July 1996 Bulletin

Managed care trend seen slowing

Put patient first and regain control, says Rep. Coburn


Tom Coburn, MD, delivers about 75 babies a year to happy parents. As U.S. Representative from Oklahoma, he'd like to deliver legislation that would make physicians happy by ending some of the restraints imposed by changes in the health care system.

He's particularly concerned with "gag" clauses that prevent physicians from telling patients about treatment options. A hearing by the Subcommittee on Health and the Environment of the House Commerce Committee in May disclosed the use of "gag" clauses and the adverse impact on patients.

"We've got to tell the real truth about managed care," Rep. Coburn told the National Orthopaedic Leadership Conference last month. More hearings are expected in the fall.

"I hope that we're at the apex of the movement of managed care into medicine and that we can soon put the patient first, not profit first. We want everyone to have access to care."

Managed care not only has traded dollars for diminished medical care, Rep. Coburn said, but also has eroded the confidence of the patient in the physician. "Confidence is one-half of the process of healing and we're losing that in managed care," he said.

Disclose truths

Rep. Coburn believes there has been some progress on disclosing the truths about managed care. "I think we're past the worst point," he said. "I feel comfortable that we have stopped the train and slowly are putting it in reverse.

"We're not going to do it quickly. I think you're going to see a reversal of the situation in the next three to five years when the public sees the downside of managed care."

In response to a question by a member of the Board of Councilors about the loss of control of patients, Rep. Coburn said part of the reason is that "we built businesses rather than doing what's best for our patients. And that's really our charge-we are the primary advocates of our patients. If we'll return to that and sell that, we're going to get control of our patients again. I truly and honestly believe that we have seen the worst in terms of the loss; it's going to slow down and go the other way because the tremendous downside in what we've seen in managed health care is just starting to percolate out.

"We also should not be afraid to say that we've learned things from managed care. To deny that takes away from our credibility of our argument that we ought be back in charge. I am a more efficient doctor today because of managed care than I was before. I'm not embarrassed to admit that, but that's a different statement than saying managed care companies truly have my patients' best interests at heart. They don't; they have their bottom line at heart.

Patients' advocate

"We have to start moving in the direction where we are not looking at our bottom line and we truly are an advocate of the patient."

In a question and answer period, Rep. Coburn said he didn't expect the current session of Congress to provide physicians any relief from federal antitrust regulations. However, he said that if Rep. Newt Gingrich (D-Ga.) remains as Speaker of the House of Representatives next year, there could be some progress in this area.

Responding to a question about the stringency of the fraud and abuse legislation in Congress, he said "as physicians, we shouldn't be afraid to have severe penalties for those who violate the ethics of our profession.

"You didn't know what the rules were and if you asked HCFA, they didn't know the rules." The objective, he said, was to inform physicians, clearly and concisely, "here's what's right, here's what's wrong, and if you violate this, there is a heavy penalty. There was no intention in that law that if somebody makes an inadvertent one-time coding error you're going to be punished."


Dale Butler, MD, left; William W. Tipton, Jr., MD; Academy executive vice president, right center; and Diane Przepiorski, executive director, California Orthopaedic Association, right, discuss health care reform with Rep. John Doolittle (R-Calif.), center.


Robert F. Lindberg, MD, left, and David R. Mauerhan, MD, right, meet with Sen. Daniel K. Inouye, (D.-Hawaii).


Fortney "Pete" Stark, (D-Calif.), right, meets, clockwise, with Peter J. Mandell, MD; Diane Przepiorski, executive director, California Orthopaedic Association; Sanford H. Anzel, MD; Dodie Filler and Blair Filler, MD. William Vaughan, Rep. Stark's administrative aide, is at the upper left.


Discussing health care issues are, from left, Rep. Richard J. Durbin (D-Ill.); William W. Tipton, Jr., MD, Academy executive vice president; Amy Winn, Academy legislative analyst; Eugene C. Wittenstrom, MD; and Joseph M. Schrodt, MD.


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