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by Dr. Ron Ripps

Pressure on a nerve in my patient's wrists makes her hands numb and painful. The problem has intensified in the past two years and her hands are now so dysfunctional she can no longer put up her hair in the morning. It's three days before I am scheduled to perform corrective surgery, and her HMO has just denied payment.

Despite a busy office, I call the HMO, climb their endless phone tree, endure a lot of "hold", and explain the case in detail, only to hear: "We'll submit your appeal and notify you within 30 days."

My patient sits before me, a forty year old nurse, wringing her hands in pain and disbelief. I became a doctor to help people. I have been a practicing orthopedic surgeon here in Connecticut since 1975. Why, you ask, do I put up with this?

Because right now I have to. Through HMOs, managed care insurers have gained the "right" to drive a wedge of administrative and financial priorities between patient and doctor. Disallowing surgery my patient needs is but one offense among many: Arbitrary, ever-declining About 47M Americans belong to HMOsrates force physicians to see more and more patients in less and less time to meet their overhead; capitation schemes in effect pay us to turn patients away; some insurers claim the right to "deselect" (fire) physician panelists without cause; other codicils permit corporate management to modify our contracts without negotiation or notification.

Too often, managed care insurers force doctors into signing one-sided contracts that violate the professional and ethical standards of care to which we have always been held. If we don't sign, we stand to lose so many patients we may face insolvency. If doctors organize to negotiate better contracts, we meet the anti-trust wrath of the Justice Department and the Federal Trade Commission.

As long as predatory insurers manipulate the terms of our contracts unchecked, however, physicians cannot function as true patient advocates. Because insurance companies own one third of all the money in the United States, their lobby is very influential and passing legislation to limit their power is difficult. Can existing laws do the job? The Connecticut Medical Society, of which I am a member, has just sued our largest managed care insurer charging "Illegal, immoral, unethical, and oppressive conduct" in violation of the state's Unfair Trade Practices Act. We'll see what happens.

Meanwhile, I have to explain to my patient that the solution to her problem is more political than medical. At present, like her, my hands are tied.

Ron Ripps serves on the Board of the Connecticut Orthopedic Society and will be its President in the spring of 2000.

Related Links:
(1) Central States Orthopedic Specialists Inc.,
Excellence in Orthopedic Medicine — Information about the hand and wrist

(2) American Federation of State, County and Municipal Employees, AFL-CIO
What Price Patient Care? A Nurse's Story
Winter 1999

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WHO IS: Dr. Ron Ripps serves on the Board of the Connecticut Orthopedic Society and will be its President in the spring of 2000.

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