Arkansas cardiologists accuse hospital of collusion

A cardiology group in Arkansas is taking on the state's largest hospital system in a federal lawsuit accusing the facility of conspiring with Arkansas' biggest health insurer to keep the doctors and their specialty hospital out of the network.

The suit by Little Rock Cardiology Clinic PA against Baptist Health is an example of similar legal battles going on across the country. The cases underscore doctors' antitrust and patient access concerns sparked when they believe large hospital systems and insurers squeeze specialty facilities to insulate themselves from competition for certain medical care.

"This is especially reprehensible when restraint of trade restricts patient choice and access to the highest quality of cardiology services," said Janet L. Pulliam, the doctors' attorney. The lawsuit was filed in federal district court in the Eastern District of Arkansas.

Mark Lowman, a vice president at Baptist Health, declined to respond to the allegations. Arkansas BlueCross BlueShield, which is not a defendant but is mentioned in the lawsuit, did not return calls for comment.

Hospitals often say doctors have a conflicting financial interest when referring patients to specialty hospitals in which they have ownership.

Tensions between physician-owned hospitals and their more dominant competitors are common, and it is patient care that suffers in the end, said American Medical Association President William G. Plested III, MD.

"In the long run, those hospital administrations alienate the physicians and they alienate the patients in the community," he said. "The reality is, whoever is providing a better service, people ought to embrace that."

Rocky Wilcox, general counsel for the Texas Medical Assn., said a dominant hospital can dictate what an insurer can do in a particular market by offering lower-cost services in exchange for an exclusive contract and a flow of patients. "[Insurers'] response is not that they don't want to contract with other facilities, but they say the rates will change, so they are looking at it as an economic cost to them and their ability to offer premiums less than the next company," he said.

The TMA and the AMA are assisting doctors in a similar case -- that of two orthopedic surgeons in Amarillo, Texas, entrenched in a year-long battle with a hospital-owned network with which they contract. The Texas doctors own a competing specialty surgical hospital. In their antitrust lawsuit, the physicians accuse the hospital of ending their privileges and excluding their specialty facility from the network to "punish" them.

Suddenly outsiders

Meanwhile, the Little Rock Cardiology Clinic doctors, who are part owners in Arkansas Heart Hospital, say they opened the surgery center in March 1997 because patients did not have much choice of places to get cardiology care. "They still refer patients to other hospitals," Pulliam said.

But Baptist controls more than 80% of the cardiology market in central Arkansas, where the two facilities compete, she said.

In 1993, Baptist and the Arkansas Blues plan created an HMO network, Health Advantage, through which patients could get fully covered services only from Baptist Health.

Little Rock Cardiology Clinic had been part of the Blues' various plans since 1975. But in July 1997, Arkansas BluesCross Blue Shield told the doctors they would be removed from the insurer's networks because they did not need any more cardiologists.

The insurer refused to admit Arkansas Heart Hospital into its plans, court records show. Some doctors were let back in the BlueCross BlueShield network after they left Little Rock Cardiology Clinic to practice elsewhere, the complaint said.

In addition to reducing referrals to the cardiologists, Baptist Health's actions "have jeopardized the health of consumers by precluding their access to superior health care while charging increased prices for inferior health care," the complaint states.

In a separate lawsuit filed in 2004, the cardiology clinic's doctor owners sued Baptist Health in state court to block the hospital from enforcing an economic credentialing policy that prohibits staff doctors from keeping their privileges if they have any interest in a competing hospital. The physicians won a temporary injunction, which allows them to continue practicing at Baptist Health while the case is pending. At press time, no trial dates were set for the two lawsuits. Baptist declined comment.