Friday, August 25, 2006
Another exmaple of how HMOs work
In California, the SEIU has leaked an internal John Muir Physician Network (JMPN) memo that instructs doctors not to "refer patients for a screening colonoscopy if their life expectancy is less than five years." The memo orders doctors to deny the test to patients with AIDS, chronic renal failure, advanced cirrhosis of the liver, COPD, active hepatitis, obesity and other conditions. The memo also threatens "financial penalties" for doctors who don't comply with the order. Taken at face value, JMPN's blanket denial of colonoscopies for certain patients is a violation of several federal laws. Regulators say they are planning to investigate the matter.
For more on the controversy: check out this article from the Contra Costa Times and read the SEIU press release for more details from the memo. Remember: Gov. Doyle thinks guys like these -- HMOs -- are going to save Medicaid. Sigh.
P.S. And who gets to decide whether you "life expectancy" is less than five years? Doctors have enough trouble with the 6-month rule for hospice. I'm willing to bet that since this decision has "financial penalties" attached to it, that the docs have to figure out who the HMO expects to life fewer than five years. In fact, the HMO has already given them a starting point: the list of conditions for which they are prohibiting colonoscopy. I note, with personal interest, that the obese are on the list. I guess I have fewer than five years left to live. Idiots.
For more on the controversy: check out this article from the Contra Costa Times and read the SEIU press release for more details from the memo. Remember: Gov. Doyle thinks guys like these -- HMOs -- are going to save Medicaid. Sigh.
P.S. And who gets to decide whether you "life expectancy" is less than five years? Doctors have enough trouble with the 6-month rule for hospice. I'm willing to bet that since this decision has "financial penalties" attached to it, that the docs have to figure out who the HMO expects to life fewer than five years. In fact, the HMO has already given them a starting point: the list of conditions for which they are prohibiting colonoscopy. I note, with personal interest, that the obese are on the list. I guess I have fewer than five years left to live. Idiots.
