LEXIS-NEXIS® Academic Universe-Document

LEXIS-NEXIS® Academic

June 25, 1999, Friday, FINAL EDITION

SECTION: NEWS; Pg. 14A

LENGTH: 528 words

HEADLINE: Doctors' union move exposes managed care's flaws

BODY:
After a decade of ruthless managed care crank-downs that stripped
doctors of their authority and prestige, no less a bastion of
the health care establishment than the American Medical Association
has decided to help physicians unionize. Paging Dr. Sam Gompers.

There is reason for skepticism. The median physician income, $ 166,000
in 1997, is not exactly blue-collar. And although the AMA insists
it is trying to protect the integrity of the doctor-patient relationship
and assure quality of care, there's little doubt that doctors
are also concerned about their own bottom lines.
The specter of unionized doctors raises questions about what might
happen if physicians recapture too much control. In the past,
some doctors used their authority to overtreat and overcharge,
contributing to double-digit medical inflation.

The cost spiral gave birth to the managed care explosion, and
the irony today is that managed care's emphasis on cost-cutting
has been so ruthless that even $ 166,000-a-year doctors look sympathetic.

How did managed care manage that? With tactics that undercut doctors
and compromised patient care, including:

* Undue second-guessing

. Managed care plans routinely oversee and often overrule
physicians' treatment decisions and referrals. Sometimes, the
reviewer is no more qualified than a clerk. Often, the decision
dismisses legitimate medical concerns to save money. And the appeals
process is time-consuming and frustrating, inhibiting doctors
and patients from standing up for themselves.

* Disincentives to care. A variety of health plans give
bonuses to doctors who provide less treatment. Some plans also
discipline and even discharge doctors who spend too much time
or money on one patient.

* Prescription controls. Managed care plans use formularies
of preferred drugs and pressure doctors to prescribe from them,
even when other drugs are more suitable.

* Limits on advocacy. At one time, some managed care contracts
prevented doctors from discussing every treatment option with
their patients. Nowadays, such gag clauses are history, but many
doctors still say they feel pressure to forgo vigorous advocacy.

As that list of grievances shows, the interests of patients and
doctors are tightly entwined. And absent any alternative, consumers
might as well accept physicians as their advocates and the union
movement as their champion -- at least until Congress and the
states enact other patient protections.

How broadly and with what limitations, however, is open to question.
Current law allows unionization only of about one in seven of
the nation's doctors -- those who already are employees. But even
before the AMA vote, Congress had been discussing a plan to exempt
doctors from some antitrust laws. Texas enacted a physician collective
bargaining law in May. And support for doctor unions is growing
in dozens of other states.

The AMA says it won't endorse strikes. But there's nothing that
prohibits them, which ought to leave everyone feeling a little
queasy. After all, it's not like managed care has done much so
far to prevent them.

GRAPHIC: GRAPHIC, B/W, Ryan Mallory, USA TODAY, Source: KPMG Peat Marwick; Health Insurance Association of America (BAR GRAPH)

LOAD-DATE: June 25, 1999