August 2001 Bulletin

Bush backs specialty care

Meets with AAOS, other medical societies to support bill

Surrounded by representatives from leading medical specialty organizations, including Richard H. Gelberman, MD, AAOS president, far left, President Bush urges approval of the Fletcher Patient's Bill of Rights in the House of Representatives

AAOS leaders meeting with President Bush in early July said they are encouraged by the president’s support for patient access to specialty care.

Richard H. Gelberman, MD, AAOS president, and William W. Tipton Jr., MD, executive vice president, were among the leaders of medical specialty societies who met with the president July 11, 2001. Bush used the occasion to promote a patients’ bill of rights that was about to be debated in the House of Representatives. Bush said the meeting with the medical specialty leaders who represented about 300,000 physicians demonstrated that not all doctors support the Bipartisan Patient Protection bill which was approved June 29 in the Senate. The American Medical Association supports the Senate bill.

Dr. Gelberman commended Bush’s call for health care accountability. "This can be achieved through the use of binding, expedited, independent external appeals mechanisms that permit review of coverage, decision-making and grievances against a health care plan, said Dr. Gelberman. "Accountability ensures that our patients have access to needed care."

"This will strengthen the quality of patient care," said Dr. Tipton. "And so will President Bush’s belief that medical decision-making should be in the hands of doctors, not HMOs or lawyers."

Dr. Tipton noted that "for seven years, AAOS has been at the forefront of the battle for legislation that protects managed care patients." AAOS is cofounder of the Patients Access to Specialty Care Coalition, a coalition of nearly 70 organizations representing patient, physician and health associations.

Five years of heated debate in Congress over passage of a patients’ bill of rights is reaching a crescendo of politicking. As this is being written Republicans and Democrats in the House of Representatives are squaring off over two bills, while outside the halls of Congress, health plans, attorneys, and patients’ rights groups are voicing their positions.

The battle has spilled over from two weeks of debate in the Senate in June when Democrats and some Republicans approved the Bipartisan Patient Protection bill by a vote of 59 to 36. It is a bill that President Bush vowed to veto, if it ever reached his desk.

In the House, a companion bill to the Senate legislation is sponsored by Charles Norwood (R-Ga.); Greg Ganske, (R-Iowa); and John Dingell (D-Mich.). Two years ago, a Norwood-Dingell bill was approved by the House and another bill by the Senate, but legislation never made it out of a House-Senate conference committee.

Republican leaders and Bush are supporting an alternative bill sponsored by Ernest Lee Fletcher, (R-Ky.). If a bill approved by the House is substantially different from the Senate bill, both will go to a conference committee to iron out differences.

Both bills provide a wide variety of patient "protections" such as access to emergency care without prior authorization, access to OB/GYNs and timely access to specialists. But there are differences, too, and the biggest is the legal remedies following appeals to independent review panels. The Senate bill allows patients to sue in state court for medical decisions or in federal court for administrative decisions. In federal court, there would be no limit on damage awards for economic losses or pain and suffering and plaintiffs could collect up to $5 million in civil assessments. In state court, damages would be subject to the limits of state law, if any exists.

The Fletcher bill, as originally written, allows a patient to sue in state court, if an insurer fails to comply with the decision of an independent external review panel and the patient is harmed. If an insurer makes a coverage decision that harms a patient, the insurer can be sued in federal court, if the patient first completes an external medical review and the panel overturns the insurer’s decision. Economic damages are unlimited and noneconomic damages are limited to $500,000.

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