HOSPITALISTS: Docs Moving to Limit Mandatory Programs
Efforts by insurers to mandate the use of hospitalists are meeting resistance in some areas. A coalition of doctors' groups in Texas has proposed a bill scheduled for a hearing this week in the state House Insurance Committee that would prevent insurers from mandating the use of hospitalists, the Wall Street Journal/Texas Edition reports. While no insurer in Texas has implemented such a mandate, it is not from a lack of trying. Cigna HealthCare of Texas recently proposed a mandatory hospitalist plan for 33 hospitals in the Houston area, set to begin April 1, but was forced to withdraw the plan in the face of staunch doctor opposition. Doctors may now "forego using a hospitalist if they notify the insurer in writing by May 1." Humana Inc. proposed a similar plan slated for last September in the Austin area, but under similar pressure, the insurer ultimately allowed doctors to opt out. Kim Ross, the Texas Medical Association's vice president for public policy, said hospitalist programs work "well when it's a collaborative effort. When it's mandated is when there are problems." But Cigna spokesperson Howard Drescher said, "We have no interest in erecting any kind of barriers that would in any way limit the quality of care for each individual patient" (Elder, Jr./Terhune, 4/14).
In a similar move, the Florida Medical Association "has quietly tried to win approval of a short amendment in the state Legislature that would prohibit [an HMO] from restricting a 'physician's ability to provide and manage inpatient hospital services." The impetus for the amendment appears to be a new program set up by Prudential HealthCare plans in South Florida and Tampa, which "compels the majority of its physicians to refer their patients to a hospitalist because most of the doctors fail to meet the company's benchmarks for appropriate hospital care, such as lengths of stay." Dr. John Nelson, a hospitalist for 11 years and co-president of the National Association of Inpatient Physicians, said, "I think making it voluntary is the better way to go. By making it mandatory, you just solidify the resistance." Prudential says its program is not mandatory because it allows doctors a choice, so long as they meet the benchmarks. Kirk Cianciolo, the insurer's senior medical director for South Florida, said, "Prudential is very sensitive to the physician-patient relationship. We are in no way trying to interfere with that" (Terhune, Wall Street Journal/Florida Edition, 4/14).