Patients' rights top AAFP priority list
AAFP President Neil Brooks, M.D., of Rockville, Conn., spent time in Washington recently, talking to national media representatives about patient protection legislation.
"Our patients tell us that they are sometimes unhappy with their health plans. As family physicians, we sometimes encounter problems with health plans that make it harder for us to provide high- quality, effective health services," said Brooks.
"Actual decisions about health care ultimately must be made by physicians and patients."
-- Neil Brooks, M.D.
Patient protection legislation, also known as patient rights or health care quality guarantees, is considered the most important pre-election issue facing Congress.
Patients and physicians want more protection; managed care companies want less. And everyone seems to have his or her own definition of "quality" health care.
"Quality health care is the care that results from doctors and patients working together to achieve the most effective, medically appropriate care in the most appropriate settings," Brooks said. "Quality health care improves the patients' health status and respects patients' values and preferences."
Brooks told media representatives that certain protections must be legislated to alleviate concerns with getting and providing quality health care:
First of all, patients should feel confident that primary care physicians in their health plans have the training and experience to provide preventive care, diagnosis, treatment and referral.
"Physicians who provide primary care need to have breadth and depth of knowledge as well as training in all organ systems of the body," Brooks said. "If doctors don't have that knowledge and training, then they are not primary care physicians."
And patients should be able to get complete information about their health care options.
Health plans should provide adequate information about participating physicians to enrollees who request it, including board certification status, credentials availability, specialty focus, affiliation arrangements, consumer satisfaction and methods for compensating participating health professionals.
"Also, any patient protection legislation needs to ban gag clauses," Brooks said.
Second, health plans should work for health.
"The ER is no place to worry about whether you have the right health card in your pocket," the AAFP president said. "The Academy supports the prudent layperson standard that requires health plans to pay for emergency room services."
Health plans should have an internal and external appeals process, and physicians should not be penalized if they act as patients' advocates. "I compare the external appeals process to a crossing guard," said Brooks. "You want to think your child knows how to cross the street safely. You want to believe drivers know how to watch for children. But the guard will be there to help if things don't go right. And that's what the independent outside review is all about."
Third, any legislation should include means for measuring and improving quality. The AAFP doesn't want to create a new bureaucracy when it comes to health care, Brooks said. "Instead, Congress should provide adequate funding to the Agency for Health Care Policy and Research," he said. "This would ensure that the necessary primary care research would be conducted and published, enabling physicians to translate the breakthroughs in medical knowledge into effective treatments."
However, patients' rights legislation should never interfere with clinical decision making. "No matter what the legislation finally says, actual decisions about health care ultimately must be made by physicians and patients," Brooks said. "Americans trust their physicians with their lives. They need to know that government regulations will enhance this trust, not diminish it."
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
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