Prefiled bills may address local doctors? concerns

The Woman's Clinic lawsuit against St. John's might just "go away" if the General Assembly passes bills prefiled by Republican State Sen. Marvin Sing-leton, according to Dr. David Redfern of the Woman's Clinic.

But Mike Merrigan, general counsel for St. John's, said the prefiled bills are old news.

Similar bills submitted last year didn't even get voted on. None of the bills ad-dress the real issue, Merrigan said, which is how to balance patient choice and re-duce health care costs.

Senate Bill 713

Singleton, who is a practicing physician in Joplin as well as a state senator, filed Senate Bill 713 with the intent of clarifying the use of noncompete clauses in contracts between doctors and hospitals, and making such clauses invalid when the hospital is a not-for-profit health services corporation, according to a news release from Singleton's office.

The issue of noncompete clauses is to be addressed in the Woman's Clinic suit set for trial in U.S. District Court in Oc-tober.

Under the proposed legislation, noncompete clauses would be enforceable only when:

they don't deny the doctor access to a list of patients he has seen within a year of ending the contract, or

they provide the doctor access to patient medical records with the patient's consent and in an accessible format, or

they provide a reasonably priced buy-out-of-covenant provision for the doctor, or

they allow the doctor to continue treatment to specific acutely ill patients after the contract is terminated.

Senate Bill 652

Singleton's other bill, Senate Bill 652 would no longer allow public hospitals to refuse Missouri-licensed doctors the right to practice in their hospitals as long as the doctors comply with hospital rules.

"This would allow the independent practitioner the ability to practice and use the services of the hospital without discrimination and for patients to continue to see a physician of their own choosing," Singleton said.

According to the senator's press release, hospitals for many years have practiced "economic credentialing, de-fined as hospitals choosing whom they will let practice in their facilities based on financial reasons rather than qualifications."

"The operation of hospitals is becoming increasingly corporate," Singleton said.

He said his bills are intended to "make certain that physicians and pa-tients are not overlooked in that process" and will affect how hospitals are allowed to do business with doctors. The American Medical Association opposes the practice of economic credentialing, too, Singleton said.

Currently, doctors are given hospital privileges only if they are exclusive with one hospital, or if they guarantee a certain percentage of work will be performed at a particular hospital in order to receive privileges, according to the senator.

Senate Bill 651

A companion piece of legislation, Sen-ate Bill 651 requires a health carrier to allow any health care provider to participate in a network if that person satisfies all the selection standards. The bill is to be known as "The Patient Freedom of Choice Act of 2002," according to the Senate Web site.

"This bill would level the playing field for independent doctors such as myself as far as being able to maintain network provider status," Redfern said.

"This bill would not let health care providers (hospitals, insurance companies or physician-managed care organizations) discriminate against nonemployed physicians," he added.

That's a major issue for Redfern. The Woman's Clinic alleges in its lawsuit that as soon as St. John's has enough doctors on staff to replace the Woman's Clinic doctors, the clinic's contract won't be re-newed and the clinic's doctors will be out of the network.

Domino effect

However, St. John's attorney Merrigan said, "The potential legislation doesn't solve all the issues. We appreciate Dr. Singleton's attempt to resolve some matters, however our concern is that (the legislation) creates more issues than it remedies."

The current lack of patient choice isn't a simple problem to fix, and if mandated choice becomes part of the law, Merrigan sees a dangerous domino effect.

For instance, in the workers' compensation realm, "Missouri law says that the employer has the right to choose the doctor the employee goes to.

"What is the impact (patient choice legislation) will have on work comp, which is becoming very expensive for employers ... today?" Merrigan said.

For employers who provide health insurance as an employee benefit, Mer-rigan doesn't see the proposed legislation as helpful.

"Payers specifically choose the pro-viders they want in the hopes of keeping costs down," Merrigan said. The proposed legislation "doesn't help them control their cost if they are not able to limit the number of providers their staff sees. It's a balancing act between patient choice and the ability to pay the costs. That's what the whole arena is about trying to balance."

The way it works is "you start limiting choice. You contract with a set group of providers that give you a discount and narrow the costs in the hopes of maintaining cost affordability," Merrigan said.

The General Assembly went into session Jan. 9 and is set to conclude May 17.