Physician, cut thy costs - medical providers are considering taking part in the cost cutting battle - includes related information on physician specialization, American College of Physician's reform criteria, and worker's compensation - Cover Story

Business & Health, June, 1991 by M. Mary Conroy

Check the record

In the same letter, she presented her alternative to managed care systems. i would like to propose that your company consider designating a new class of providers,' namely those who are known to have been giving quality care at low cost throughout their history as providers, which can easily be proven by either their Medicare profile or their office records and also by their income, which is usually modest by comparison with procedure-intensive specialties."

"At any time," the letter continues, "if the individual physician exceeded your expectations with regard to average charges (in other words, if the individual doctors were costing you more than your other PPO doctors) you could retain the right to terminate him or her."

Dr. Granat said she makes her proposal because she believes it's unfair for her patients to be forced to seek care elsewhere, "when I know that their care will not be as good and that it will not be any cheaper than if they had stayed with me."

While Dr. Granat hasn't had any employers take her up on her offer, she has had patients return to her, even if it meant paying for their own care. Moreover, she believes that other physicians would be happy to make the same offer that she does to employers.

ACP's 16 steps to better health care

Like many other physician groups, the American College of Physicians has come out with its own version of what health system reform should look like. Here are the ACP's 16 reform criteria, as published in the Annals of Internal Medicine, May 1990:

Benefits

* There should be a mechanism for determining the scope of benefits. The health care system may not be able to accommodate financially the clinical capacity to provide all possible services. The challenge is how best to select and prioritize the vast array of services which could be made available.

* There should be uniform, minimum benefits. Coverage must not vary geographically as it does presently among both public and private insurance plans because of different judgments among carriers as to what is and what is not appropriate. Lack of a uniform minimum coverage policy is perplexing to both patients and physicians and results in inequitable access to some health care services.

* Coverage decisions should be based on clinical effectiveness. An ideal health care system would provide insurance coverage and payment for appropriate and efficacious health care services, but would not cover services that are inappropriate, ineffective, or unnecessary.

* Coverage and benefits should be continuous and independent of place of residence or employment. Coverage should be "portable"; persons changing jobs or moving from one state to another should not lose their health care benefits.

Financing

* Financing should be adequate to eliminate financial barriers to obtaining needed care. The financial burden for the program should be shared progressively. Any premiums, copayments, deductibles, or taxes used to finance it should be based on ability to pay.