Comparison of Dem. & GOP "Patients' Rights" Bills
(Page 1. More on page 2: Exec Salaries
Page 3: Current HMO News from Medscape
DISSATISFIED WITH MANAGED CARE?
Harming your practice? Hurting your patients?
Call this toll-free number: 888-SAY-NO-MC (729-6662)
National Coalition of Mental Health Professionals & Consumers, Inc.
P.O. Box 438
Commack, N.Y. 11725-0438
http://www.execpc.com/~mastery/coalitionMain.html
Anti-Managed care activist Karen Shore and members of the National Coalition of Mental Health Professionals and Consumers, Inc. are gathering signatures on petitions they hope will attract the attention of President Clinton and Congress. The idea is to convince political powers to withdraw their support from managed care initiatives and to consider alternatives.
Sign Petition for PATIENTS BILL OF RIGHTS
A new Texas law signed by Gov. George Bush (Jr.) allows patients to sue
managed care firms for malpractice if denial or delay of treatment causes
injury. The law takes effect Sept. 1, 1997, and was strongly supported
by the state medical association and consumer groups.
Sources: Practice Strategies; Substance Abuse Report
GOT A COMPLAINT? The American Psychiatric Association's Office of Special Counsel wants to hear complaints about managed care. The office is actively seeking complaints from members and patients and will fast track them for litigation.
Contact the Office of Special Counsel, American Psychiatric Association, 1400 K St. NW, Washington, DC 20005. Phone: 800-343-4671.
o Managed Care________________________________________________
Medscape Viewpoint
- Viewpoint: Physicians Need to Fight the Business Model of
Medicine
----------------------------------------------------------
What can be done about the corporate tidal wave that
threatens to destroy medicine as a healing profession?
Hippocrates 12(5):25-28, 1998]
Geo. Washington U.'s Viewpoints
Current HMO News from Medscape
WASHINGTON--Feb. 21: (1998) President Clinton on Friday ordered all federal health plans, including Medicaid, to provide their nearly 90 million patients with a "bill of rights" protecting them from extreme cost-cutting moves.
Some Republicans also support efforts to curtail the tactics of HMO's, but Republican leaders have announced intentions to block any such measure.
The president's executive order would extend protection to all federal employees, Medicaid recipients, American Indians and all military personnel, military veterans and their families. The protection was extended to Medicare last year.
The bill of rights says this:
You have the right to know all your medical options, not just the cheapest.
You have a right to choose a specialist for the care you need.
You have the right to emergency room care wherever and whenever you need it.
You have the right to keep your medical records confidential.
You have the right to bring a formal grievance or appeal of a health care decision with which you disagree.
Rep Charlie Norwood, R-Ga, a dentist, has sponsored a bill which would allow patients to sue HMO's for medical decisions made based on business concerns.
The Coalition for Patient Choice, a group allied with the insurance industry, began running radio advertisements this week attacking some of Norwood's 200 co-sponsors.
Opponents such as the coalition and Blue Cross Blue Shield maintain the patient's rights proposals will result in higher premium costs to patients.
Norwood's measure also has been condemned by House Majority Leader Dick Armey, R-Texas, and Senate Majority Whip Don Nickles, R-Oklahoma.
The web site Contact Your Congressperson has useful information on contacting your member of Congress or call the Congressional Switchboard toll-free at 800.972.3524.
Key members to contact include: Sen. Shelby (R-Ala.), Sen. Stevens (R-Ark.), Sen. Campbell (R-Colo.), Sen. Lieberman (D-Conn.), Sen. Graham (D-Fla.), Sen. Grassley (R-Iowa), Sen. Brownback (R-Kan.), Sens. Breaux and Landrieu (D-La.), Sen. Snowe (R-Maine), Sen. Cochran (R-Miss.), Sen. Bond (R-Mo.), Sen. Burns (R-Mont.), Sen. D'Amato (Well... once upon a time... ) (R-N.Y.), Sen. DeWine (R-Ohio), Sen. Specter (R-Pa.), Sen. Chafee (R-R.I.), Sen. Bennett (R-Utah), and Sen. Enzi (R-Wyo.).
Pedram vs Herdrich: Containing HMO Costs at Patient Expense
A number of clinicians say they're receiving notices from MCC Behavioral Health that the company will begin to require telephone authorization after an initial four sessions. Reasons given were rising treatment costs, increased efforts to partner with therapists, and to be more clinically responsive to patients and providers.
Latest word from one Colorado group is that when a managed care firm there lost a contract, the company dropped case rates from $200 to $110.
The National Association for Social Workers (NASW) wants the government to deny new mergers of managed care companies. Magellan Health Services, Inc., has corralled 53.4 million lives, or 31.5% of the 168.5 million Americans who arae covered by managed behavioral health plans. Companies under the Magellan umbrella include Merit Behavioral Care, CMG Hesalth, Human Affairs International, Vista Behavioral Healthcare and Green Spring Health.
