ROANOKE TIMES
Copyright (c) 1995, Roanoke Times
DATE: Wednesday, December 27, 1995 TAG: 9512270115
SECTION: EDITORIAL PAGE: A9 EDITION: METRO
AS PRESIDENT of the Virginia Academy of Family Physicians, the statewide medical association of over 1,250 practicing family doctors, I am writing to address Medicare reform and its impact on Virginia.
Family physicians treat the entire family: children, moms, dads, grandparents. Often, the family physician is the only physician these families will ever know. We are concerned about several issues being discussed in Washington regarding Medicare reform that will directly impact family doctors' ability to continue to effectively treat their patients.
Three issues are of special concern to Virginia's family physicians, because they affect our ability to care for our patients:
Antitrust and insurance regulations that control formation of health plans.
Medicare reform is supposed to give the elderly more choices of health plans, mostly in the form of HMOs and other managed-care plans. More choices may be a good thing. However, most HMOs won't locate in rural areas because there are not enough patients to offset the extra overhead. Also, Medicare payment rates for HMOs are too low.
If the rural elderly are going to have more choices, it will be because rural physicians, hospitals and other providers join together to form their own health plans. But that can't happen unless Congress makes some changes in the antitrust and insurance regulations that control the formation of these health plans. So far, Medicare-reform legislation fails to make these changes.
The medical-liability crisis in obstetrics.
In rural areas, many family physicians provide obstetrical care. However, a recent survey indicated that one out of four family physicians who previously provided obstetric services no longer does so. Why? Because they can no longer afford the medical-liability insurance, or the insurance is no longer available to them.
This is frightening! Because of the medical-liability crisis, many pregnant women in rural areas must travel long distances, often at great risk, to faraway hospitals to deliver their babies. These women are already at greater risk of delivering unhealthy babies. The crisis has put these women and their babies at even greater danger.
Regulations forcing doctors to stop doing laboratory tests in their own offices.
In 1988, the Clinical Laboratory Improvement Amendments were passed, forcing physicians' office labs to go through piles of paperwork and procedures in order to perform the simplest of laboratory tests. The law was put in place to address large labs performing pap-smear analysis, but was expanded to cover all labs.
The amendments have had an even stronger negative effect on rural communities. Because of them, seven out of 10 rural-physician practices have either reduced or eliminated on-site lab testing.
Patients either must travel long distances to go to laboratories for the tests, or they don't get the tests at all. This means delays in diagnosis and treatment of health problems. Also, many patients now go to the emergency room for lab tests their doctors can't do. This adds another unnecessary expense to our nation's already bulging health-care system.
If Congress and the White House would exempt physician-office labs from the law's cumbersome requirements, patients could receive laboratory services, results, treatment and diagnosis in a more timely manner.
These are just three issues Congress is discussing that will directly affect family physicians' ability to deliver quality, cost-effective health care to our patients. As Congress and the White House negotiate Medicare reform, they must consider the impact of their plan not just on the insurance industry, managed-care organizations and hospitals, but also on the doctors and patients who will have to live with them.
Roger A. Hofford, M.D. of Lynchburg is president of the Virginia Academy of Family Physicians.
LENGTH: Medium: 76 lines ILLUSTRATION: GRAPHIC: MATT MAHURIN/Los Angeles Timesby CNB