A Video Tape Premier Years Reg. Dr. Marwan Adjan, an internal medicine physician, is suing the Akron-based insurer for removing him after he refused to sign its plan to bring down his patients' medical costs. During testimony in Summit County Common Pleas Court, Dr. Linda Peeno, a former medical director and national health-care consultant, said SummaCare imposed restrictions on Adjan's practice without proper justification. The insurance company never tried to figure out whether there were legitimate reasons why his patients' costs were higher than expected, she said. The two sides have been at odds over a managed-care practice known as physician profiling.
Insurers create profiles to compare the medical costs of a doctor's patients to a target.
SummaCare officials have testified that profiles were just one tool to start discussions and help them work with physicians to improve their practices. Representatives from the insurance company met with Adjan in person and sent several letters asking him to go along with its plans, SummaCare President Marty Hauser testified yesterday. Each letter encouraged Adjan to call with questions. In Adjan's case, his patients' medical bills for 1997 and the first half of 1998 exceeded SummaCare's goals in several areas, including hospital care, emergency services and speciality treatment. Peeno questioned whether the profiles were even statistically significant.