Mercy pact with doctors aims to bolster care, insurance deals

2/26/2004

Mercy Health Partners, which owns several area hospitals, has signed an agreement with a 230-member physician organization to try to improve patient care and help Mercy and the physicians obtain better deals from insurance companies.

The agreement may not have an immediate impact on patients because usually their insurance provider - not physicians or hospitals - decides where patients go for reimbursed treatment.

But Steve Mickus, president of Mercy, said by improving patient care, he hopes insurance companies will give Mercy and the Region I Physician Association better deals.

“This is preliminary, but we ve discussed ways we could work together to make it attractive to managed care companies to say, Look, if we can reduce the admissions per 1,000 by treating them well in the hospital, are you willing to talk to us about an incentive-based contract? ” he said.

Mercy owns St. Vincent Mercy Medical Center in Toledo, St. Charles Mercy Hospital in Oregon, St. Anne Mercy Hospital in West Toledo, and hospitals in Willard and Tiffin. Region I physicians are scattered throughout the metropolitan Toledo area.

Mr. Mickus said the proposal might work like this:

For many chronic diseases, such as asthma or diabetes, there are widely accepted ways to treat patients. But there is some variation in the way some physicians treat the diseases.

The theory is that if more physicians followed agreed-upon principles, sometimes referred to as “evidence-based medicine,” patients would do better. If patients do better, that usually means they need less expensive care and insurance companies save money.

If insurance companies save money, Mr. Mickus hopes they might reward Mercy and the Region I Physicians Association with better contracts.

Dr. Jeff Swartz, president of RIPA, said another of his organization s goals is to become more integrated. Doing so may give the physicians association more power in negotiating with insurance companies.

Mercy and RIPA physicians also are discussing the possibility of building specialty centers, which are often a lucrative source of income for physicians and health systems.

This is the second agreement of its kind that Mercy has signed with a physician organization. In May, Mercy signed with NorthWest Ohio Specialists. While the 140 members of NWOS are specialists, RIPA has mostly primary care physicians, such as family practice physicians, pediatricians, and internal medicine doctors.

Mr. Mickus and Dr. Swartz said their efforts would not exclude any health system or hospital. RIPA physicians would be able to work freely with anyone - a marked difference in what they say exists in much of the Toledo area.