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May 2, 2011

Doctors to push for control of patients' access to care

MedChi, the Maryland state medical society, adopted principles Saturday that the group’s leaders say will protect patients' access to care. The principles will guide the group’s legislative efforts.

The doctors' group, which tussles with cost-conscious insurers over coverage, wants to establish itself as the primary decision makers for patients.

“MedChi has increasingly heard from our physician members about the significant intrusion of health insurance plans into the patient-physician relationship, and about the adverse impact that these barriers to care can have on patient health,” said Gene Ransom, chief executive of MedChi, in a statement.

Ransom claims insurers have a “well-established track record of implementing complex requirements” that end up being such a burden some doctor quit their practices.

Ransom said the move to electronic records around the state will be an opportunity to improve communications with insurers.

The principles are on the next page.

+Physicians must retain the ultimate responsibility for patient treatment decisions regarding all medical issues, including what services, procedures and medications are most appropriate for individual patients on a case-by-case basis;

+Within the bounds of accepted medical practice, clinical judgment and patient choice must always take precedence over payer cost considerations in decisions about individual care, and should supersede fail first (step-therapy), therapeutic substation, generic switching and other protocols that restrict the physician’s ability to make the most appropriate treatment decisions for individual patients;

+It is the responsibility of attending physicians to make the most therapeutically appropriate AND fiscally responsible choices for individual patients; as such, health insurers can provide information about treatment options and costs, provided it is evidence-based, but final decisions must rest with attending physicians;

+With the adoption of HIT and e-prescribing platforms, physicians must be able to prescribe any medication available in the United States without electronic barriers preventing transmission of a prescription to a pharmacy;

+Electronic medical record systems should be provided through a neutral and open platform that does not advance the commercial interests of any particular participant (e.g., health insurers, hospitals, pharmacy benefits managers, pharmaceutical companies, etc.) to the potential detriment of the patient;

+Health plans shall not cause harmful delays in care by using fail-first (step-therapy) protocols, which restrict the physician’s ability to make the most appropriate treatment decisions for individual patients in a timely fashion;

+E-prescribing platforms must include easy and obvious mechanisms by which physicians can over-ride insurance plan protocols for step-therapy, therapeutic switching and generic substitution when the physician determines they are not in the best interest of the patient.

Posted by Meredith Cohn at 7:00 AM | | Comments (1)
Categories: Health care professionals


This might be more credible if the doctors included some principles about self referral.

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About Picture of Health
Meredith CohnMeredith Cohn has been a reporter since 1991, covering everything from politics and airlines to the environment and medicine. A runner since junior high and a particular eater for almost as long, she tries to keep up on health and fitness trends. Her aim is to bring you the latest news and information from the local and national medical and wellness communities.

Andrea K. WalkerAndrea K. Walker knows it’s weird to some people, but she has a fascination with fitness, diseases, medicine and other health-related topics. She subscribes to a variety of health and fitness magazines and becomes easily engrossed in the latest research in health and science. An exercise fanatic, she’s probably tried just about every fitness activity there is. Her favorites are running, yoga and kickboxing. So it is probably fitting that she has been assigned to cover the business of healthcare and to become a regular contributor to this blog. Andrea has been at The Sun for nearly 10 years, covering manufacturing, retail , airlines and small and minority business. She looks forward to telling readers about the latest health news.

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