October 1995 Bulletin

Coalitions move ahead in 12 states

Seeking legislation on access and choice issues

In 1993, as the Clinton administration moved forward with its plan to reform this nation's health care system, the American Academy of Orthopaedic Surgeons met with other national surgical organizations, medical organizations, and musculoskeletal specialty organizations to address concerns about patient care. The result was the national Patient Access to Specialty Care Coalition, a combination of physician groups and patient organizations.

The goal of the coalition is to assure patient access to the medical specialist of their choice, at a cost that is not prohibitive, and to prevent the use of financial incentives which could interfere with medical judgment.

Although Congress chose not to adopt full-scale health care reform at that time, the effort continues to garner a great deal of interest. As many of the efforts to reform the health care system have moved to the state level, the Academy, along with other medical specialties and patient groups, has begun to form state-level coalitions in key states. The purpose of these coalitions is to develop effective grassroots lobbying activities to secure passage of legislation which protects patient access and choice to timely and appropriate medical care.

The Illinois coalition is being used as a model for this effort. The Illinois coalition began with a meeting hosted by the Illinois Orthopaedic Society. Representatives from the American Medical Association, the Illinois State Medical Society, and state medical specialty organizations representing allergy and immunology, otolaryngology, dermatology, and cardiology, were present. Patient groups, including the Multiple Sclerosis Society, Lupus Foundation, TMJ Association, and Hemophilia Foundation, also participated in the initial meeting.

After hearing presentations about the national Patient Access to Specialty Care Coalition, an update on state legislative activity regarding health care, and comments by Academy President James Strickland, MD, discussions focused on appropriate activities in Illinois. Patient groups and physician groups agreed that a formal coalition, modeled after the national coalition was needed in Illinois.

Different approach

There were areas where the Illinois coalition decided to take a slightly different approach than the national coalition. Illinois patient groups made it clear that they not only faced problems accessing the appropriate physicians outside a managed care plan, but also within the plan. The group also stressed the need to access the appropriate physician, whether it is a primary care physician or a specialist. As a result of these concerns, the Illinois group decided to call itself the Illinois Coalition for Patient Access and Choice. The coalition decided, if possible, to work closely with the Illinois State Medical Society—a very powerful and effective lobbying group in the state.

The first effort of the coalition was to secure the passage of a resolution by the Illinois State Medical Society, calling for patient choice. As a result of this resolution the Illinois coalition will work closely with the state medical society to develop, introduce, and pass appropriate legislation.

Other states with active patient access coalitions include California, New York, Texas, and Washington. Several others are in the process of developing coalitions, including Colorado, Indiana, Iowa, Massachusetts, North Carolina, Oregon, and Pennsylvania. State orthopaedic societies will play a key role in each of these coalitions.

As the coalitions develop, each state takes on a character of its own, due to the varied nature of issues and strategies. California, for example, has been especially successful in bringing patient groups into their coalition. At this time, there are approximately 80 patient organizations involved in the California coalition. Early and extensive involvement of patient groups is essential to the success of the coalition effort. New York has been successful in developing a "Patient Bill of Rights" which did pass the assembly, but failed in the Senate. The coalition hopes to get the legislation reconsidered during a likely special legislative session this fall. In addition, the Texas legislature deleted patient access provisions in legislation which they had considered. The coalition will continue its efforts in that state.

Assures choice

Maryland is the only state that has already been successful in passing legislation which assures patient choice. Earlier this year, the legislature passed and the Governor signed into law, legislation which requires every employee be offered a "point of service" plan if the employer offers a closed panel HMO. Although the legislation is not exactly what the coalitions advocate, it is certainly a good first step. The legislation
is also the first to abolish withholds.

It is hoped that next year's state legislative sessions will bring about many more success stories for patient access and choice coalitions, the medical community, and orthopaedic surgeons.

Reported by Virginia V. Mann, director, department of state society relations


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