In the weeks since Summa Health’s abrupt changeover of its emergency room physician group on New Year’s Day and the growing dissent by hundreds of doctors calling for the resignation of hospital leadership, many patients have been emailing us, calling and posting questions and comments to social media.
So today, I am dedicating my consumer column to getting patients the answers to their questions. They’re concerned as they’ve read the news stories. They want to know how the unrest among hundreds of physicians, who have voted no-confidence in Summa CEO Thomas Malone, affects their health care.
If you need to catch up on stories about the Summa situation, you can go online at www.ohio.com/betty and find links to our extended coverage.
Here are the top health-related questions I asked Summa, based on queries from readers. Answers come from Summa spokesman Mike Bernstein. I’ve also included additional information that could be helpful.
Q: How can we trust the care we receive when all of this chaos surrounds the hospital?
Summa response: “The emergency medicine transition caused disruption for patients and employees, but it did not compromise care. When entering our emergency departments, people saw dedicated nurses and physicians caring for patients and focused on that duty.
“Summa Health has been providing care to the community since 1892 with the founding of Akron City Hospital. While health care certainly has changed dramatically during that time, the commitment to quality care the community has received from Summa during the past 125 years has not.”
Q: In light of what is happening, how can patients trust that the hospital is not trying to dictate our care and services, favoring cost savings over what’s in the best interest of my health?
Summa response: “The mission of Summa Health is and always has been about contributing to a healthier community. Our vision is about much more than just low cost. It’s rooted in quality as evidenced by our accountable care organization recently achieving a total quality score of 95 percent by making sure that patients receive important preventive care and services to improve their health.
“The community also can take comfort knowing the great lengths Summa went to in ensuring our emergency departments stayed open while our former providers walked out during their shifts on Jan. 1.”
Additional info: Dr. Jeff Wright, who leads Summa Emergency Associates (SEA), the emergency room doctors’ group whose contract was not renewed, has said Malone’s contention that SEA doctors walked out is “100 percent false” and that all patients had been seen by about 11 p.m. Dec. 31, when doctors from the new group arrived. SEA doctors stayed until after midnight, Wright has said.
Q: Do the insurance contracts of the new ER physician group, US Acute Care Solutions, align with Summa’s? If not, are steps being taken for USACS to become a network provider? And in the meantime, what steps have been taken to ensure that patients will not be charged out-of-network fees by the emergency medicine doctors for going to Summa ERs?
Summa response: “We are working closely with USACS to ensure alignment with payor agreements and our contract with USACS requires its participation in all insurance contracts Summa Health participates in.”
USACS RESPONSE (from Marty Richmond, spokesman): “USACS is working closely with the payer contracting leadership at Summa to align the emergency medicine group contracts with those of the health system. USACS has not released any claims to payers yet, and will not do so until we have the necessary data interfaces built and secured. When USACS does release claims incurred since Jan. 1 to the various payers, we will not be charging patients out-of-network fees for going to Summa ERs. The patient’s portion of any bills we issue will be typical of emergency services rendered by in-network providers.”
Q: I have heard that USACS balance-bills patients. Will Summa ER patients be balance-billed or do you have anything in the contract to protect patients from balance-billing? Does Summa or its contract physicians balance-bill in other departments?
Summa response: “It is customary for patients to receive separate bills from the hospital where the treatment is provided and from the independent clinician or independent clinical group providing the care. Balance billing occurs when the independent provider attempts to collect full charges from the patient as opposed to simply accepting what the insurance company or what the providers’ contract with the insurance company allows. We are working closely with USACS to ensure alignment with payor agreements and our contract with USACS requires its participation in all insurance contracts Summa Health participates in.”
USACS RESPONSE (from Richmond): “Summa ER patients will not be balance-billed for out-of-network fees going to an in-network hospital. Any bills that we issue to patients will be typical of services rendered on an in-network basis.”
Q: If my doctor no longer has privileges at Summa, what can I do? What if I want to see that doctor and I am admitted to the hospital’s ICU?
Summa response: “The recently expired ICU contract does not impact physician privileging. Those physicians still are able to see their patients in consultation.”
Additional info: The three-year contract for Respiratory, Critical Care, Sleep Associates (RCSA) expired on Jan. 5 and was not renewed by Summa. Eleven physicians with RCSA had been staffing the Akron City critical-care units, including medical and surgical intensive care units, together with Summa-employed physicians.
Dr. Charles Fuenning, RCSA managing director, said the nonrenewal means he and 10 other doctors with the practice can still see their patients at the hospital, but they cannot be the head physician for deciding care.
The doctors are practicing at other hospitals, including Western Reserve Hospital, University Hospital Portage Medical Center (formerly Robinson Memorial Hospital) and Mercy Medical Center in Canton.
Q: I have SummaCare — either through my employer or as my Medicare Advantage provider — and am very worried about what’s going on. What can I do? Do I have to go to a Summa facility or see a Summa physician or do I have other choices?
Summa response: “The recently expired emergency medicine contract does not involve SummaCare. Each SummaCare plan and network is different and anyone with questions about benefits should call the customer service number on their insurance card and/or refer to their plan information or provider directory.”
Additional info: Medicare enrollees typically must stick with the same Medicare Advantage plan for a year after the open enrollment period ends. However, consumers can switch into a plan with a 5-star quality rating at any time, without having to wait for open enrollment. In the Akron area, AultCare’s PrimeTime Health plans earned five stars.
To get more information or find out what physicians are included, go to www.primetimehealthplan.com or phone 330-363-7407.
Consumers also have the first 45 days of the year to leave their existing Medicare Advantage plan and revert back to original Medicare. Consumers could choose another Medicare Part D prescription plan but not a Medicare Advantage plan, which offers enhanced coverage for medical care.
For questions about an insurance plan offered through an employer, contact your company’s human resources department.
Q: If I am a patient and I come to a Summa ER, am I going to have to wait longer than before?
Summa response: “No. Wait times during the first few days of the ED [emergency department] transition were increased but have returned to normal. For example, the most recent available data from the Akron City ED on Jan. 18 shows 268 patients treated with an average door-to-doctor time of nine minutes.”
Additional info: Cleveland Clinic Akron General spokesman Joe Milicia said wait times and traffic were high in its downtown campus emergency department for a few days during the first week of January, but overall volumes were about the same as last year. However, for the first three weeks of January, Milicia said volume at all five of its emergency rooms have been higher than normal. Milicia said there could be a number of reasons for the increase, saying it is always a busy time of year.
Q: Should I worry that my doctor is going to lose hospital privileges or be fired if he or she has been outspoken about what’s going on with Summa?
Summa response: “No.”
Betty Lin-Fisher can be reached at 330-996- 3724 or blinfisher@thebeaconjournal.com. Follow @blinfisherABJ on Twitter or www.facebook.com/ BettyLinFisherABJ. Stories at ohio.com/betty.