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On the other hand, if the HMO would just let the doctors do what they are supposed to do, including the decision of how long the patient needs to be hospitalized, and what treatment is needed in the best interests of the patient, they could SAVE millions of dollars spent for advertising, lawyers, lobbyists, and salesmen. If I were an employer and an HMO could save me money, while PROTECTING the health and well being of my employees, and giving them good value in health care, while giving them a choice of doctors, I'd be happy to give that HMO my business. Some of them have gone in the other direction, and given the whole industry a black eye. I am not a doctor, lawyer, or employer by the way, just an employee of a company, so my concern is affordable and quality health care. I have seen the distress caused by the HMOs to PWPs and it is very distressing. [OO] LOOKING FOR RADIOS! Ken Becker [log in to unmask] On Sun, 15 Dec 1996 [log in to unmask] wrote: > >Well said, Kathy. My fear is that the final decision could be made > >by a worker at an HMO computer terminal! > > What surprises me is that disgruntled patients have not attempted > to prosecute non-MD HMO administrators for "unlicensed practice > of medicine." If the administrator is telling a physician what, or > what > not, to do with a patient, it would seem that the administrator is > "practicing medicine." > > >Think about it: "This > >"Jones" person has cost us a lot of money, and according to the > >printout, is past middle age, and only has a few kids...we could > >save THOUSANDS of dollars if we put him out of our..I mean HIS > >misery before the end of this fiscal month." If anyone thinks that > >is not a possible scenario, let me know the last time your > >employer, or whoever provides your medical benefits sent you a > >letter about improving or giving you MORE coverage, or REDUCING > >your expenses for whatever coverage you have? Maybe in dreams, but > >not in real life. Anytime I see an envelope from the "Human > >resources" dept, I get nervous. If HMO's were such a wonderful > >idea, they would not need to spend millions of dollars in > >advertising, to convince them how great it is to have a lesser > >choice of medical providers, and possibly have to pass local > >hospitals to travel miles to the nearest approved facility! The > >worst part is gagging the doctors right to suggest further > >treatment and tests. ANYTIME the bottom line of a financial report > >is considered more important than the best possible medical care, > >I feel it is immoral. > > The doctor is in a bad position... if he/she does not recommend > appropriate treatments or tests, the doctor is exposed to charges of > malpractice, or unprofessional conduct. If he violates the gag > order, the HMO can fire him. But I would think that a hard-nosed > attitude by patients might help: "If the HMO takes action against you > for practicing the best medicine you can, I will bring the HMO's > conduct to the attention of the district attorney (unlicensed > practice > of medicine by the administrator), the state board that licenses > hospitals, > etc. and so on. > > Then there's "raising the stakes." E.g. an HMO wants to discharge > a > woman the day she has her baby, or perform an "outpatient > mastectomy." > The patient should place her objections on record with witnesses and > a personal injury lawyer, and make sure the HMO knows it. Now the > stakes have gone up. If there are no complications, all well and > good. > (Who wants to spend extra time in the hospital?) If there are, the > HMO > has been set up for negligence charges, malpractice suits and, if the > patient dies, possible criminal prosecution for manslaughter- with > all > the ensuing publicity. The military term is "collateral damage." > > It adds outcomes to the HMO's "decision tree." Instead of "Save > $3000 by discharging the patient early," it becomes, "Save $3000 > by discharging the patient early. If something goes wrong, though, > we assume unknown risks of losing our accreditation, losing > hundreds of thousands in a lawsuit, or even going to jail. Bad > publicity is a near certainty." The HMO may now be willing to make > the extra effort to assure a favorable outcome. > > I am not a lawyer and this is not legal advice, but I would think > the > presence of a lawyer at the HMO might make the HMO's bureaucrats > much more circumspect. > > > -Bill >