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President Proposes Plan to Protect Patients


Both the House and Senate bills would strengthen patient access to emergency room services, the right to see specialists, and the ability to keep seeing a physician even if an HMO stopped contracting with that clinician.

Formal House and Senate negotiations broke down long ago on final legislation, but on Monday several House GOP lawmakers outlined their efforts for a last-ditch agreement.

Reps. Shadegg and Tom Coburn, MD, (R-Okla.) said that their proposal, backed by House GOP leadership, would empower doctors and patients. Shadegg and Coburn argue that a recent patients' protections proposal from Rep. Charlie Norwood (R-Ga.) -- which is endorsed by the American Medical Association (AMA) -- empowers trial lawyers or HMO bureaucrats.

Unlike the Norwood (R-Ga.), the Shadegg/Coburn plan would require that patients take all disputed claims through an outside review by independent doctors before they could file a lawsuit against a health plan.

But Coburn said he suspected that Democratic leaders may be reluctant to compromise on an issue that they view as key to their election prospects this November. Last week, key Democrats blasted the Norwood proposal as inadequate for patients.

Most health plans, meanwhile, remain strongly opposed to any expansion of liability, contending that external appeals systems are sufficient to ensure that health plans are accountable for the medical decisions they make.

Even as a physician, Coburn expressed frustration with the AMA's continued support for the Norwood lawsuit provisions. "I think doctors ought to be controlling patient care, and I have some question as to whether the AMA's been lobbying for doctors or lawyers," he tells WebMD.


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