BY FELICE J. FREYER Journal Medical Writer ffreyer@providencejournal.

com UnitedHealthcare of New England is dropping dozens of doctors from its Medicare Advantage plans, narrowing the choices for thousands of elderly patients in Rhode Island and enraging the doctors who were eliminated. United has notified the affected doctors but so far has not told the patients, who have until Dec. 7 to reenroll with United or choose another plan. Patients whose doctors have been cut can choose another doctor, choose another Medicare plan

or pay for their doctor out of pocket. United declined to answer questions about how many doctors were being eliminated and by what criteria, except to say that the insurer aims to provide a network of physicians who we can collaborate with to help enhance health plan quality, improve health care outcomes, and curb the growth in health care costs. Some 36,000 Rhode Islanders are enrolled in Uniteds Medicare Advantage plans, an alternative to traditional Medicare in which a private health plan manages all care for a flat per-patient fee. Larry Grimaldi, spokesman for the state Department of Elderly Affairs, said he believes that somewhere around 95 doctors are being removed from the network. He said that Uniteds provider directory already reflects the changes, even though they dont take effect until Feb. 1, so beneficiaries can check now to see if their doctor is in the network. The changes apply only to Uniteds Medicare Advantage product; these doctors are still in-network for Uniteds commercial subscribers. This decision is unfair and very abrupt, without any well-communicated reasons, said Dr. Walid Saber, an interventional cardiologist in Woonsocket. Saber said that his two-physician practice had been cut from Uniteds Medicare network, affecting about 450 patients or 13 percent of the practice. This has not happened before. There has never been an incident where a health insurance company dismisses mass numbers of physicians from different specialties with no reason. Steven R. DeToy, spokesman for the Rhode Island Medical Society, said that United wont answer doctors questions about its reasons, but seems to be targeting those who work in small groups. Additionally, many are specialists, especially in cardiology, dermatology, endocrinology and ophthalmology, he said. Some are doctors who have not yet adopted electronic medical records. They look at your patient mix, said Newell E. Warde, the medical societys executive director. Theyre not just dumping doctors. Theyre dumping patients. These may be expensive patients. He said that the doctors that United chose to cut may have sicker, costlier patients, who may then switch to Blue Cross & Blue Shield of Rhode Island to stay with their doctor. Asked to comment on this accusation, United spokesman Ben Goldstein said in an email: Ultimately the network for our Medicare plans has to be more focused around the needs of our members. The changes we are making will encourage higher quality health care coverage and help keep that coverage affordable for them.

United has made similar moves in other states, including Connecticut and Florida. We understand that a change in doctor can be concerning and we are prepared to support our members to help minimize disruption in their care, said a statement emailed to The Providence Journal from United. Members may choose other providers in our network. In some plans, members may choose to continue seeing their current providers on an out-of-network basis, in accordance with their out-of-network benefits. These changes have no impact on plan benefits. Members undergoing a treatment plan may request to continue care with an out of network provider. Our patients are freaking out, said Dr. Lynn Iler, an East Greenwich dermatologist, who has been informing patients that United cut her from the network. Literally, there was a woman shaking. We have very loyal long-term patients. Iler says she treats many elderly people with recurrent skin cancers. These patients are likely to switch to Blue Cross, she said. So Blue Cross loses and United wins. Unlike some of the others eliminated, Ilers practice is not small, with eight physicians, three physician assistants, a nurse practitioner and a fellow (graduate medical trainee). And its a busy practice. We have a waiting list, Iler said. Im booking out through 2015. Dr. Charles S. Faber, a Warwick ear-nose-and-throat specialist, said his threedoctor practice was cut even though it includes the only ENT specialists who respond to emergency calls from the Kent Hospital emergency department, something that happens about twice a week during the winter. Its going to be a burden on these patients, he said. Were going to have to bill them separately. Whether United pays for that bill, Im not sure. Its just not fair to the elderly. Dr. John Conte, a rheumatologist in a five-doctor practice in Pawtucket, said that far from having issues with quality, United had awarded his practice little gold stars for being efficient, but they were still eliminated. With only about 17 rheumatologists in Rhode Island, Uniteds Medicare patients may have difficulty finding a doctor after this decision, he said. Medicare Advantage plans are regulated by the federal government; state agencies have no jurisdiction. However, doctors have complained to Attorney General Peter F. Kilmartin and the Office of the Health Insurance Commissioner, and both are talking with United. Were going to continue to look into it, said Herbert W. Olson, executive counsel to Health Insurance Commissioner Kathleen Hittner. The commissioner is very interested in it. We certainly want to know how different carriers are behaving. The Department of Elderly Affairs is holding a series of enrollment events to help Medicare beneficiaries select coverage. To find a nearby meeting, call 401462-3000, or visit www.dea.ri.gov.