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HMO rescinds policy after College protests
HCFA will not release information without physician consent
College releases principles on health care reform

HMO rescinds policy after College protests

From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

The College successfully convinced a Muskegon, Mich., area HMO to rescind a policy that prohibited patients from selecting internists as their primary care physicians.

Last fall, Care Choices HMO, a subsidiary of the Trinity Healthcare Network, enacted a policy that reclassified internists as specialists. The move forced patients who were already seeing an internist to select a new primary care physician from the HMO's panel of family physicians and general practitioners.

In December, Walter J. McDonald, FACP, the College's Executive Vice President, sent a letter to the HMO voicing ACP-ASIM's objections. "Internal medicine training is designed to develop highly skilled competent primary care physicians of adult medicine," he wrote in the letter. "Denying patients the opportunity to see internal medicine physicians in the primary care setting is inappropriate."

In early January, ACP-ASIM's Public Affairs Department followed up on the letter by launching a media campaign to inform the public of the negative consequences of the HMO's action. Within a few days, Care Choices rescinded its policy and issued a statement acknowledging that it "did not understand the impact the decision would have on the relationship between the physicians and their patients."

The College commends the decision of Care Choices, which serves more than 188,000 Michigan residents. ACP-ASIM has long opposed attempts by managed care organizations to restrict access to primary care physicians based solely upon specialty and will continue to fight such actions.

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HCFA will not release information without physician consent

From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

Contrary to newspaper reports, HCFA is not planning to give Medicare recipients information about their doctors' role in care that is being investigated unless physicians first give their consent.

In early January, The New York Times and several other newspapers reported that HCFA would soon release physician-specific information gathered by peer review organizations (PROs) investigating patient complaints. HCFA policy currently requires PROs to disclose physician-specific information to patients only when physicians involved have given consent.

The published reports said that HCFA was contemplating changing its policy and releasing physician-specific information without doctor consent because of a Florida lawsuit. In that case, the son of a Medicare beneficiary who died sued the local PRO to force it to release physician-specific information. While that case has not been resolved, several newspapers reported that HCFA was using it as the basis to change its disclosure policy.

Shortly after those reports were published, however, representatives from HCFA and PRO organizations emphatically denied that they were planning to release physician-specific information without physician consent. A HCFA spokesperson said that the agency's policy has not changed and that it planned to issue a clarification to ensure that PROs comply with existing regulations.

HCFA officials have said they are planning to examine the agency's rules regarding PRO disclosure of information to make sure that Medicare beneficiaries receive all the information they are entitled to under the existing law. Any changes in policy, however, would be made available for public comment before becoming law.

The College strongly supports HCFA's policy of requiring physician consent before the disclosure of physician-specific information. ACP-ASIM will continue to lobby Congress for patient safety legislation that encourages physician participation in activities to reduce medical errors.

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College releases principles on health care reform

From the February 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

The College has released a set of 14 core policy principles to guide health care reform.

In "Providing Access to Care for All Americans: A Statement of Core Policy Principles," the College says that any proposed health policy must include a comprehensive method to provide health care to all Americans, with a fixed timetable for implementation. The College asserts that any health reform proposal must establish a uniform minimum package of benefits for health care coverage that is independent of place of residence or employment status.

The principles also say that policy-makers should address the underfunding of health care services for the poor, excessive administrative costs and disparities in care based on gender, ethnicity and race.

The College says that funding for these initiatives should be progressive, and that individuals with higher incomes should contribute more than those with lower incomes. The principles note, however, that means testing should be discouraged.

The full text of the principles is available on ACP-ASIM Online at http://www.acponline.org/hpp/pospaper/access_principles.htm.

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