12/14/2009 2:38:00 PM Group works to put patient choice on 2010 ballot
Dr. Edward Douglas of Advanced Alternative Healthcare and a MUCH board member treats patient Judy Pruett by massaging muscles and articulating joints. Douglas expects that legal challenges to the ballot measure will be resolved by February.
Dr. Gerry Catapang, an independent provider and MUCH board member, has been on the patient side of a health plan change after his daughter was diagnosed with cancer.
A Springfield-based grassroots movement to let patients choose their own doctors is gaining steam, but its efforts are not without opposition.
At issue, according to organizers of Missourians United for Choice in Healthcare, is the unique relationship between doctors and patients. It's a relationship that is based on trust, developing over time and steeped in issues of everyday living as well as life and death.
And when employers change their health plans and require employees to change doctors, patients protest.
Consider the recent experience of the state's Missouri Consolidated Health Care Plan. Leaders had decided to switch from Mercy Health Plans, affiliated with St. John's Hospital locally, to United Healthcare, affiliated with the CoxHealth network locally.
Employees were so distraught about losing their St. John's physicians that MCHCP's board ultimately voted to allow the state's 9,000 covered employees an unprecedented choice: They could stay with Mercy Health Plans and keep their current doctors, or they could switch to United Healthcare.
MUCH would like all Missourians to have that freedom of choice, and the group is working to launch a petition drive to put a constitutional amendment on the November 2010 ballot allowing patients to choose any qualified health care provider, regardless of network affiliation and without out-of-network financial penalties.
To participate, providers would have to meet the quality standards of the health plans and agree to their reimbursement terms. As a result, independent providers could join existing health care networks and enjoy the benefits of in-network reimbursement without losing their independence.
The group isn't yet collecting signatures, however, as it awaits the outcome of a lawsuit that likely centers on ballot language, according to Dr. Marsha Taylor, a physician with Ozarks Community Hospital and MUCH board secretary.
Gerry Catapang, an independent doctor of physical therapy, is a MUCH board member who got involved with the group for personal and professional reasons.
"The first reason is my daughter had cancer when she was 5 years old," said Catapang, who owns Springfield-based Physical Therapy Care, Manual Physical Therapy & Industrial Rehab Center PC. In 1996, he learned that not only did his daughter have cancer, but also his three other children were at risk for the disease. The family's pediatrician was Dr. Don Sponenberg, a St. John's physician who had the family's full confidence.
Then Catapang's employer switched health plans.
Catapang was not willing to switch doctors in the midst of his family's crisis, but the cost of that decision was devastating.
"Instead of paying the copay of $10, I had to pay 50 percent of the tab every time we went to see Dr. Sponenberg," he said, noting that the cost was multiplied by four because all of his children were being seen at that time.
Catapang emerged from the experience convinced that patients should be able to keep their doctors without financial penalties.
On the professional side, as an independent provider who is not employed by either Cox or St. John's, Catapang supports MUCH's effort to balance what he sees as an unequal playing field.
With very few exceptions, doctors who are not employed by major health systems cannot join local health insurance networks, he said. Out-of-network providers receive lower and sometimes no reimbursement from health plans, forcing patients to pay more out of pocket.
"That's very frustrating for me as a provider, but also for all of these patients," added Dr. Edward Douglas, of Advanced Alternative Healthcare, another MUCH board member.
Douglas offers alternative pain management through osteopathic manipulation, as well as acupuncture services, herbal medicine, and general health and nutrition counseling.
"With our amendment," Douglas said, "we're not saying that insurance companies have to offer special deals to any particular provider."
Providers may join a network, but only if they agree to the terms of the insurance contract, he said, and networks don't have to admit providers who are not willing to abide by their terms.
While the Missouri Hospital Association has previously fought legislative efforts to establish freedom-of-choice or any-willing-provider law in Missouri, MHA has yet to take a stance on MUCH's initiative petition.
"It will probably be something that the board will opine upon later, if, in fact, it gets the required number of signatures and gets on the ballot," said Dave Dillon, MHA spokesperson. "It's just too early to really take a stance on it or, frankly, to decide what we're going to do to support or oppose it."
Historically, MHA has opposed legislation related to freedom of choice for a host of reasons, arguing in particular that it could increase costs.
"The contracts that exist between providers and the insurance companies that pay them, many of them are based on a certain scale of utilization," Dillon said.
Providers offer a discounted price for services in exchange for a higher volume of patients, who are driven to those providers by network restrictions. If patients can go to any provider, that captive patient volume, and the incentive for lower prices, could vanish, he said.
Proponents of the measure argue that increased competition can lower costs, Taylor said.
MHA has also argued previously that freedom-of-choice requirements undermine the validity of contracts between insurers and health care networks.
While MHA, including members CoxHealth and St. John's, could ultimately oppose the ballot measure, formal opposition has been registered only by individuals in the form of a lawsuit.
Signature gathering delayed
There are two versions of the ballot measure on file with the Secretary of State's office, and both have been challenged in a lawsuit filed by Alex Bartlett, an attorney with the Jefferson City office of Husch Blackwell Sanders, on behalf of Dennis C. AuBuchon and Deanna F. Goettsch. Calls to Bartlett regarding the lawsuit were not returned by press time.
"When you do a legal challenge and you're the opposition, you can do it on the language itself or the auditor's note, the fiscal note, and they had issues with both," said Taylor, who also is an in-network physician for CoxHealth.
Until the legal challenge is resolved, the petition process is at a standstill.
"We could start gathering signatures now," said Holly Cuoco, patient advocate and president of the MUCH board. "But if they came back and said that needs to be reworded, then we'd have to redo those signatures."
"We're anticipating (the legal challenge) being resolved by January, and at latest February," Douglas said.
In the meantime, the organization is raising funds as the Campaign for Patients Rights to cover the expenses of gathering signatures and campaign advertising. To date, it has raised almost $34,000.