Insurer signs Mercy accord

10/10/2001

Patients with Medical Mutual of Ohio health insurance will continue to have access to Mercy Health Partners hospitals for at least the next decade as a result of an agreement between Medical Mutual and Mercy.

Mercy Health Partners owns St. Vincent Mercy Medical Center, Riverside Mercy Hospital, St. Charles Mercy Hospital, Mercy Children's Hospital, and Mercy Hospitals of Tiffin and Willard.

Cleveland-based Medical Mutual covers 1.6 million members in Ohio and 210,000 in a 16-county area in northwest Ohio.

The agreement, which is the longest Medical Mutual has ever signed, won't change things that much for most patients because Medical Mutual allows those covered by its insurance to receive care at Mercy facilities. Medical Mutual-covered patients can receive care at St. Luke's Hospital and Medical College of Ohio Hospitals.

One change that will affect some patients is that Medical Mutual patients most likely will no longer be able to receive reimbursed care at Flower Hospital after October, 2002.

Mike Taddeo, a vice president at Medical Mutual, said the biggest benefit for patients is they have some peace of mind in knowing that all hospitals they use, except for Flower, will continue to be covered by Medical Mutual for many years.

The new agreement does contain some significant changes for physicians and Mercy and Medical Mutual, including:

Medical Mutual will get out of capitated health insurance contracts it has with Mercy and go to a fee-for-service arrangement.

In capitated contracts, physicians receive a set amount per patient monthly. Because physicians receive more money the less care that is provided, some doctors have questioned whether such contracts are ethical. In addition, the contracts sometimes are big money losers. Medical Mutual has about 13,000 members in capitation contracts here.

Medical Mutual and Family Health Plan, a health plan owned by Mercy, have dropped merger talks. For 21/2 years, Medical Mutual considered buying Family Health Plan. Family Health Plan, which covers about 43,000 people in the area, will remain a viable health plan, according to its president, Tom Beaty, Jr. However, Mr. Beaty said Family Health Plan may get out of capitation-type health contracts.

Medical Mutual will transfer about 6,000 Medicaid patients to Family Health Plan pending regulatory approval. The patients, which are the last group of Medicaid patients Medical Mutual has, join about 12,000 Medicaid patients now in Family Health Plan.

Patricia Beham, vice president of managed care for Mercy Health Partners, said she expects physicians will view the agreement favorably, as doctors are generally more comfortable with fee-for-service arrangements.