Group of traditional medical practices bucks HMO trend

A few California doctors are swearing off HMOs and IPAs and forming self-contained fee-for-service networks.

By Leigh Page, AMNews staff. Jan. 15, 2001.

Sacramento, Calif. -- Although some doctors in this highly penetrated managed care market see as many as 60 patients a day, Hillis Warren, MD, puts his daily rate at about 25.

"I work at my own pace," the solo ophthalmologist said in a recent interview, noting with pride that his office was empty at 4 p.m.

Dr. Warren is head of a local physicians' organization, the Traditional Practice Alliance, which bills itself as the polar opposite of managed care.

It is a loose network of 52 primary care physicians and specialists who gradually replace their HMO contracts with fee-for-service and self-pay patients. He says they can survive because they often get paid better and do not have the extensive support staff needed for managed care paperwork.

Other doctors increasingly rely on managed care data and "best practice" guidelines, but the alliance prides itself on having no rules: no medical necessity determinations, no requirements on numbers of patients to see per day, no physician profiles.

Members pay a $300 yearly fee, which goes toward background checks of applicants and joint advertisements for patients in newspapers and radio. Dr. Warren's own office provides administrative support. Primary care physicians often refer to specialists in the group, but they don't have to.

The association has spawned three sister groups around the state since Dr. Warren founded it six years ago. But membership was sluggish until last year, when the Sacramento group added a record 11 new doctors. [...]