ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, March 3, 1996 TAG: 9603010030
SECTION: BUSINESS PAGE: G-1 EDITION: METRO
COLUMN: Health Care
SOURCE: SANDRA BROWN KELLY
Doctors, especially those struggling to remain independent, are prone to say: ``We feel like we know best what a patient needs.''
There's little doubt, they do know best. But can they deliver the best? Or, are they becoming so bound politically and financially that their allegiance shifts from our health care to their accounting books?
Last week, I got to read correspondence related to current negotiations between a group of Virginia doctors and a health care system interested in buying their practices. Four times the 21/2-page letter mentioned that the proposal would give doctors a controlling voice in how health care is delivered.
The rest of the letter had to do with:
The financial value of the offer;
How much equity the doctors could hold if they also invested in the project;
How much pretax return could be expected (300 percent after several years);
That the value could eventually be even greater if other mergers took place;
That this deal is worth three times as much as one with a similar group of doctors in another state;
How the doctors will be too financially weak if they delay a decision too long;
That competitors have deep pockets and are willing to spend millions to win business.
This is all excellent information for doctors preparing to make a major work-life change. It also is a grim reminder that managed care is business first and health care second.
As the physician editor of Medical Ethics, a newsletter from Lahey Hitchcock Clinic, noted in this month's issue:
Even the ``most virtuous'' primary care physicians ``will feel pressure to limit care'' if they are rewarded as a result of it.
This isn't a new dilemma, though, points out Dr. David Steinberg, who edits the Burlington, Mass.-based publication. The fee-for-service health care system we've been used to also has financial incentives: The more services doctors give, the more money they and hospitals make. So, patients have been over-tested.
Under managed care, patients might be under-tested. So far, though, the health outcomes don't appear to be much different under either system, Steinberg said.
But now doctors are not being evaluated just on how good they are at treating the ill, they also must pass some sort of economic test.
Dr. Edmund D. Pellegrine, professor of medicine at Georgetown University Medical School, called this ``morally dubious.''
Having to be judged on some economic basis ``generates a conflict between the responsibilities of the physician as a primary advocate of the patient and as guardian of society's resources,'' Pellegrine told Steinberg.
Many physicians worry that health care will fall victim to a ``corporate mentality responsive to stockholders, not patients,'' Steinberg wrote. But he believes that we - patient and doctor - can stop this from happening, if we set up candid communications.
Last month, the American Medical Association asked insurance companies to get rid of ``gag'' clauses in their contracts with doctors.
Such clauses are designed to keep physicians from telling patients about treatments that aren't covered by the patient's insurance.
Patients need to be told about all treatments, Steinberg said. Likewise, managed care companies need to be very clear about what they do and don't cover, and there must be an appeals process.
Some schools of thought believe physicians should even disclose their financial relationship with the insurer, Steinberg said.
Steinberg argues that managed care should be an opportunity for doctors and companies to improve health for everyone through screenings, stop-smoking programs, vaccinations and general education.
It's foolish for managed care companies to take offense "at the notion that health care professionals have a primary allegiance to their patients." Someday, he continues, these managed care companies will be distinguished by quality, not price.
``Managed care companies that establish good patient care as their priority may spend more in the short run but should be winners in the long run,'' Steinberg wrote.
The Virginia doctors now in negotiation had that as a goal when they set off on a new path, so they likely won't forget it.
LENGTH: Medium: 92 linesby CNB