Sunday, August 28, 2005

Tufts Health Plan: Back to the Managed Care Future

The Boston Globe reported how Tufts Health Plan (in Massachusetts) is going back to "old-fashioned managed care" as a way to cut costs, and try to reduce its chronic double-digit rate increases. The methods it plans to use include requiring prior authorization for a variety of interventions, not only imaging tests, as we noted earlier, but also now back surgery and hysterectomy.
Dr. Allen J. Hinkle, the Plan's chief medical officer, noted, ''We're getting push-back from providers."
That seems to be an understatement. Dr. Alan M. Harvey, the President of the Massachusetts Medical Society commented, ''Their blanket programs for hysterectomy and back surgery are unacceptable. We're mindful of costs, but if every procedure has a hoop you have to jump through, it's an incredible hassle. At some point you'll have physicians saying to patients, 'You need to change your insurance, because we can't keep up with all the hoops we need to jump through.' "
Hinkle countered, 'They don't like when we infringe on their office practice. They don't like the radiology and prior authorization plans. But if costs are left unmanaged, it will break the system."
True, but once again, I wonder why the Plan doesn't seem to want to address the price it pays for individual services, preferring instead to increase bureacracy to try to decrease across-the-board utilization of these services. (See previous post here)
In that context, let me finish with a letter sent by Health Care Renewal blogger Cathleen Hood to Dr. Hinkle.
Dear Dr. Hinkle,
This letter comes in response to your announcement that effective 9/26/05,we will be required to get prior authorization for all CT, MRI, PET, and Nuclear stress tests.
I am writing to strenuously object to being subjected to yet anotheradministrative burden in the course of caring for our Tufts patients. This new program will materially impact my ability to do my job. I am sick and tired of being second-guessed at every turn, and required tojustify my recommendations to some functionary at a hired agency before mypatients can get what they need and have already paid for. I have been dealing with the same agency, NIA, under protest, for my Harvard/Pilgrimpatients and it has been costly, time-consuming, and has obstructed thetimely care of my patients. In addition, Harvard has failed to stream-line the process after 2/05 as promised initially on implementation last Fall.
If you have unmanageable imaging expenses, talk to those who set the prices. Cease attempting to economize on the backs of your already beleaguered and thoroughly disgusted primary care doctors.
We've had enough! We want new contracts. To whom do we speak?

No comments: