|
President's MessageFlorida Legislative Efforts To
|
| Almost five million Floridians (approximately one third of the state's population) are enrolled in managed care plans. The health care of a very large portion of the citizens of the state is therefore dependent on good medical decisions being made within managed care plans. Physicians have long endured the unwarranted actions of some managed care organizations that have attempted to restrict the practice of good quality medicine. Patients in Florida are now feeling the effects of these ill-fated managed care company decisions, and are now screaming for reforms. Acting as patient advocates, the Duval County Medical Society and the Florida Medical Association are working hard this spring in the Florida Legislature to bring about some real reforms to our current managed care system. Our principal efforts in managed care reform legislation have been summarized by the FMA as follows: Hospitalist (HB 149, SB 866). The DCMS and the FMA firmly support legislation that would eliminate managed care's use of "mandatory hospitalists". The physician patient relationship, the longstanding cornerstone of high quality medical care, continues to come under attack by managed care organizations. Throughout the state, managed care organizations are implementing mandatory hospitalist programs forcing physicians to turn over their patients to a hospitalist upon admission to the hospital. The mandatory hospitalist is being used by the managed care company to monitor these inpatients primarily to ensure that the financial resources of the company are being utilized in the most economical manner, with little interest in the quality of medical care delivered. The mandatory use of an HMO designated hospitalist is contrary to a patient's ability to choose his/her physician in both an outpatient and inpatient setting, and directly interferes with access and continuity of quality medical care. The Florida Association of Hospitalists is working with the FMA to assist with the voluntary use of their member's services by an admitted primary physician, in a manner similar to any other medical specialist. Prompt Pay / Downcoding (HB 913 / HB 1475, SB 2234 /SB 706). The DCMS and the FMA firmly supports legislation that defines a clean claim and provides physicians with a remedy in the event claims are improperly denied or downcoded by HMOs. This bill will require HMOs to pay clean claims in a timely manner. In addition, organized medicine supports legislation that will help bring an end to certain payment abuses practiced by many HMOs in the state. For example, HMOs should be required to make payments to contracted physicians and non-contracted physicians who provide emergency services and care in a hospital setting in a timely fashion, and not unduly burden physicians with administrative requirements, or routinely "downcode" all submitted claims. This bill will also create an external review mechanism within the current Provider and Subscriber Assistance Program. This mechanism will allow physicians to directly appeal any improperly denied claim to an impartial panel that will hear the case and act in an expedited manner. Adverse Determination (HB 913, SB 162). The DCMS and the FMA support legislation that would provide that making of an adverse determination for medical care to be provided by a managed care organization should be made only by a physician licensed by the State of Florida. Many HMOs have non-physicians making treatment plan decisions, and moreover, there is currently no requirement that the physician medical director of a managed care organization be involved in denial of care. There is currently no requirement that the person making those decisions has any adequate medical training and experience! While there is some Florida law that addresses the HMOs responsibility in designating a "medical director" (Sections 641.495), this proposed legislation is needed to put teeth into these statutes and ensure that a Florida licensed physician is involved in making all adverse determinations. HMO Accountability (HB 291, SB 424). The DCMS and the FMA support legislation to hold managed care organizations responsible and accountable for the failure to exercise ordinary care when making health care treatment decisions. Managed care has thus far been exempted from laws applying to conventional health insurance that allow civil suits to be filed for bad faith practices, whereas Floridians with conventional health insurance have been provided this right since 1982. According to new reports, Florida's HMOs rate poorly by failing to meet minimum quality standards. Unfortunately, grievance procedures and government regulations have proven to be inadequate to protect patients, while HMOs face no liability for making medical decisions that harm patients. This pending legislation would allow patients to file lawsuits against managed care organizations that fail to exercise ordinary care when making health care treatment decisions where such failure is the proximate cause of harm to the patient. Texas recently passed a similar law which has been upheld by the United States District Court of the Southern District of Texas, and this fact has been frequently emphasized by candidate George W. Bush in campaign debates. The importance of these managed care reforms to our patients cannot be understated. More details on these issues can be found on the DCMS website, and a listing of legislators can be found in the 2000 DCMS Directory. In addition, a weekly legislative update is available upon request from the DCMS office (legislation@dcmsonline.org). As I have stated in these pages previously, it is imperative right NOW that all area physicians communicate (letter, phone, fax, email) with our North Florida legislators about these issues. April, 2000/ Jacksonville Medicine
What's New
·
Northeast Florida Medicine Journal ·
Know Your Physician
· Legal
& Legislative
Duval County Medical Society
·
555 Bishopgate Lane
·
Jacksonville, FL 32204 |
|
