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Rhode Island Chapter Opposes UnitedHealthcare Mandatory Hospitalist Program: Chronology of Events

July 19, 1999

A July 8, 1999 "Dear Colleague" letter from Anthony J. Kazlauskas, MD, Medical Director of UnitedHealthcare of New England (UHCNE), announced that UHCNE was introducing a hospitalist program statewide and that its use would be required for patients covered under UHCNE's Medicare HMO product. The Rhode Island Chapter of ACP-ASIM has taken the following actions in response to this letter:

  • An official letter of protest on behalf of the Chapter was sent to Dr. Kazlauskas. In it the chapter states the College's opposition to mandatory hospitalist programs.
  • The Chapter's Health and Public Policy Committee has held regular e-mail discussion on this issue daily since July 9 and has arranged a meeting with Dr. Kazlauskas on August 5 to discuss the College's opposition to UHCNE's program. Representatives of other medical organizations will be invited to participate.
  • The Chapter leadership has contacted the leaders of the Medical Society, the Rhode Island Academy of Family Physicians, and several of the largest group practices in the state to coordinate efforts to stop UHCNE's program. In addition, the ACP-ASIM Washington office and, through the Medical Society, the AMA have also been made aware of UHCNE's plans.
  • Members of the chapter who are on the e-mail and fax lists have received periodic updates on this matter. So far, all responses to these messages state strong opposition to UHCNE's plan.

July 27, 1999

In response to a question from the Rhode Island Chapter, UHC Medical Director Anthony Kazlaskas, MD clarified that the hospitalist will participate in the decision to admit or discharge a patient from the emergency room. He noted that the primary care physician would be consulted wherever possible by the Cogent hospitalist, but in the event of a disagreement, the Cogent physician's recommendation would take precedence, and Cogent would assume any liability in that case. The RI Chapter's Health and Public Policy Committee will meet with Dr. Kazlauskas on August 5 to discuss this issue further. Representatives of other specialty societies will also attend.

August 6, 1999

On August 5, the RI Chapter's Health and Public Policy (HPP) Subcommittee met with Anthony Kazlauskas, MD, Senior Medical Director of UnitedHealthcare of New England (UHCNE) to discuss UHCNE's plan to implement a mandatory hospitalist program for its Medicare risk patients. Attending the meeting in addition to myself were HPP Chair Fred Crisafulli, MD, FACP; HPP members Scott Hanson, MD, Mitchell Pressman, MD, FACP; RI ACP-ASIM Governor Fred Schiffman, MD, FACP; and Michael Fine, MD, who is President of the Rhode Island Academy of Family Physicians and was invited by us to participate.

We reiterated our strong objection to the mandatory nature of the hospitalist program and raised additional issues, including potential medicolegal exposure resulting from this program. Dr. Kazlauskas summarized UHCNE's rationale for adopting this mandatory hospitalist program. UHCNE saw itself in a "do or die" situation with its Medicare risk product and viewed the mandatory hospitalist program as a means of preserving UHCNE's participation in Medicare risk in our area. In addition, Dr. Kazlauskas felt that the quality of inpatient care would be increased by the hospitalists. We disagreed with the assumptions and interpretation of existing data on hospitalist programs upon which UHCNE's expectations were based and pointed out that many of UHCNE's goals could be accomplished with a voluntary program.

Dr. Kazlauskas noted that the original September 1 date for starting the program will need to be pushed back because the RI Department of Health (RIDOH) has categorized the program as a "material modification" to the Medicare product that must be approved separately. The RIDOH is awaiting additional details from UHCNE on the composition of the hospitalist network, and following receipt of this information will begin a 30-day public comment period before making a decision. Patients would not receive a notification from UHCNE until the program was approved.

Dr. Kazlauskas was, as usual, quite up front with us, but not surprisingly, the meeting ended without a change in UHCNE's position. Similarly, the RI Chapter, along with the national ACP-ASIM and AAFP, plus local organizations such as the RI Medical Society and the RI Academy of Family Physicians, will continue to oppose the mandatory hospitalist program in the regulatory and legislative arenas.

Finally, a comment on communications with patients prior to the RIDOH's approving or rejecting the mandatory hospitalist program. In response to a question on whether UHCNE would attempt to "gag" physicians who want to discuss their objections to the hospitalist program with patients, Dr. Kazlauskas recommended that physicians check with the RIDOH on what would be appropriate discussion content. He felt that UHCNE would not take action unless it believed that a physician was intentionally misinforming patients, and noted that in the past, the Department of Health has taken action when it felt that patients were being put "in the middle" of disagreements between physicians and insurers. The RI Chapter will ask the Medical Society's counsel to advise us on this.

August 12, 1999

ACP-ASIM mailed letters stating the College's opposition to mandatory hospitalist programs to UnitedHealthcare of New England as well as to UnitedHealthcare's national corporate office in Minnessota.

Letter to UHCNE Senior Medical Director
Letter to UHC Corporate Medical Director

Members of the Rhode Island Chapter should check this page periodically for additional information. If you would like to be added to the Chapter's e-mail list, please send your name and address to RIACPASIM@worldnet.att.net. You should contact the Chapter at that address if you have any questions or comments as well.

October 4, 1999

United Healthcare informed the RI Chapter that it will make its hospitalist programs voluntary for all of its products, including Medicare risk. Therefore, there will not be a mandatory hospitalist program. A letter from Dr. Kazlaukas will be sent to participating physicians announcing this change in plan.

Page updated: 06-25-03

Page updated: 06-25-03