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ACP-ASIM Urges Promotion of Health Care Quality by Passage of Patient Protection Act

June 27, 2001

Debate Over Lawsuits Not Main Issue, Says Doctor's Group

(Washington, DC): The insurance industry is misleadingly trying to paint the debate in the Senate over the Bipartisan Patient Protection Act as a "right to sue," charges the American College of Physicians - American Society of Internal Medicine in a letter sent today to the United States Senate.

"They are gambling that they can win the fight against the patient bill of rights if the debate can be shifted toward a discussion of lawyers and lawsuits, rather than doctors and patients," said ACP-ASIM President William Hall, MD, FACP. "The real issue though is not the right to sue, but the right of patients to get the right care, at the right time, without having to fight an entrenched insurance bureaucracy."

The Bipartisan Patient Protection Act of 2001, S. 1052, is a common sense bill that would put the patient back in the driver's seat when it comes to their medical care, according to the letter. It guarantees choice of physician and access to appropriate specialty care.

"This bill would prohibit insurers from denying coverage for emergency room visits for symptoms, such as chest pains, that a reasonable non-medical person would view as life-threatening," said Dr. Hall. "It requires insurers to make determinations in a timely manner. It guarantees access to a truly independent review of health care denials by outside medical experts, based on the treating physician's professional judgment and expert opinion and published studies, rather than on the insurers' own criteria for payment."

Dr. Hall took time off from his practice June 26 to visit the Senate and urge members to not be fooled by the lawsuit arguments and to support the quality protections in the BPPA.

Also, Dr. Hall criticized the shortcoming of several other competing legislative proposals.

"For instance, the external review in a competing proposal would allow the insurers to pick the review body-a clear conflict of interest," said Dr. Hall.

States with weaker protections could also "opt-out" if they could make a claim that their laws were consistent-but not equivalent or greater-than the federal protections. "These and other differences in approach are as, and in some ways more important, than the much-publicized debate over the conflicting liability provisions," said Dr. Hall.

The BPPA would allow the patient to hold the MCO accountable in a court of law, but only if the MCO has acted in a way that has caused irreparable harm to the patient.

"Quality HMOs, of course, will put in place measures to make sure that patients aren't harmed in the first place, rather than having to end up in court," said Dr. Hall.

"America's internists believe that the Bipartisan Patient Protection Act of 2001, S. 1052, is the best bill for patients," concluded Dr. Hall. "Not just because it offers appropriate redress in court when a patient has been irreparably harmed, but because it is the only bill that will truly level the playing field between patients and an entrenched insurance bureaucracy."

The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) is the largest medical specialty society in the United States, with a membership of more than 115,000 physicians and medical students.

Jack E. Pope, ACP-ASIM Washington Office, 202-261-4556

Page updated: 11-04-03

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