ACP-ASIM Urges House to Pass Senate Version of Patient Protection Act
(Washington, DC) The American College of Physicians - American Society of Internal Medicine (ACP-ASIM) is urging the United States House of Representatives to approve the Bipartisan Patient Protection Act of 2001 (BPPA), S. 1052, as passed by the Senate June 30, 2001.
"The Senate BPPA keeps the legislation focused on what should be the main priority for any bill - the patient," said Dr. William Hall, MD, FACP, president of the ACP-ASIM. "The quality of patient care can never be significantly improved unless more accountability is provided for managed care companies. The BPPA provides this accountability."
Dr. Hall noted that the Senate BPPA is a compromise that addresses key criticisms of an earlier version. Under the Senate bill, employers and health care professionals would be shielded from new liabilities, states would maintain the flexibility to enact their own patient protections as long as they were in substantial compliance with federal law, and individuals in all but a few cases would be required to use the external review process before they could file a lawsuit.
Dr. Hall also noted that House passage of legislation virtually identical to the Senate bill best assures that it does not become substantially weakened or even bottled up in conference due to irreconcilable differences.
A letter from Dr. Hall to member of the House of Representatives acknowledged the effort made by Representative Fletcher to develop an alternative bill, H.R. 2315, that meets principles outlined by President George W. Bush. He concludes, however, that the Senate bill provides a substantially superior level of patient protections. Major benefits of the Senate bill, compared to H.R. 2315, include:
- Better access to specialty care. The largest medical specialty societies and almost all patient groups have declined to endorse the more limited patient protections in H.R. 2315.
- Better access to external appeals. By contrast, H.R. 2315 would impose a new onerous administrative burden on doctors to certify that a patient's health would be in substantial jeopardy if the patient wished to appeal a denial for a claim involving less than $100. This requirement would leave many patients-especially those with limited means--with no recourse if a needed test or visit is denied by a health plan and the physician is unable to certify that their health would be in certain jeopardy. It will also create incentives for insurers to disaggregate treatment plans so that each denied claim is less than $100.
- A better and more independent external appeals process. By comparison, H.R. 2315 includes several "affirmative defenses" that will encourage health plans to demand excessive documents from patients and physicians-creating another hassle factor--to delay, and thereby negate, the external review process.
- The Senate bill, unlike H.R. 2315, would not pre-empt state laws that hold insurers to a higher standard of patient protection. H.R. 2315 would pre-empt state laws and court decisions that hold health plans accountable in a court of law -violating the basic principle that at the very least, a federal patient protection bill should "do no harm" to state laws and court decisions on accountability.
- The Senate bill holds health plans truly accountable for harm done to the patient. By contrast, H.R. 2315 allows access to a state court only when the external reviewer rules against the health plan and the latter refuses to abide by its determination. This means that a patient who has suffered irreparable harm to their health, but ultimately prevails in the external appeals, has no recourse for holding the plan accountable in court for the damage that has already occurred.
ACP-ASIM is the nation's largest medical specialty organization and the second largest physician group. Membership encompasses more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America.