 |
Any Willing Provider Laws: A Managed Care Perspective
In April of this year, the United States Supreme Court ruled unanimously that states may choose to force Managed Care Organizations to open up their networks to any provider who is willing to comply with the requirements of a given contract. About half the states in the US have already enacted such laws, although some are quite limited in scope.
In theory, this is a step forward for consumers since it means that MCOs can no longer force them to go only to the low bidder who won the HMO contract. In practice, it may have other ramifications as well. For example, as the National Association for the Advancement of Orthotics and Prosthetics commentary notes, this may paradoxically reduce the likelihood for federal legislation that might make the AWP rules more uniform across the country. [Click here www.oandp.com/resources/ to read NAAOP's report.]
In an interesting article in Managed Care Magazine notes that this ruling may have opened the door to state regulation of HMOs even if they have contracted with self-insured companies. At present, self-insured companies escape many of the checks and balances that apply to insurance policies purchased by individuals. For example, it is often impossible to obtain an external review of a denial of coverage by self-insured companies, which means that their initial denial can simply be rubber-stamped by internal reviewers who are employees or contractors. In my experience, this often results in such arbitrary policies as an exclusion of all electronic prostheses, forcing amputees to restrict their rehabilitation to 30 year-old options.
One other possibility is that this ruling might spur MCOs to develop quality rankings of providers and to create financial incentives for patients to see top tier caregivers. In this scenario, the patient's co-payment costs would be substantially higher should they chose to see a second tier provider. The argument for this approach is predicated on the situation where all providers in a given area have signed contracts with all HMOs, so no further price competition is possible. The skeptical observer might expect MCOs to foster competition to reduce costs in other ways, such as by defining a "quality provider" as one who decreases utilization.
The entire article is posted online at www.managedcaremag.com.
|
|
SCO Training Seminar
John, Many thanks for your input and summarization of the qualities of the miriad of orthoses presented. Things are still spinning around in my head. Which is which. I did not see the outline of the last thing you were talking about at ... read more
|
Re: SCO Training Seminar
The summary is posted in October's Corner; feel free to click on it there. I'm happy to email or otherwise help any Qualified practitioner working with Horton's SCOKJ. It's really very straightforward to fab and adjust, but it's always ea... read more
|
|
|
Muchas gracias.
Ciudad de Mexico 19 de Septiembre, 2003.
Muchas gracias por sus comentarios Sr. Felix Gamarra y Sr. John Michael. Es un hecho que la obligacion de todo aquel dedicado a la atención del paciente discapacitado es compartir sus conocimientos ... read more
|
|
felicitaciones Sr. Castillo
Estoy muy feliz de seguir siendo un lector asiduo de la pagina oandp y mis felicitaciones van para el Sr. Alberto Castillo quien nos ofrece la traduccion facilitandonos la vida profesional con toda esta importante informacion.
Que sigan ... read more
|
Re: felicitaciones Sr. Castillo
We too are very grateful for Sr. Castillo's dedication and expertise, which he shares freely by translating this Corner and many other P&O resources into Spanish. He is an outstanding role model for CPOs worldwide, although few of us come ... read more
|
|
|
contact an old friend - lost your adress- sorry
Hi John,
lost your adress, contact me on the e-mail way when your timetable is not overbooked.
Best regards
Andreas
|
|
Ertl and Valley Forge
John,
|
|
jkjk
lklk
|
|
|
|
