Family Physicians Speak Out for Patient Protections that Truly Protect
Contact: Maureen Maxwell of the American Academy of Family Physicians, 888-794-7481 or 202-232-9033; Web site: http://www.aafp.org
WASHINGTON, July 8 /U.S. Newswire/ -- In anticipation of next week's Senate debate about patient protection legislation, the American Academy of Family Physicians today sent to all members of the Senate a list of provisions that must be included to assure protection for all patients.
Emphasizing inclusiveness, the letter called for expanding the bill to cover all health plans, not just those governed by the Employee Retirement Income Security Act (ERISA). The Academy also called for gag clause protections to cover all physician-patient communication, prevention of retaliation by health plans toward physicians who advocate on behalf of their patients within the health plan or before an external review entity, and the right of court recourse for patients seeking enforcement of external review decisions.
In addition, the Academy wishes to assure that family physicians, who see one out of four women for their health care needs, be included in provisions ensuring access to physicians specializing in obstetrics and gynecology. The same inclusion is sought for access to physicians who specialize in pediatrics, as family physicians see one out of every five children in the U.S.
Attached is the letter sent to the Senate. If you wish to speak to a family physician about patient protections, please call Maureen Maxwell, 888-794-7481 or 202-232-9033.
------ Founded in 1947, the American Academy of Family Physicians (AAFP) represents more than 88,000 family physicians, family practice residents and medical students nationwide. Family physicians are medical specialists trained to treat the medical problems of patients of all ages and both sexes.
------ LETTER TO ALL MEMBERS OF U.S. SENATE
July 8, 1999
Dear Senator,
As the Senate begins debating S. 326, The Patients Bill of Rights, managed care reform and patients' rights, the American Academy of Family Physicians, representing 88,000 members, urges your serious consideration of the following recommendations.
-- Scope of S. 326 needs to be expanded to cover all health care plans S. 326 falls well short of providing protections for all patients enrolled in managed care plans. The protections of S. 326 only apply to self-insured plans under the Employee Retirement Income Security Act (ERISA). Patient protections should protect all patients.
-- Gag clause protections need to be extended to all physicians Physician-patient communication must be protected and extended to health insurers' contracts. Unfettered medical communication is undeniably in the best interest of patients--all patients. Subpart C, Section 727, needs specific language stipulating that any provision of a contract between a health plan and a physician that restricts physician-patient communication is null and void.
-- Physician advocacy must be protected S. 326 does not include provisions to prevent retaliation by a health plan toward physicians who advocate on behalf of their patients within the health plan, or before an external review entity. Family physicians, as primary care physicians, play a pivotal role in ensuring that their patients get access to the care they need. Health plans should not have the power to threaten or retaliate against physicians they contract with to provide needed health care services.
-- External review standards must be strengthened The bill lacks a fair "de novo" standard of external review by an outside entity. It makes no sense to pay an outside reviewer to use the same standard of care used by some health plans, which may limit care to the lowest cost option that does not endanger the life of the patient. All of our patients deserve better.
-- Patients need the right to seek enforcement of external review decisions in court Subtitle C, Section 503 makes clear that the decision of the external review entity is binding on the health plan. However, if patients have no explicit recourse to the courts, these protections are meaningless. Language must to be added to Section 503 (e)(6) asserting that no one is prevented from bringing action in an appropriate court to enforce the decisions of an external appeals entity. It may be appropriate to add limitations on punitive damages if a plan has honored the decision of an external review entity.
-- Family physicians should be included as women's health care providers S. 326 includes language that ensures access to physicians specializing in obstetrics and gynecology. Family physicians see one out of four women for their health care needs and therefore should be included in any description of women's health providers. The treatment of women's reproductive health and pregnancy-related care is an integral part of the education, training and experience of family physicians. By inserting language into Subpart C, Section 723 that includes all physicians who are trained and experienced in women's reproductive health care, all qualified physicians would be listed.
-- Family physicians should be included as children's health care providers Likewise, S. 326 includes language that ensures access to physicians who specialize in pediatrics. Again, family physicians are trained and experienced to treat children and currently see one out of every five children in the U.S. By inserting language into Subpart C, Section 724 that includes all physicians who are trained and experienced in children's health care, all qualified physicians would be listed.
Thank you for this opportunity to share our views on S. 326. We look forward to working with you as this debate moves forward.
Sincerely,
Neil H. Brooks, M.D. Chair, Board of the Directors
-0- /U.S. Newswire 202-347-2770/ 07/08 17:16
Copyright 1999, U.S. Newswire
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