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HMO DEAL ON MEDICARE SPARKS ANGER, CALL FOR ACTION

Reps. Jack Quinn and John LaFalce Friday demanded a meeting with the president of Independent Health to discuss a deal the HMO struck that limits the hospitals its Medicare patients can use.

A spokesman for Quinn, R-Hamburg, said that about 100 angry citizens had called the congressman's office demanding action. A spokesman for LaFalce said the Town of Tonawanda Democrat received more than two dozen calls.

Callers were responding to a story in The Buffalo News Wednesday that spelled out the deal between Independent Health and CGF Health Systems Network.

Under the deal, Independent Health's Medicare patients will have to use hospitals that are part of CGF Health Systems, which is a network including Buffalo General, Millard Fillmore, Children's and DeGraff Memorial hospitals.

Also Friday, Erie County Legislature Minority Leader Frederick J. Marshall, R-East Aurora, said that Democrats and Republicans had united to stop a similar move in the past and should do so again.

The county spends more than $14.1 million a year on employee health contracts with Independent Health.

Legislature Majority Leader Crystal D. Peoples, D-Buffalo, said, "We have to look out for the bottom line of the county hospital's fiscal health. You can't do that by letting our employees, retired or otherwise, buy into a plan that excludes our hospital," Erie County Medical Center.

In a letter to Independent Health President Frank Colantuono, Quinn wrote: "Although I understand the need to keep health costs from rising, I do not understand the reasoning behind your decision to exclude certain area hospitals that have been serving my constituents for the past 50 years."

Quinn said he wanted to discuss the impact that the changes will have on seniors in his congressional district.

Marshall said: "When you do all that business with the county and then say you are not going to do business with the county hospital, that is a little bit shocking. The Legislature has to think long and hard if we want to keep Independent Health as an insurance plan for county employees."

Independent Health designated CGF Health System as its exclusive hospital network in Erie County for members of its Medicare plan, Encompass 65.

Independent Health's Medicare subscribers will have to use CGF hospitals. But members' ability to use the medical center, Roswell Park Cancer Institute and Bry-Lin Hospital will be restricted to emergencies and a small number of specialty services. In the case of the medical center, these services consist of treatment for trauma, burns, HIV infection and chemical dependency.

The changes, which take effect Jan. 1, also mean that current and new members of Encompass 65 will not be able to use the five hospitals of the Catholic Health System, except for emergencies.

Encompass 65, with 25,000 members, is one of three Medicare HMOs in the region and is a health coverage option senior citizens can take in place of traditional Medicare. Medicare is the government health program for the elderly.

Under county union contracts, 2,533 employees currently have family coverage with Independent Health; 1,416 have single coverage.

County Budget Director Kenneth C. Kruly said a family contract costs the county about $387 a month; a single contract, about $130.

Ms. Peoples recalled that in 1996 the county persuaded the new Community Blue Advantage program to revise a proposal that snubbed ECMC. Legislators and other officials threatened to seek exclusion of all Blue coverage from county labor contracts.

The county does about $30 million a year in business with health insurance plans, and Independent Health and the Blues share two-thirds of it.

Kruly said the county and its employees, including more than 2,000 in the ECMC Health Network, might face a difficult decision.

"Limiting options is not somethings most of us would prefer," said Kruly. "If that means we have to get aggressive about all of the services we purchase, we would have to do that."

News Medical Reporter Henry Davis also contributed to this report

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