LEXIS-NEXIS® Congressional Universe-Document

LEXIS-NEXIS® Congressional

JUNE 22, 1999, TUESDAY

SECTION: IN THE NEWS

LENGTH: 1544 words

HEADLINE: PREPARED TESTIMONY OF
GARY C. DENNIS, M.D.
PRESIDENT
OF THE NATIONAL MEDICAL ASSOCIATION
BEFORE THE HOUSE COMMITTEE ON THE JUDICIARY
SUBJECT - H.R. 1304, THE "QUALITY HEALTH CARE COALITION ACT
OF 1999"

BODY:

Mr. Chairman and members of the Committee, thank you for the opportunity to present the views of the National Medical Association (NMA). 1 am Dr. Gary C. Dennis, President of the NMA and Chief of the Division of Neurosurgery at Howard University College of Medicine, in Washington, D.C. I would like to commend you for convening this important hearing. H.R. 1304 is a critical bill that has tremendous implications for the delivery of health care services across the Nation.
As the leading force for parity and justice in medicine and the elimination of disparities in health, the National Medical Association is pleased to support HR. 1304, the "Quality HealthCare Coalition Act of 1999," which was introduced by Congressman Tom Campbell (R-CA) and Congressman John Conyers (D-MI) in March. This landmark legislation allows physicians and other health care professionals, who contract independently with health insurance and managed care plans, to collectively join together when negotiating the terms of a contract with an insurer. This is critical, as the bargaining power of individual physicians is often completely overwhelmed by the take-it- or-leave-it, heavy-handed bargaining tactics of managed care plans which have a history of coercing doctors into signing (often exclusionary) contracts. These contracts are notorious for being laden with clauses that restrict what doctors can tell patients about treatment options and other constraints that determine how health care services are to be delivered to plan enrollees. HR. 1304 is an important step in shifting medical decision making power away from health plans and back to physicians and patients where it belongs.
Over the years, our Nation's health care system has grown into an industry that is increasingly driven by the profit making motives of managed care organizations and healthinsurance companies. In fact, over the last 10 years, there have been more than 162 health plan mergers. According to recent data, 92 percent of the Nation's doctors have contracted with at least one managed care plan, while 80 percent of Americans are enrolled in HMOs. And, as states seek to expand health care coverage of the uninsured, the numbers of Medicare and Medicaid beneficiaries being forced into managed care plans continues to escalate.
It was once thought that managed care would provide increased coverage, expand access to health care services and lower the cost of care. However, concern is mounting over accounts of physicians being de-selected, without just cause, from managed care plans and of patients being denied the health care services they need, from the withholding of medication to being prematurely released from the hospital. More and more, physicians are being excluded from the medical decision making process. This has left many patients in the hands of corporations primarily concerned with cutting costs and increasing profits. It has also placed doctors at the mercy of insurers who have such a large market share that they, as providers, cannot afford to walk away; or risk expulsion if they do not comply with the corporate will.
For the overwhelming numbers of African American physicians, who have historically cared for those individuals who are the sickest and poorest among us, the current system of managed care is not serving our practices nor our patients well at all. Daily, Black doctors encounter incredible barriers that have hindered our inclusion in managed care networks. Because our practices are more likely to be established in minority and underserved communities and to serve predominantly low-income, poor and severely ill patients, African American physicians have been excluded and even expelled from participation in many managed careplans. Physicians who treat poorer patients tend to be excluded from these panels because the increased services provided to sicker patients, unable to pay for their care, reduces the cost effectiveness of our practices. By redlining those doctors who treat patients who are disproportionately ill and poor, health plans save money and reduce medical risk loss. However, the exclusion and de-selection of Black doctors from health panels has critical implications for the access to and delivery of health care services to African Americans and the underserved. With African Americans comprising 12 percent of the population, yet only 2- 3 percent of the Nation's medical professionals, the health status of our community is largely contingent upon our access to quality and affordable health care services. Factors that threaten the full participation of Black doctors in our Nation's health care system reduce the number of physicians that serve minority and underserved patients and threaten the health of these communities. Leveling the playing field to permit physicians to collectively bargain with health insurers would enable us to work with health plans to address these and other issues that threaten the health of our patients.
As you know, health insurers benefit from a special exemption from the anti-trust laws. This puts them in a position to engage, without recourse, in anti-competitive practices to patient care. These contracts often permit managed care organizations to impose substandard health care services, deny care and/or unfairly compensate physicians for their services. As mergers within the health insurance industry continue to go unchecked, and the managed care industry gains leverage, physicians and consumers have an increasingly limited choice of health plans.As a result of this utter lack of true competition, physicians across the United States have even less ability to negotiate on behalf of the medical needs of patients.
When patients are denied necessary health care, physicians must go through an unreasonably bureaucratic process that is often quite exhausting and that tends to result in health plans getting what they want at the expense of our patients' needs. In addition, insurers tend to adopt health care policies without consulting practice physicians or patients. This leaves physicians few options to block policies that ultimately hurt the quality of patient care. If physicians are to serve as advocates for the best interests of our patients' health, we must be able to redress the problems associated with "monopolistic health plan behavior." Only then will we be in a position to guarantee that medically necessary treatments are provided to patients by experienced, qualified and well-trained physicians who are concerned about providing patients with optimal health care services.
Allowing physicians to engage in joint negotiations with insurers would ensure the best terms for contractual agreements with health plans and would enable market forces to determine the parameters of the relationship established between the insurer and the medical professional. The benefit of collective bargaining for patients is that doctors could insist on better care and protection for their patients. Without the authority to engage in collective negotiations with insurers, physicians have no option but to agree to the terms of the insurer regarding the delivery of care, the ability to make medically based decisions for their patients and payment for services rendered. The only other option for physicians without bargaining power is to refuse to servepatients enrolled in certain insurance plans. This reduces patients' options to choose health care providers and causes physician practices to lose money.
Mr. Chairman, the physician union is not a new idea. Such entities have been in existence since the 1960s, when New York City hospitals' staff negotiated fair wages for residents and interns who were earning only $50 to $100 per month. More recently, efforts have surfaced, in Washington State, Texas and Pennsylvania, to address the imbalance of power that exists between physicians and health plans and to enable physicians in these states to negotiate favorable contract terms with insurers. Physicians across the Nation are looking for solutions that will permit them to negotiate with insurers, on fair terms. Under the current structure, physicians and patients stand at the mercy of health insurance and managed care plans. These plans have entirely too much power over the manner in which medicine is practiced. The participation of physicians in health plans is dependent upon the will of the insurer, as are the terms of our contracts. Permitting doctors to collectively bargain with health insurers and managed care companies would put physicians on solid ground and ensure the provision of quality health care to patients in the future.
The "Quality Health Care Coalition Act of 1999" creates a fair environment for physicians to collectively negotiate the terms under which they practice their profession, without violating anti-trust laws. Physicians and patients, not corporate administrators, should be the ones making medical decisions. This legislation will help to ensure that this happens. The NMA strongly urges rapid bipartisan support and passage of this critical legislation. Its passage will be a victory for patients, a victory for doctors and a victory for quality health care for all Americans.
END

LOAD-DATE: June 24, 1999