With the largest companies sharing about 40% of the national pool of contracted providers, and all looking for new ways to cut costs, it's reasonable that clinicians are curious about their futures. Magellan absorbed Charter Medical Corp. as it bought 51% of Green Spring in 1995. The remaining major players are United Behavioral Health with 11.3 million lives; First Mental Health with 6 million; MCC with 5.7 million; and Options Health Care with 3.9 million lives.
HMO - Employer Love Affair May Be Ending
Losing HMO's Tightening Belts
Profit pressure on HMO's will force employers to step up efforts to manage benefits this year. That means prices will go up and services will be limited, since provider fees have already hit rock-bottom in most areas.
Sources: Practice Stragegies, PRNewswire.
National MH Parity Act of 1996:
* benefits for MH must equal medical benefits, if the employer offers MH coverage.
* Limits must be equal, but the do not have to be separate.
* Employers are not required to offer MH benefits.
* Businesses may not opt out of the parity requirement if after 6 monts they can demonstrate a 1% or higher increase in costs.
* Companies with 50 or fewer employees are exempt.
* Substance abuse treatment is not covered.
* Employers have until April to meet requirements.
EAP providers for Merit Behavioral Care have received notices that they will no longer be paid when treatment begins for clients under case rate agreements. Instead, they will receive payments after filing reports at the end of treatment. The letters tell those providers who object that their choice is to "...respond in writing within 30 days, stating that you are not interested in serving EAP clients for MBC..."
The National Association of Social Workers has joined a class action lawsuit
charging nine large managed behavioral health care firms with violations of
federal anti-trust laws. In Stephens, et al v. CMG Health, et al, filed in
U.S. District Court for the Southern District of New York last fall, NASW says
joining the suit creates an opportunity to address key provider issues,
including low fees and limits on provider panel membership. Written
statements should be addressed to: Office of General Counsel, NASW,
750 First St., NJE, Ste. 700, Washington, DC 2002-4241. Phone: 1800-
638-8799, ext. 290 or 217.
Source: NASW News, Practice Strategies
IF THEY CAN GET ORGANIZED, THEN WHY CAN'T THE REST OF US?
Employer Group Withdrawing From Big HMO's
TERMINATED PHYSICIAN ENTITLED TO FAIR REVIEW
In a case which may apply to marriage & family therapists, a California Appellate Court decided that healthcare provider networks are required to provide a fair procedure when terminating a physician from a health care provider panel.
In Patton v. Metropolitan Life Insurance, the court ruled for a physician who entered into an agreement with a health care provider. The physician was terminated for no cause, which was expressly allowed in the agreement. Nevertheless, the physician argued that he was entitled to respond to their reasons for terminating him -- namely his malpractice history.
Finding that a private association is obligated to provide a fair procedure before excluding a member when membership in that organization can effect an important economic interest, the court held that the physician is entitled to a formal process to determine if the termination was arbitrary or not.
Families USA Managed Care Site
The Federation of Societies for Clinical Social Work has answered managed care questions from more than 60 member organizations since starting its Federation Hotline. The most frequent concernes have been about: closed panels, terminations without cause, excessive delays in payment and the managed care firms' efforts to direct the treatment course. The Hotline is a service for members only.
IF THEY CAN GET ORGANIZED, THEN WHY CAN'T THE REST OF US?
Gags are gone at Humana, Inc. The Kentucky-based HMO has announced that it will not enforce gag, or non-disparagement, clauses in existing
provider contracts. And the agreements to discourage providers from making
negative comments about managed care firms will be dropped from future
contracts.
Source: Humana, Inc. Louisville, KY. Ph.: 502-580-3683
Five States passed parity laws in 1996, requiring health plans to offer mental
illness treatment equal to that for physical illnesses. The states are:
Maine, Maryland, Minnesota, New Hampshire, and Rhode Island. North
Carolina and Texas passed parity laws for state and local government
health plans. Four other states, La., N.D., OK, and Va. -- agreed to
study parity and make recommendations.
Source: American Managed Behavioral Healthcare Association, 700 13th St.,
Washington, D.C. 20005. Phone: 202-434-4565. Also from Practice
Strategies.
Managed Care Meets the Symphony
- Update: Professional counselors and managed care
ACA Archive
Practice Strategies is published by the AAMFT. Subscription $79/year. To subscribe, call 202-452-0109.
The idea of unionizing appeals to independent practitioners who want to fight managed health care. There are at least four physician unions operating, some affiliated with the AFL-CIO. Meanwhile, a group of N.Y. psychologists who work in managed care have started a discussion group to air their dual dilemma of workling as private practicioners and as company case managers. To join the discussion group, e-mail your comments to Efeld12345@aol.com.
