Food For Thought
© copyrighted

What HMO'S and Doctors Won't Tell You
Could Cost You Your Life?
September 18th, 2000
by columnist
David Lawrence Dewey

"Reading provides knowledge...
knowledge leads to answers."
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Warning - this article will shock you because you may not want to believe it!

Rosemary Dudley in Fort Worth Texas thought she had received the best of care in fighting her cancer in 1995 from her HMO doctor. Not because she belonged to an HMO, but because she also worked for the doctor as his nurse.

However, in 1997 things changed. He told her a recent followup CAT scan showed no recurrence of the cancer she'd battled for two years, she believed him except for one thing. When she complained about the knot on her jaw, he only replied that a referral to a cancer specialist for the knot on her jaw wasn't necessary. The reason... her health maintenance organization paid him thousands in bonuses for holding the line on such costs.

Four months later in January, 1998 she decided to take matters into her own hand. She went to another physician, paying for it out of her own pocket. He ordered another CAT scan and it showed the cancer had moved from her jaw into her lung, to the bones in her ribs, hips and legs. It was terminal. It had gone too long without being treated.

Rosemary sued her doctor and former employer. Dudley along with a group of separate patients are sued the Harris Methodist Health Plan, ( keep in mind the word Methodist ) on that basis that the HMO offered financial incentives to keep costs down. The Harris Health Plan paid nearly $6 million to settle the class action lawsuits and resolve Dudley’s case in an indisclosed amount.

Shortly after this, The Texas Deparment of Insurance fined Harris $100,000, citing a state law banning financial incentives that provide inducement to limit medical care. It ordered the HMO to pay another $3.4 million to physicians that had been penalized under the system.

It is rather hard under present state and federal laws to sue HMO’s for malpractice, however the cases against Harris focused on treatment incentives and disincentives which are suppose to be illegal under Texas Law. Or so the people of Texas thought.

This last summer, ruling in another case, the U.S. Supreme Court said such incentives do not violate an HMO's fiduciary duty under federal law. "In an HMO system, a physician's financial interest lies in providing less care, not more," Supreme Court Justice David Souter said. "No HMO organization could survive without some incentive connecting physician reward with treatment rationing." His statement is the bare truth of of the matter which our politicians in Washington continue to ignore to makes changes in the laws to forbid this type of health for profit.

Americans need to know about this recent ruling because it will affect the various laws against incentives and disincentives in Texas and 22 other states. It also leaves wind open now for HMO’s to continue even more this practice without fear now of a lawsuit. If such incentives are legal as ruled by the U.S. Supreme Court how will affect care for the millions in HMO that are aging and developing health problems?

What are some of the incentives/rules that HMO’s have for doctors. Although not all HMO’s use all of these, these are the most widely used practices. And the doctors in these HMO’s that you are sitting across from will not tell you these either.

Ordering expensive tests or treatments on patients can be deducted from a doctors pay in an HMO. In some HMO’s, such as in Illinois, they actually receive bonuses for providing less care because less expenses mean for profit for the HMO. Doctors are paid a set amount for each visit ranging from $8 to $12. If they order too many tests, some do not even get the fee and may also have costs deducted from their paycheck. So patients can become financial burdens to the doctor not the HMO.

Dr. Beatrice Murray, a pediatrician in Grand Rapids, Michigan lost her private practice because she cared too much amount the children she treated. She was a contracted HMO doctor, however the HMO started deducting expensive from her $10 fees per visits. She wound up literally going bankrupt caring for children out of her own pocket when the HMO should have been picking up the tab.

It has gotten so bad recently in some HMO’s that some doctors head of a financial burden by not accepting certain patients with known costly health problems. There are many documented cases where doctors in HMO’s have refused to see a patient because they have diabetes, cancer and especially if they are disabled from some condition or injury. There are doctors that do still follow their health oath, but when they do, they usually get fired from the HMO. A recent case in was where a doctor was fired becasuse he actually attracted these type of people because of his being known as a good doctor.

Some HMO’s will actualy fire doctors for treating patients too aggressively or expensively. How do they do this...the HMO’s in this country have invested hundreds of millions of dollars on extensive computers and programs to track doctors and patients individually. HMO’s know exactly how much each patient is costing them. For those that have prescriptions paid by their HMO, be careful. You may be getting less type drugs in treating your illness because they cost less. Now here is the bothersome matter. Many doctors now are contracted with HMO’s for a set per fee basis with deductions. If you have a major illness, they usually turn your case over to a doctor that works directly for an HMO at the hospital. Be real careful here for this is where the penny pinching really starts.

I’ve received emails of very sad stories of how patients in certain HMO’s died because they did not receive the type of treatment they should have. And the big “C” is the most expensive of all. If you are in a HMO, pray to God that you do not get this.

My advice, if you are in a HMO that will not provide to you their cost containment practices to their physicians they contract with or for those doctors that work directly for them, get out of it. Switch to a PPO provider where you can select your doctor and know what you can expect for referrals and so forth. It will cost more, but it is like the old saying. “You get what you pay for.” If you are paying only $8-$20 a month for your HMO insurance, truly, be realistic, can you really expect the best of health care for this amount? Its' time for our elected officals in Washington to do something about this now! Federal laws needs to passed to prohibit this type of practice in the health care system. Tax incentives need to be given to physicians to be able to remain in private practice without the fear of becoming bankrupt because they follow their conscious in treating patients. It is up to you, the voter to do something about this. Start writing your elected officials. Tell them you want change... and NOW!

If you want to read more about this serious health crisis in America, then read this story.

If you are also concerned about your health, then make sure you read my column,
Hydrogenated Oils-Silent Killers. You'll learn how these oils are causing you everything from premature heart disease, high cholesterol and triglycerides levels to diabetes type II.

My next column will be about the real health dangers of the so called "additives" that have been allowed to be put into the gasoline supply in this country. Why did Alaska ban such additives in 1993? Did they know something the rest of us didn't?

~ God Bless ~

~ David Lawrence Dewey ~

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