Hoag gets dropped as CalPERS provider

Alicia Robinson

The California Public Employees Retirement System plans to drop Hoag

Hospital from a list of places people can get care under one of its

health insurance plans.

CalPERS announced it will drop as many as 38 hospitals around the

state from the network open to those insured by its Blue Shield

health maintenance organization.

Hoag is the only Orange County hospital to be dropped. The

hospital network changes will be effective in 2005. In Orange County,

21,000 CalPERS members use the Blue Shield HMO, and 2,400 of those

are served by the Greater Newport Physicians group, which includes

doctors who work out of Hoag Hospital or refer patients there, Blue

Shield spokeswoman Patrice Smith said.

The decision to drop some hospitals from Blue Shield’s network was

an effort to control healthcare premiums, which increased 50% over

the last three years, CalPERS spokesman Clark McKinley said.

“We found that hospitals were the No. 1 factor in our annual

premium increases,” he said.

Hoag was notified in late May, after it was announced publicly,

but officials are awaiting more details from CalPERS, Hoag

spokeswoman Debra Legan said.

“We really don’t know how it’s going to impact us yet,” she said.

“It’d be premature to even speculate.”

McKinley said local patients who use CalPERS Blue Shield won’t

have to change doctors if their doctor is affiliated with another

hospital besides Hoag. Patients will still have access to a hospital

within 15 miles or 30 minutes of their home, which is a state

standard, he said.

“If their doctor is affiliated with only Hoag Hospital, then that

means they have to get another doctor,” McKinley said.

The hospitals being removed from the network were chosen based on

a survey conducted by Blue Shield. McKinley said some hospitals were

dropped if their costs were significantly higher than the area

average, but Smith said she can’t release cost data from the survey.

Any hospitals to be dropped from the network can ask to get back

on the list if they meet certain quality criteria and agree to adjust

their prices to the statewide average, McKinley said.

Hoag is a preferred hospital in Blue Shield health plans other

than the CalPERS HMO, so hospital officials expect to talk with

CalPERS about why Hoag isn’t a preferred hospital in its plan, Legan

said.

McKinley said the hospital network changes must be approved by the

state Department of Managed Health Care, which he expected to discuss

the issue within the month.

Assemblyman John Campbell last week called for more information

from CalPERS because of what he said are political motives in some of

the agency’s other recent decisions. Campbell is on the Assembly

Public Employees, Retirement and Social Security committee.

“I want to see what they say about various of these hospital

removals to see if it’s legitimate or if it’s union grandstanding,”

Campbell said.