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By Todd Zwillich
WASHINGTON, Mar 14 (Reuters Health) - Three out of four physicians prefer an independent appeals process over lawsuits as a way for patients to resolve disputes with their health plans, according to a survey released today by the American Association of Health Plans, the nation's largest HMO industry group.
The group's officials said that data show both doctors and consumers want external reviewer and not juries to decide denial of care cases with HMO's. That issue is at the center of debate on Capitol Hill over controversial Patients' Bill of Rights legislation that could end up giving patients the right to sue their health plans for damages resulting from refused coverage.
"This is a turning point in the debate," said AAHP president Karen Ignani in a briefing with reporters.
But American Medical Association president Dr. Thomas Reardon attacked the survey, saying in an interview that its methodology was rigged to "cloud the debate and muddy the waters."
AAHP commissioned a survey by Ayers, McHenry & Associates of 400 physicians nationwide. Doctors were asked which option they thought was in the best interest of patients when disputes with health plans arise: to have the chance to sue the health plan and possibly recover damages, or to give patients the option of a quick appeals process with independent review of the patient's complaint.
Seventy-five percent of physicians said they preferred an appeals process. Seventeen percent said they preferred the lawsuit option, and 8% said they did not know or had no opinion. The results carry a margin of error of plus or minus 5%. Data commissioned in November, 2000 showed that consumers favored the appeals process over the right to sue 65% to 19%.
"If politicians choose to take it, there's a roadmap here for reform," Ignani said. AAHP is among the leading voices against moves in Congress to give patients the right to sue their health plans. The group came out strongly against bipartisan legislation introduced by Sens. John McCain (R-Ariz.) and Edward Kennedy (D-Mass.) that calls for independent appeals and a right to sue with punitive damages limited to $5 million.
The American Medical Association strongly supports passage of HMO reform legislation that includes both an independent review of appeals and legal recourse once those appeals are exhausted. Reardon said that many more physicians support the right to sue than AAHP's survey indicates.
"They asked the question as an 'either or' and this is not an 'either or' issue. If you ask physicians if they support patients having legal recourse once their appeals run out, nearly all of them would support it," he said.
But Ignani defended AAHP's survey, noting that 61% of doctors also felt that the current medical liability system is unfair while 31% said it was fair or somewhat fair. Those data shed light on physicians' distaste for the tort system and explain why few seem to want it pervade more of health care. I "think physicians are expressing a real-world concern over more litigation," she said.
Reardon argued that linking patient protection legislation to tort reform--which the AMA also wants--is a "a smokescreen."
"There is strong support in Congress for passing (a Patients' Bill of Rights), and the president has said he'll sign it. I think (HMO's) are getting desperate," he said.
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