Letters to the Editor - March 9, 2009

MSSNY president: Insurer settlements highlight need for code of conduct

Attorney General Andrew Cuomo's latest settlement with a major health insurance company has again shined the spotlight on a secretive practice by the health insurance industry that has seriously impacted patients and their physicians for many years.

The agreement with health insurance giant UnitedHealthCare settled accusations that its Ingenix subsidiary manipulated data to cause much higher out-of-pocket costs for patients, and significant underpayment for their treating physicians. A report issued by the attorney general indicated that the scheme "translates to at least hundreds of millions of dollars in losses for consumers over the past 10 years."

Both patients and physicians will now have transparency into how health insurers determine payment levels. However, the abusive business policies that led to this historic settlement highlight the need for comprehensive reform of the practices of this multibillion-dollar profit-generating industry.

The attorney general's settlement comes on the heels of other major settlements with the health insurance industry that revealed the extent to which some health insurance companies have profited at the expense of patients, as well as doctors who sought to provide the best clinically appropriate treatment. But these settlements have only begun to scratch the surface of insurance problems encountered by patients and their physicians.

Many believe that these problems can be addressed voluntarily by the health insurance industry on a national basis. It is for this reason that New York sponsored a resolution at the AMA Interim Meeting in Orlando, Fla., calling for a voluntary Code of Conduct for the health insurance industry.

The purpose of the code is to articulate a series of principles that a health plan would follow when they create policies that impact upon review of medically necessary care, creation of drug formularies and payment for care. Central to this initiative would be assuring greater transparency to patients and their doctors regarding how these policies are developed.

Such a code would better assure that the business decisions these companies make are not inconsistent with their oft-stated goals of assuring that patients receive the most clinically appropriate care and medication. It is anticipated that this code will be reviewed by the AMA House of Delegates in June. Hopefully it will be a bridge to a better working relationship between physicians and the health insurance carriers.

--Michael Rosenberg, MD, president, Medical Society of the State of New York

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No-sedation colonoscopies will prompt many to say no to the procedure

Regarding "Study supports use of no-sedation colonoscopy" (Article, Jan. 12): I usually try to read AMNews in one sitting to limit the time of depression activated by the topics. I think any physician who is bipolar would find the news an aid in reducing his manic spells. But the colonoscopy article made me laugh.

I have enough trouble convincing patients to have a scope when they know it is painless with sedation. What do you think the repercussions will be when one of the painful ones gets discussed at the family reunion, etc.? Having undergone several sedation-less scopes, I can tell you the number of scopes will plummet.

Perhaps that is the real goal. More money for those CEO performance bonuses.

--Joseph Karcavich, MD, Lockport, Ill.

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Tell it like it is: Doctors need fair pay for services, not "reimbursement"

Regarding "Florida projects worsening doctor shortage" (Article, Jan. 22): Please consider reducing or eliminating the use of "reimbursement" when you mean "payment." For example, the article's first subheading reads "Too little reimbursement, too much bureaucracy." Reimbursement means repayment. Webster's dictionary defines reimbursement as compensation for damages or losses or money spent. Patients who pay at the time of service should be reimbursed by their insurers, and physicians who lay out money for injectable medications and vaccines should be reimbursed for their costs, but payment for evaluation and management services is not reimbursement.

Is there a reason why we physicians can't get payment for our services? Is reimbursement a euphemism to make it sound like we're not asking to be paid fairly? Surely other professionals expect to be paid for their services.

There are times when medical terminology provides precision lacking in everyday English, but there are other times when we must say what we mean and not misuse words to obfuscate or mislead.

--Alan G. Pocinki, MD, Washington, D.C.

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