L.A. physicians hit by worst flu season in years.

L.A. COUNTY - The past flu season has taken its toll on Los Angeles-area doctors, even those who never came down with the bug.

That's because most independent physicians today provide care for members of health maintenance organizations and insurance companies under a "capitation contract."

Under such contracts, physicians receive a flat fee every month, meaning they get the same amount of money regardless of how many patients they see in a month.

That arrangement may not have been to many doctors' liking during this past flu season, which extends from November to February. It was L.A.'s most severe flu season in a decade, reported Dr. Shirley Fannin, director of communicable disease at the L.A. County Health Department. And that required physicians to incur higher utilization costs for providing increased health care.

One factor providing evidence of the flu season's severity is that absenteeism at L.A.-area high schools skyrocketed to between 10 and 35 percent last winter, significantly higher than the usual 8 to 10 percent rate experienced in the typical flu seasons.

Although contracting the influenza virus is not a reportable disease, Fannin said absenteeism is a reliable indicator of a flu season's severity.

Flu bug thrives

Dr. Anne Vannier, director of microbiology at Kaiser Permanente's Regional Laboratory in North Hollywood, said the whole country has suffered from a higher incidence of the flu virus since around 1992.

Of the more than 800 vital throat cultures collected in the Southern California region by the Kaiser lab last winter, about 24 percent tested positive for influenza virus. That was more than double the 1994-95 winter season's total of 11 percent, Vannier said. She added that a large chunk of the flu cases reported for Southern California were concentrated in the L.A. area.

And in this managed care world, patients are not the only ones who suffer from a flu epidemic.

"A bad flu season is bad for doctors," explained Dr. Melvin Kirschner, a family medicine practitioner in Van Nuys. He said that, even if a patient is paying $60 per month for health care, the physician only gets about $7.50, with the remaining amount going to the health plan company.

In addition, some health plans cover the cost of influenza shots and some do not, he added. Among the plans which cover flu shots, Kirschner said, are MediCal, Medicare and Champus, a health plan covering military personnel and their dependents.

Because HMOs provide an incentive for independent physicians to limit "unnecessary care," patients actually may end up visiting the doctor more than once for the same illness. And that ends up being a further strain on physicians, who still get paid the same flat fee per month, Kirschner said.

A 35-year veteran of practicing family medicine, Kirschner asserted that the capitation contract "limits the liability for insurance companies and puts the responsibility on physicians."