A Justice Department managed care & fraud working group includes FBI agents, Health & Human Services representatives & state attorneys general, and is looking at fraudulent marketing, financial solvency and false statements in managed care settings. Capitated, or pre-paid plans, have raised the red flag.
The group is creating tools based on the idea, "...under-utilization is a
fraud if you're not meeting what you promised."
Source: BNA's Health Law Reporter, & Practice Strategies.
FHC/Options, Inc. dropped gag clauses several months ago at the urging of the APA. Foundation Health PsychCare Services, Inc. has agreed to remove contract language that would require the provider or company to potray each other positively to plan members or the public.
US HealthCare has announced that it will replace its gag clauses with ones that protect the provider's freedom of speech.
According to the Managed Care information Center, the average 1995 salary
for managed care professionals was $79,886.
Source: The Managed Care Executive's Salary & Benefits Survey, & Practice
Strategies.
Lawmakers have considered more than 1,000 bills on managed care and passed 56 into laws in 35 states in 1996. Laws limiting gag clauses were passed by 14 states.
The American Psychiatric Association has recommended that members be on the lookout for HMO contract provisions that protect the managed care firm in case of a malpractice suit. Says Steven Hoge, M.D., "Mental health professionals should be advised not to agree to indemnify managed care entities." Source: Psychiatric News, and Practice Strategies.
Large behavioral health groups are beginning to speak out against rising overhead and lower fees from managed care operations. Serious discussions are beginning of alternatives to carve-out firms -- including regional and national alliances to market directly with employers.
Steps being considered include: * Taking their plight to the managed care firms through the industry trade association, the American Managed Behavioral Healthcare Association, * entertaining proposals from outside groups that could lobby and market on their behalf, * producing benchmarking studies compaaring the costs from group practices to deliver services with the quality of care. Source: Practice Strategies.
Practice Strategies is published by the AAMFT. Subscriptions are $79 per year. Send Name, Address, City/State/Zip with your check to: Practice Strategies, P.O. Box 79445, Baltimore, Md. 21279-0445. For credit card orders, include your card#, type card, and expiration date.
Credit card orders may be faxed to: 202-223-2329.
A survey of managed care consumers shows that 35% consider mental health benefits inadequate and only 15% rated care as excellent. That's the lowest satisfaction reported for any type of treatment. CareData Reports, Inc.
Thumbs down to any willing provider laws, says the National Governor's Association. Adopting a policy in support of managed care, the states' chief executives said laws requiring managed care firms to contract with willing providers can hamper efforts to cut costs. CCH Monitor
WHO SAYS YOU HAVE RIGHTS?
According to a subcommittee of the Presidents Advisory Commission on
Consumer Protection and Quality in the Health Care Industry, allowing
consumers to choose their health coverage and practitioner is preferable,
but should not be an enforcable policy. The panel is charged with
developing a consumer bill of rights by October.
Source: Health News Daily, and Practice Strategies.
Recently purchased by Columbia/HCA, the managed mental health unit of Value Health has been returned to the market. Potential buyers include Merit Behavioral Care Corp. and Magellan Health Services.
2/3 of employers responding to a national survey say they require performance guarantees from behavioral health providers. And, they say they're twice as likely to cap behavioral health benefits than general medical claims. The guarantees they most often require are: timely processing and accuracy of claims; provider credentialing and monitoring; employee access to care; employee satisfaction; and grievance resolution measures.
EAP's have gone managed care, a new survey shows. Nearly 3/4 of employee assistance professionals manage the care they provide -- up from 70% two years ago. EAP's are using a variety of methods to manage care, the most prevalent being: use of EAP as a gatekeeper, 8l0%, utilization review 60%, and provider networks 55%.
A U.S. District Court has cleared the way for a lawsuit filed against MCC Behavioral Care by the APA and the New Jersey Psychological Association. The Lawsuit challenges MCC's "no-cause" termination of psychologists from its provider networks. A federal judge drew a parallel with an employer who wrongfully fires an employee for conduct that is protected by public policy.
Motorola has designed its own benefits plan, with the company's internal Employee Assistance Program (EAP) dirving care decisions through unlimited access and referral services. They avoid the trap of micro-managing and telling providers how to do their job, cutting a session here or there in order to save in the short run. "We don't erect barriers to prevent access to care, which is a ploy of managed care," said a spokesman.
MANAGED CARE EXECS MAKING MILLIONS
Sample Letter to Your Legislator
Current HMO News from Medscape
o Managed Care________________________________________________ Full Text
- How to Kill Managed Care (Excerpt at: Part I
----------------------------------------------------------
Managed care is not a by-product of the free market, but
emerged in response to severe regulation of the health market.
Through legislation and the concerted efforts of both
physicians and patients, a protest against managed care can
take place.
[Ear, Nose & Throat Journal 77(8):592, 594, 596, 598-600,
602, 604-605, 608, 1998]
Current HMO News from Medscape
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