduction to doctors – to take effect in March – would have happened irrespective of the SHAPE study. The reason for the cut, Fraser said, is that Blue Cross has been paying reimbursement rates for certain procedures that are higher than other insurers pay.
He added that the study’s 29-member advisory committee – which included physicians and other health-care providers – OK’d the content of the ads ahead of time.
Meanwhile, leaders of the state’s mental-health field convened an “emergency meeting” last month partly over concerns that the SHAPE study does not delve deeply enough into what they say is a crisis in access to psychiatric care.
The report did touch on inpatient mental health services, warning that the state’s projected 319 psychiatric beds in 2006 likely wouldn’t be enough to meet demand. But it says nothing of the state’s perceived shortage of outpatient psychiatric services – a cresting concern among mental-health advocates.
“If you come away from the SHAPE study with the assumption that we need to create more beds but we don’t have to add capacity to the outpatient system, that would be a problem,” said Elizabeth V. Earls, president and chief executive officer of the Rhode Island Council of Community Mental Health Organizations.
Officials from Butler Hospital and the mental health organization said they are concerned that the Carcieri administration will use the SHAPE study as its primary tool for outlining new health policies.
“That’s an assumption on our part, but it seems logical, given the publicity (the report) has generated,” said Ann Powers, vice president of marketing and public affairs at Butler.
But Neighborhood Health Plan Chief Executive Officer Christopher Koller, chairman of Gov. Carcieri’s 15-member health-care task force, said the Blue Cross report is just one tool that the committee has used.
“The timing of the SHAPE study certainly was useful for us, and we’re taking the information very seriously,” Koller said. “But it’s not the only information we’ve looked at.”
Koller said the committee, which is made up of doctors, hospital executives, health policy makers, insurers and local government officials, also has relied on the Governor’s Advisory Council on Health report, state Medicaid data and other sources. He said the cross-section of committee members allowed it to view the SHAPE report with a wary eye.
“In effect, we have the (SHAPE) report and the people who were being talked about in that report at these meetings,” Koller said. “So we haven’t swallowed (the content of the SHAPE study) hook, line and sinker.”
The committee has met three times since November and has issued a draft report to the Carcieri administration outlining 10 broad recommendations on health policy. Among them: suggestions for boosting access to primary care; easing the labor shortage; standardizing health-care information systems and maintaining the state’s low rate of uninsured.
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