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June 24, 1999, Thursday METRO EDITION

SECTION: ;NEWS; Pg. 1

LENGTH: 1054 words

HEADLINE: Union Debate Muted For Omaha Doctors

BYLINE: STEVE JORDON

SOURCE: WORLD-HERALD STAFF WRITER

BODY:
Independent family doctors in Nebraska and Iowa may be interested in forming unions if federal law is changed to let them bargain collectively with managed-care companies, a Nebraska Health System executive said Thursday.

But managed-care officials in Omaha said they have a history of good relations with doctors and hospitals, making the formation of physician unions less likely here than in some other regions.

The American Medical Association voted Wednesday to form a national union for doctors in what it called an effort to get back the autonomy that managed-care companies have taken away.

The new AMA union would apply only to salaried employees and medical residents, especially doctors who are employed directly by managed-care companies. The next step would be enabling independent doctors to unionize. The AMA, which has long decried the continuing shift of patient-care decisions to insurers, plans to lobby Congress to exempt self-employed doctors from federal antitrust rules that bar them from collective bargaining.

Dr. Dale Michels of Lincoln, president of the Nebraska Medical Association, said he sees the union vote as a response to changes in American medicine. Managed care has become a major player, and increasing numbers of physicians are becoming insurance company employees.

The goal is to give physicians a tool to help protect patients and themselves and to regain more control of health care, Michels said from the AMA's meeting in Chicago.

In Omaha, only a few primary-care doctors are employed directly by insurers, said Cory Shaw, vice president for managed care with the Nebraska Health System. An estimated 60 percent to 70 percent are employed by the hospital groups or other health-care providers, which negotiate provider contracts with managed-care organizations.

But independent physicians are likely to form unions, he said, if federal antitrust restrictions are lifted. Shaw said that like their peers around the country, doctors in Omaha are troubled by their lack of control over patient care.

"Everybody is more and more pressured to figure out a way to make ends meet and to do the things they've committed to do to take care of patients on a declining budget," he said. "There are times that we get frustrated with what we perceive to be limits or interference with things that we should do with our patients."

Shaw said doctors probably had too much control over medical treatment and costs 15 years ago. Now, the pendulum may have swung too far toward those wanting to cut expenses, and the AMA is trying to get it back into balance.

John Braasch, chief executive with United HealthCare of the Midlands, said the union debate doesn't apply much in the Omaha market. Locally, he said, health-management organizations such as United contract with hospital groups for doctors' services, rather than employing them directly.

United, a division of a Minneapolis-based managed-care company, employs only five doctors in the Omaha area, and that number has been declining.

Omaha-area hospitals employ about 70 percent of the physicians who are responsible for United members' primary medical care, so United, in turn, contracts mostly with those physician hospital associations. Most of the remaining independent physicians also contract through hospital groups, Braasch said.

There are more independent physicians in Lincoln, he said, but those doctors are affiliated with United through hospital groups.

Braasch said the paperwork that the AMA is complaining about often aren't the fault of managed-care companies. National accrediting associations and federal Medicare overseers, for example, impose much of the reporting requirements on medical care.

"We're not fighting the doctors in terms of quality," he said. "We want to work with them in providing quality service."

Surveys of customer and physician satisfaction with United are consistently higher in Nebraska than nationally, he said.

"United has worked hard to have good relationships with doctors, and I think our competitors have done that as well," Braasch said. "I think Omaha's the type of a community where the relationships are generally better between the health-care folks, the medical centers and the managed-care people."

Celann LaGreca, a spokeswoman for Blue Cross Blue Shield of Nebraska, said it's too early to tell what the AMA's actions means for the state.

Much will depend on the position taken by the Nebraska Medical Association, she said.

Mutual of Omaha spokesman Jim Nolan said concerns among doctors that would lead to unions appear to be more intense on the coasts than in the Midwest.

Nationally, friction between doctors and managed-care insurers is growing.

Insurers predicted that physician unions would mean higher costs for consumers. Forming unions could add 2 million people to the list of the uninsured and push premiums up by more than 10 percent, said Chip Kahn, president of the Health Insurance Association of America.

But doctors favoring unionization portrayed themselves as saviors in an industry they say is increasingly dominated by bureaucratic bean counters instead of scientists.

Federal Trade Commission Chairman Robert Pitofsky told the House Judiciary Committee on Tuesday that creating an antitrust exemption could lead to price-fixing and boycotts by physicians, dentists and pharmacists.

"Even though there are serious problems concerning the relationship of HMOs and other health plans to doctors and patients that deserve to be addressed, this proposal is the wrong approach," Pitofsky said.

Supporters of the vote sought to reassure wary observers that the Hippocratic oath would still rule and that doctors would never abandon sick patients.

"Doctors will not strike or endanger patient care," said Dr. Randolph Smoak Jr., chairman of the AMA board of trustees. "We will follow the principles of medical ethics every step of the way."

Nationwide, an estimated 38,000 to 45,000 doctors belong to unions, up from only about 25,000 two years ago, and experts predict the numbers will continue to grow. Those numbers are roughly 6 percent of the nation's 600,000 practicing doctors.

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