If Scott Rifkin's revolt against HMOs works, he and other 'old-time doctors'will be ... Operating Independently

July 25, 1995|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

It's 7:30 a.m., and on the 10th floor of the Alexander & Alexander building in Owings Mills, a vigilante group of doctors is plotting to take back control of its patients' health care.

Scott Rifkin, 35, an internist in a rumpled suit and the leader of this revolution, rushes in with the agenda. As the hunt for coffee begins, he tells them that Sandy Granger, a new hire, will hit the streets Monday to help recruit doctors in Baltimore, Towson, Annapolis and on the Eastern Shore and wants every name on their lists. Heads perk up.

In the past year, Dr. Rifkin and others have persuaded 35 Baltimore-area doctors to sell their practices in exchange for a share in a new, doctor-run company. The lure: a chance to regain the power to treat patients the way they want.

"This is the last attempt by private physicians to preserve relationships with their patients, to be old-time doctors," Dr. Rifkin says.

With a boyish face, tousled hair and steel-rimmed glasses he regularly pushes up his nose, Scott Rifkin has the air of an eager schoolboy. But his political connections -- his brother, Alan, is the top lobbyist in Annapolis -- and business smarts make him a force to be reckoned with as he seeks to put doctors back in charge of their patients.

His idea is the Doctors Health System, a health care network in which doctors decide the rules for care -- where and which patients get X-rays, operations, second opinions -- with the same lump sum of money that now goes to health maintenance organizations and other managed-care companies. He is telling insurance companies, "Give us your patients and a lump sum of money, and we'll take care of them."

What difference does it make who is in charge -- doctors, an insurance company, or hospital executives -- if everyone is trying to cut costs with preventive care, shorter hospital stays and less use of specialists?

If doctors set the rules, they will both make more money and provide better care, Dr. Rifkin says. Patients won't have to switch doctors when they or their employers switch health plans, which will make it easier for them to establish long-term relationships with physicians and get better preventive care.

Dr. Rifkin's group is competing directly with powerful new alliances of hospitals, which also want to manage health care.

Groups such as the Helix Health System, which owns Union Memorial, Franklin Square and Good Samaritan hospitals, and Johns Hopkins are deluging primary care doctors -- internists, pediatricians and family doctors -- with letters asking them to join health care systems. The hospitals hope they will get first crack at any patients that need to be hospitalized, and send other patients into hospital-run health systems that would provide a variety of care options -- nursing homes, hospices, home care, etc.

Dr. Rifkin says doctors can do all this better and cheaper because they don't have the overhead of a hospital or the pressure to fill empty beds. Nor are they beholden to certain hospitals that may be more expensive or to the hospital's specialists. And they would probably make more money.

One way the doctors would cut costs is by reducing hospital days and providing alternative and preventive treatments. The Doctors Health System could send a patient on IV fluids home from the hospital with a full-time nurse. Or it might send a carpenter to fix stair railings in the homes of patients over 70 who are at risk for falling and breaking a hip -- an injury that can lead to long hospitalizations and end in death from pneumonia.

"Hospital groups can't do this. They have to fill beds," Dr. Rifkin says.

To convince others, he carries around a golden-covered book authored by hospital consultants that rates doctor-run groups "A+" and hospital groups "C" for their long-term ability to run health care systems.

Driving his brother-in-law's old Toyota Camry, Dr. Rifkin criss-crosses Baltimore to sell everyone from Blue Cross and Blue Shield of Maryland to Gov. Parris Glendening on the Doctors Health System. An empty Kit-Kat wrapper lies on the car floor, partially hidden by the wrapper from a Baskin-Robbins ice cream cone. "Watch out for dog hairs," he tells a passenger.

Another doctor is taking his patients today, but on his car phone, Dr. Rifkin tells a businessman complaining of a sore throat to come by the Doctors Health System corporate office at 6 p.m.

"There's gotta be a flashlight there somewhere," he says. "You gotta treat your patients like they are family and, what happens ++ is, you get a lot of referrals," he says.

In seven years, he has built a practice of 3,000 patients. A quarter of them are people he grew up with or friends of his family. He gets 40 to 50 calls a day, including sometimes a dozen during the evening. He has always given out his home phone; it's easier than going through a service.

"One day I am going to paint a picture of him and he'll be on the phone," says his wife, Fran Rifkin.

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