MCO accountability for practicing medicine

[Guest guest]

Today's Wall Street Journal contains an article about the shifting tides

towards Managed Care Organizations being held accountable for medical

decision-making - essentially practicing medicine. For example, several

states have passed or are considering legislation such as:

· Arizona 1997: State appeals court ruled that

state medical board has authority to review a health-plan medical

director's decisions on the medical necessity of treatments.

· California, Ohio 1998: Legislation pending

requiring state licensure of health-plan medical directors or defining

medical necessity decisions as the practice of medicine.

· Mississippi, 1998: Similar law passed.

( Sources: 7/13/98 WSJ quoting State boards of medicine)

Have you had problems with this issue in rehab?

What are your thoughts about this phenomenon?

What should we do about this, if it is a problem in rehab?

Should this be an area of emphasis for rehab, i.e. encouraging, lobbying

for more accountability of MCO's?

R. Kovacek, MSA, PT

KovacekManagementServices, Inc.

The FOCUS Group, Inc.

20225 Danbury Lane

Harper Woods, MI 48225

Fax

Email Pkovacek@...

<http://www.theFOCUSgroup.net>

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