Junkfood Science: Doctors for people

February 12, 2008

Doctors for people

Doctors are not only being put into service as lifestyle police and agents of the nanny state, they are now being tasked to investigate the honesty of their patients and turn them into insurance companies for anything in their past that insurance companies can use to deny them coverage.

California’s largest health insurer, Blue Cross of California, has sent out letters to doctors advising them to cull through new patients’ records, and everything shared by patients, for any information that might disclose “pre-existing” conditions the insurance company can use to cancel their coverage.

Reading the letter as a healthcare professional, it appears to threaten doctors as being culpable along with their patients for failing to disclose anything that might identify “discrepancies.” Certainly, a doctor’s continued status as an approved provider — described in this letter “as collaborative partners” with the insurer — would appear dependent on his/her cooperation.

In the letter, doctors are told to complete a “Specialty Review Request Form” after looking through all the information they have on patients, including their health history questionnaires, any previous requests to see any provider inside or outside the medical group for any reason that might indicate a chronic condition, hospitalizations, etc. that might not have appeared on their insurance applications. Blue Cross is even trying to learn if a woman might have a “pre-existing” pregnancy, and wanting doctors to confirm their last menstrual period date is prior to the date appearing on an insurance application.

The president of the California Medical Association, as reported in the Los Angeles Times, said: “We’re outraged that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality.” Patients “will stop telling their doctors anything they think might be a problem for their insurance and they don't think matters for their current health situation,” he said.

As most know, Blue Cross has recently come under fire and been subject to a series of lawsuits for failing to check applications and then canceling coverage after people incur medical expenses, claiming they didn’t know about some prior condition. Now, it appears, the company is wanting doctors to perform that investigative function for them. It is difficult to imagine any doctor wanting to be placed in this position or how it would improve healthcare for patients.

The insurance company spokesperson said these letters went out to medical groups that function as managed care or health maintenance organizations. This is when insurers pay an amount per patient each month and the doctors “are then responsible for arranging and providing patient’s medical care and take on a substantial piece of the risk,” said Blue Cross’ Wellpoint spokeswoman Shannon Troughton. As the LA Times reported, “she said the sharing of medical information with medical groups was within federal law because it fell under ‘patient, treatment and operations’ guidelines.”

As reported in the LA Times, Anthony Wright, executive director of HealthAccess California, a healthcare advocacy organization, said the letters put physicians in the disturbing position of having to weigh their patients’ interests against a directive from the company that, in many cases, pays most of their bills. “That’s about as ugly as it gets.”

What’s the wake-up call for consumers in this story?

This story is a glimpse at how our records — including the personal information about ourselves we voluntarily turn over as part of health risk assessments and “wellness” programs — can and will be used against us. It appears that doctors aren’t rushing to comply with electronic medical records fast enough, so insurers aren’t waiting for access to the information they’ll have readily available once nationalized electronic medical (shared medical, pharmacy, laboratory, lifestyle) records are in place.

More so, it is a glimpse of the importance to pharmaceutical company-insurers and government agencies of “medical homes,” the latest rendition of managed care, through which all of our care is to be monitored, coordinated, “managed” and reported to make sure it complies with their guidelines. The medical home concept, being heavily promoted by these interests, has been previously reviewed. Before medical practices are allowed to be providers and retain professional accreditation, they will be required to meet criteria that includes standards for screenings/labwork, prescriptions and implementation of ‘evidence-based’ guidelines (for managing patients’ BMI, blood pressure, lipid profiles, blood sugars and smoking cessation, etc.), systematic tracking of test results, tracking of referrals, and performance reporting. Physician practices and us will be evaluated based on our scores on meeting these measures. As has been shown in a plethora of studies, despite what might seem intuitive, these performance measures have not been shown to save healthcare costs or improve patient outcomes. That’s not what they’re really about.

Having a trusted healthcare provider who knows us, can advocate for us and help us navigate the medical system so we can get the best and most appropriate care we need and want, and has our best interests at heart, is something everyone values. It can also be life-saving. But medical homes and managed care is a very different beast. When a third party payer with its own priorities is calling the shots, both our care and freedom over our own bodies are compromised.

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