PATIENTS’ RIGHTS: Insurer Coalition Pledges Reforms
While debate over a patients' bill of rights continues in Congress, a group of 22 health plans and two trade associations -- covering a total of 100 million Americans -- yesterday announced a set of initiatives that would "make it easier for patients to choose doctors, go to the emergency room and understand their benefits," the Los Angeles Times reports. Under the guidelines, women would be allowed to see an OB/GYN "whenever they want," and children would be permitted to have a pediatrician as their primary care physician instead of a family practitioner. Health plans also would pay for emergency room visits if a "reasonable person" -- rather than a "highly trained medical expert" -- determined such care is necessary. In addition, the group pledged to create an independent, uniform review process allowing patients to appeal denials of treatment, referrals or tests. The review panel's decisions "would be binding on the health plans" (Bernstein, 7/19). In the short run, the "biggest impact" of the initiative "will be to simplify the more cumbersome aspects of health care," the Wall Street Journal reports. For example, physicians now spend a substantial amount of time applying to be credentialed by various health plans, but the initiative would allow doctors to use a universal application form (Rundle, 7/19). In addition, the health plans said they would devise a standard grid to allow customers to compare plans during enrollment periods.
Some health care experts charged that the health plans' initiative was "designed to head off congressional passage" of a patients' bill of rights. Stuart Altman, a health policy professor at Brandeis University, said, "This was a direct result of their fear that left alone, they were going to be legislated against even worse" (Ornstein, Knight Ridder/Contra Costa Times, 7/19). While the timing of the plans' announcement "seems like a coincidence," Larry Levitt, chief health care analyst for the Kaiser Family Foundation, said it also "signals a real shift" in health plans' operations. The Los Angeles Times reports that the initiative was prompted by health plans' "growing realization ... that their marketplace will slip away from them if something is not done to quell outrage and dissatisfaction among consumers, doctors and hospitals" (7/19). Leonard Schaeffer, chair and CEO of WellPoint Health Networks, which participated in crafting the initiatives, said, "I want to stress that today's announcement is not a public relations exercise and is in no way focused on activities in Washington" (Knight Ridder/Contra Costa Times, 7/19). He added that in spite of the "competitive issues" among the health plans in the group -- including Aetna Inc., Cigna Corp. and Foundation Health Systems Inc. -- the health plans understand that they "must improve in those areas where [they] share common ground." Schaeffer added, "We are serious about this project and regaining the trust of the American public through activities that impact their lives" (Wall Street Journal, 7/19).
Show Us the Action!
Despite such assertions of goodwill, consumer advocates said that without government backing, "the pledges are unenforceable." Adrienne Hahn, senior counsel for the Consumers Union, said, "They can promise you the moon, but if they don't have any enforcement, then it's meaningless -- and that's what they just did." She noted that what is "[m]ore troubling" is that without federal legislation, patients will not have an "unassailable right" to sue their health plans (Los Angeles Times, 7/19). American Medical Association President Randolph Smoak added, "Most of the elements [health plans] say they want to improve are in the patients' bill of rights. They ought to show their actions are genuine and join us in seeing that it gets passed" (Appleby, USA Today, 7/19).