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Managed Care, Ill Feelings : Monarch HealthCare independent physicians group in South Orange County has grown fast and drawn praise from doctors and patients. But it's a sore subject with some in the medical community.

September 24, 1995|BARBARA MARSH | TIMES STAFF WRITER

The plaintiffs charge that Cohen--Monarch's chairman and formerly Mission Quality's president--and directors Gordon and Shuman and others conspired to loot Mission Quality Care by shifting its contracts with HMOs and insurers to Monarch. Plaintiffs claim that they were duped into joining Monarch with promises that their bad debts would be paid. They seek $1 million in punitive damages.

A lawyer representing Monarch and its directors said the company denies the charges. He said Monarch is completely separate from Mission Quality.

What's more, one of the plaintiffs--a group of anesthesiologists, Mission Anesthesia Medical Associates Inc.--has filed a related lawsuit in the same court, charging Monarch refused to negotiate in good faith to contract with Mission Anesthesia, a charge Monarch also denies.

Still, Monarch patients evidently see little, if anything, of the ruckus going on behind doctors' doors in South County. And early indications suggest patients seem to be fairly satisfied with the care they're getting.

Terry Hargadon, a vice-president at Saddleback hospital, said, "I get mostly good reports from patients on their experience with Monarch."

Indeed, a benefits manager for one major local employer, who asked not to be identified, said that Monarch patients complained for a few months last year about delayed referrals to specialists and other communication problems but says the problems have apparently cleared up.

Besides, she said, Monarch controls so many physicians in South County that patients have few alternatives.

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Where the Money Goes

A typical individual's $100 health insurance premium, distributed among the insured's HMO, member hospitals and Monarch HealthCare physicians, would breakdown this way:

$22

HMO Charges: Administrative; costs such as drug benefits and out-of-area care

$39

Member Hospital Charges: Fund pool that member hospitals draw for patient services

$39

Monarch HealthCare Charges:

$21.45 to specialists

$9.75 to primary care physicians

$3.90 to administrative costs

$3.90 to outside referrals

Note: $100 average used for simplification; individuals' montly premiums average about $100.

Source: Monarch HealthCare; American Medical Assn.; Researched by BARBARA MARSH / Los Angeles Times

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Joining Forces

More physicians are opting to join an independent physician association (IPA) to survive in today's competitive health-care industry. Percent in IPAs, by specialty:

*--*

Specialty 1990 '94 General/family practice 18% 26% General internal medicine 19 36 Internal medicine sub-specialties 24 39 General surgery 21 31 Surgical sub-specialties 22 39 Pediatrics 28 31 Obstetrics/gynecology 25 41 Radiology 16 37 Psychiatry 10 15 Anesthesiology 15 32 Pathology 13 28 Emergency medicine 6 12 Other specialties 12 31 All physicians 19% 32%

*--*

Physicians in IPAs, by Practice Size

*--*

Physicians in practice 1990 '94 One 21% 32% Two-Four 25 37 Five-Nine 23 41 10-24 19 32 More than 24 12 28 All physicians 19 32

*--*

Source: Monarch Health Care; American Medical Assn.; Researched by BARBARA MARSH/Los Angeles Times

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