FP Report -- May 1999
Physicians fight hospitalist mandate
The AAFP, Florida AFP, Texas AFP and other medical groups are fighting the mandatory use of hospitalists.
It's doctors vs. Prudential and CIGNA regional offices, and the health plans just blinked.
"After I complained, Prudential said I could opt out of using hospitalists if I met the utilization standards, and I did," said Richard Hays, M.D., of Lake Worth, Fla., president of the Florida AFP.
Hays had fewer than 1,200 bed days per thousand elderly patients per year, so he -- and others who submit their requests and meet Prudential's criteria -- can still admit patients.
HMOs and PPOs "shall not require the mandatory use of a hospitalist."
-- H.B. 3111 in Texas legislature
However, Hays fears doctors aren't looking at the long-term consequences of forsaking hospital privileges. And he expects other health plans soon to insist on using hospitalists.
"This is going to be like a wildfire," said Hays. "Once it starts, it'll spread out of control."
Prudential HealthCare of South Florida had written its physicians Feb. 12 that hospitalists would begin admitting all adult medical, surgical and non-OB patients this spring.
The AAFP immediately objected, as did the American College of Physicians-American Society of Internal Medicine.
"We must vehemently protest the decision ... to artifically limit the scope of our specialty by denying family physicians in south Florida the opportunity to deliver hospital care," wrote AAFP President Lanny Copeland, M.D., of Albany, Ga., in a Feb. 19 letter to Prudential.
He sent a similar message March 10 to CIGNA HealthCare of Texas, which said it would require physicians to use hospitalists beginning April 1.
"The program CIGNA proposes creates a serious threat to family practice residency training programs," wrote Copeland. Future FPs must have generalist role models for inpatient training, or the residencies cannot meet accreditation requirements.
Jim White, Texas AFP executive director, said research by the national CIGNA office favors voluntary use of hospitalists. "This mandate may be a 'toe in the water' deal," said White.
By late March, CIGNA HealthCare of Texas said it would narrow its mandate, applying it only to emergency room admissions and physician outliers with excessive inpatient utilization.
A legislator working with the Texas AFP and Texas Medical Association recently proposed legislation saying HMOs and PPOs should not require the use of hospitalists. The bill, the first of its kind for any state, is in line with the notion that hospitalist systems should be voluntary for physicians and patients -- the policy of the AAFP, ACP-ASIM, American Medical Association and National Association of Inpatient Physicians.
Tom Banning, legislative affairs director for the Texas AFP, said a Humana health plan tried to impose mandatory use of hospitalists in Austin last year and softened its stance after physician groups complained.
"The mandate is a disease," said Banning. "We're trying to short-circuit it through the legislature and come up with a cure."
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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