National Journal Magazine Archive

HEALTH - Texas Beefs

	How Doctors See It 
	     Here are some of the common complaints that Texas 
physicians have about managed care contracts: 
Bait and Switch: The health plan may unilaterally change any 
provision of the contract, at any time. 
	     All Patients: The doctor must see patients from all of a 
company's managed health care plans. 
	     Held for Ransom: The HMO withholds part of a doctor's 
monthly per-patient payment, releasing it at the end of the year 
only if the doctor doesn't administer a higher-than-average 
amount of medical services. 
	     Fall Guy: The doctor alone is held legally responsible 
for the quality of care provided, but must comply with the HMO's 
limits on the amount and nature of medical services that can be 
provided to the patient. 
	     Medical Necessity: The doctor is limited to providing 
care that is ''essential'' to improving the patient's health, as 
opposed to care that is ''likely'' to improve the patient's 
health. 
How Industry Sees It 
	     Here are some of the common complaints that managed care 
officials have about physicians and their agenda: 
All About Money: Doctors' complaints are aimed more at raising 
their fees than at improving patient care. 
	     Monopoly: Giving doctors the ability to collectively 
negotiate will give them unfair power in many markets, 
essentially allowing doctors to create monopolies. That power 
would drive up health plan payments to doctors, and eventually 
raise health care premiums, to the detriment of patients. Higher 
premiums would translate into more uninsured people. 
	     New Law Unnecessary: Doctors already have the ability to 
collectively negotiate on issues of quality--just not on fees. 
	     Striking Out: Physician unions are a dangerous idea. If 
contract negotiations get nasty, doctors could decide to strike, 
endangering patients, especially in hospitals.