ASCRS supports new bipartisan patients' bill of rights act; AMA holds off on full support

FAIRFAX, Va. — The American Society of Cataract and Refractive Surgery (ASCRS) has endorsed the patient protections included in the "Bipartisan Patients' Bill of Rights Act of 2001," introduced yesterday by Sens. Bill Frist, R-Tenn., James M. Jeffords, R-Vt., and John Breaux, D-La.

According to ASCRS, the legislation would provide many needed protections to millions of Americans who depend on managed care plans for their health care needs. If the bill becomes law, it would create a federal floor of protections for all patients in managed care plans. HMO patients would have access to needed protections such as a point-of-service option at the time of enrollment, specialty care, emergency room services, plan information and clinical trials. Patients would also benefit from a fair and timely internal and external appeals process.

In a letter to Sens. Frist, Jeffords, and Breaux, ASCRS president I. Howard Fine, MD, praised the legislation and wrote, "Your bill ... contains the core principles that our organization considers critically important for inclusion in any managed care legislation ... We are optimistic that the introduction of this legislation will provide the impetus for eventual bipartisan cooperation and enactment of this much-needed legislation."

The American Medical Association has said it "welcomes Sen. Frist's efforts to enact long overdue patient protections," but has not yet fully endorsed the bill. Thomas R. Reardon, MD, immediate past president of the AMA, said his organization will be looking for assurances that the bill "does not preempt existing state laws or a growing body of case law that allows HMOs to be held accountable." Other assurances sought include that the bill "does not contain a time bomb that would nullify patient protections and remedies if the courts strike down some of the bill's provisions; that the bill contains a binding, independent, external review process without any of the loopholes contained in previous bills passed by the Senate; and that external reviewers will not be bound to abide by arbitrary definitions of medical necessity developed by insurance companies or government bureaucrats."

If the Frist bill meets those criteria, says Dr. Reardon, "the AMA will eagerly support it."

Sens. Frist, Breaux and Jeffords are touting the bill's "comprehensive" set of patient protections, including access to ob-gyns, guaranteed emergency care, a ban on "gag rules" and full disclosure of health plan information. The proposal would apply to all 170 million Americans covered by private-sector group health plans, individual health plans and fully insured state and local government plans.