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Letter to Laurie Westfall, Care Choices HMO

December 18, 2000

Ms. Laurie L. Westfall
Vice President, Operations
Care Choices HMO
34605 Twelve Mile Road
Farmington Hills, MI 48331-3221

Dear Ms. Westfall:

On behalf of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), representing more than 115,000 physicians who specialize in internal medicine and medical students, I am writing to express concern regarding a November 2000 letter sent by Care Choices HMO to its members, which states that internal medicine physicians will continue to be part of the physician network, but as specialists, not primary care physicians.

ACP-ASIM is very concerned and finds it ironic that Care Choices will deny its members choice of internal medicine physicians as primary care physicians. This peculiar policy forces many patients to sever the relationship with their personal physician and forces the patients to find another physician, which is totally unnecessary from a quality standpoint. Such a drastic action will disrupt continuity of patient care which could jeopardize patient care and increase health care costs to the HMO.

ACP-ASIM is also concerned that Care Choices new policy places an economic burden on its patients by forcing the patient to pay out-of-pocket for primary care services if the patient chooses to continue to be treated by a doctor of internal medicine.

ACP-ASIM is not aware of any other insurer in the United States with a policy denying doctors of internal medicine their right to act as primary care physicians. Internal medicine training is designed to develop highly skilled competent primary care physicians of adult medicine.

Denying patients the opportunity to see internal medicine physicians in the primary care setting is inappropriate. It is particularly troublesome if the policy actually forces adult patients to seek physicians with less training and expertise in adult medicine.

It is well known that internal medicine physicians typically treat older patient populations with greater prevalence of chronic disease conditions. ACP-ASIM would be very concerned if the intent of Care Choices new policy was to reduce costs and encourage these patients to disenroll from the network by denying patients with chronic diseases insurance coverage to see their appropriately trained and credentialed primary care physician of choice.

ACP-ASIM contends that Care Choices new policy may ultimately lead to higher costs. Patients with chronic disease conditions who are forced to see a non-internal medicine physician for their primary care may likely then be referred to an internal medicine specialist for their complicated or chronic illnesses. In essence, doubling the number of patient-physician encounters.

In closing, ACP-ASIM opposes Care Choices decision to designate internal medicine physicians within their network only as specialists. We believe that this designation is a disservice to your members and the internal medicine physicians within your physician network. Please contact John DuMoulin, Director, ACP-ASIM's Managed Care and Regulatory Affairs, at (202) 261-4535 to discuss this matter further.


Walter J. McDonald, MD, FACP
Executive Vice President


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