Minnesota Physicians’ Group Claims Contracts with Health Plans ‘Limit’ Authority , ‘Violate’ Patient Privacy

Minnesota's health insurance market has become so consolidated that insurers "can force physicians to accept lopsided business deals that limit their authority, violate patient privacy and even restrict what doctors can tell patients about managed-care plans," according to a report released May 2 by the Minnesota Physician-Patient Alliance, a doctors' advocacy group, the Minneapolis Star Tribune reports. The report analyzed "standard contracts" between health plans and doctors, finding that many "make doctors promise not to tell patients how the plans make treatment decisions" despite a state law banning such gag clauses. Dr. Lee Beecher, the alliance's president, said that because four insurance companies control 80% of the state market, "doctors and clinics have no choice but to accept even objectionable contract terms." In addition, the report said the contracts allow health plans to examine patient records without consent. Beecher said that without "public pressure," the "imbalance of power" between insurers and doctors is unlikely to change. "It seems unlikely to tell the plans that we just want them to change. ... The public is going to have to be involved in really looking at these contracts," he said.

Insurers Respond
Health plan officials, however, said that the alliance "had erred in its interpretation of the contracts and how they are applied." They said that a "full reading" of the deals shows that health plans "cannot make major changes" without physician consent; that doctors are free to discuss treatment options with patients, although discussions about cost are limited; and that "doctors often have the same option to terminate the contract without cause." As for patient privacy concerns, the officials said that insurers are required by law "to inspect patient records to ensure quality control." Jodie Root, vice president of contracting and payment for Blue Cross and Blue Shield of Minnesota, said, "Our contracts are designed to protect our patients and assure quality. It is just not in our best interests to do otherwise" (Howatt, Minneapolis Star Tribune, 5/3). To read the full alliance report, go to http://www.mnppa.org/mppa/reports/contracts.pdf. Note: You will need Adobe Acrobat Reader to view the report.