Before he leaves office, President George W. Bush will deliver a parting gift to the abortion rights opponents he has courted throughout his political career. It's called the "Provider Conscience Regulation," and effective Jan. 19 it will reaffirm that healthcare professionals can refuse to provide medical services—such as performing abortions and providing contraceptives—if they believe the services conflict with their religious and moral beliefs. Health and Human Services Secretary Mike Leavitt says the new rule "protects the right of medical providers to care for their patients in accord with their conscience."
"Doctors and other healthcare providers should not be forced to choose between good professional standing and violating their conscience," Leavitt says. "This rule protects the right of medical providers to care for their patients in accord with their conscience."
Actually, it's not clear what effect this new rule will have on healthcare delivery other than creating more confusion, particularly in rural areas where patients seeking advice on reproductive issues don't have healthcare access alternatives. If the sole pharmacist or OB-GYN in your small town won't provide contraceptives, for example, you're out of luck.
There already is a federal law in place that does much of the same thing as the new conscience rule. The law was enacted shortly after the 1973 U.S. Supreme Court ruling in Roe v. Wade that affirmed abortion rights. In a Dec. 18 press release, HHS said the new rule was needed to "increase awareness of, and compliance with, these laws."
HHS Assistant Secretary of Health Admiral Joxel Garcia, MD, an OB-GYN, took the vague rhetoric a step further and said in the same press release, "Many healthcare providers routinely face pressure to change their medical practice—often in direct opposition to their personal convictions. During my practice as an OB-GYN, I witnessed this first-hand." That's an astounding statement to make without details, especially if he "routinely" witnessed federal crimes and did nothing about it.
The Christian Medical Association, which praised the new rule, claims that 41% of its members who responded to their poll claimed to have been "pressured to compromise Biblical or ethical convictions." CEO David Stevens, MD, says "physicians report being forced out of medical positions, residents report loss of training privileges, and students report discrimination in medical school admissions." The CMA press release provides no details to support any of these troubling claims.
On the other side of the issue, Planned Parenthood and the American Civil Liberties Union have joined the American Medical Association, the American Hospital Association, and dozens of physician and hospital associations across the nation to urge HHS to rescind the rule, which they view as overly broad and hazy and subject to abuse. "We believe that the proposed provider conscience regulation could seriously undermine patients' access to necessary health services and information, negatively impact federally funded biomedical research activities, and create confusion and uncertainty among physicians, other healthcare professionals and healthcare institutions about their legal and ethical obligations to treat patients," 40 physicians' groups say in a letter to HHS.
For a ground-level perspective, I turned to Scott Duke, CEO at the 100-bed Glendive Medical Center in eastern Montana. "I don't think this will cause us to change anything, because it's already something we look at. Almost every hospital I know of has ethics committees that are there to address issues just like this," he says.
Duke says it makes no sense to pressure healthcare professionals to conduct procedures they find objectionable. "When you are taking care of people you don't want your staff to be uncomfortable. That is a formula for potential bad outcomes," he says.
Admittedly, it could get murky during emergency procedures, such as performing an abortion to save the life of the mother. "It is a different situation when you are in the middle of a life-threatening situation. But even then, if you have someone raising questions, somebody else can step up," Duke says.
Using Nexis, Google, Yahoo, and other search engines, I found no instances where healthcare professionals are forced to perform abortions, or other medical procedure they find objectionable. I'm not saying it's not happening. I'm just saying that after two years of scanning the national news media every day for medical news, I have not seen this come up.
If the Bush administration and advocates for this new rule want us to believe that there is a need to protect of healthcare workers to perform abortions and other objectionable healthcare procedures, then they should be willing to provide specific examples of that undue pressure, and tell us who is applying it.
Actually, I believe the pressure will come from abortion rights opponents. It's pretty hard to imagine a hospital forcing a doctor to perform an abortion. But it's not hard to imagine pharmacists, physicians, and hospitals in generally conservative rural areas getting pressure from well-placed local churches and abortion rights foes to stop providing contraceptives and information on reproductive rights and options—and to stop performing abortions.
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
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After spending countless hours at the mall over the past month, you probably don't want to even think about those centers of commerce and aggravation, but shopping malls could play a role in the future of health plans.
There could be a day in the near future when a trip to the mall would include a list like this:
Buy milk and eggs at Piggly Wiggly
Purchase socks at Target
Ask about deductibles and health savings accounts at the health insurer
Health insurers are looking beyond their office complexes and moving into retail spaces as a way to connect with members and prospective ones. Pittsburgh-based health insurer Highmark Inc. announced last week that it will open retail spaces in January in two Pennsylvania locations, Mechanicsburg and suburban Pittsburgh.
Called Highmark Direct, the two pilot stores will help individual policy shoppers, small business owners looking to compare plans, seniors locating supplemental insurance, and the uninsured getting information about public programs.
The move into retail marketing channels might seem strange at first blush, but it is a natural progression in consumer-driven health. If health plans want members to act more like consumers, insurers may have to meet shoppers in that consumer environment.
Studies show that health insurers need to try something new because Web portals and incoming call centers are not enough to educate consumers about healthcare decisions. Hence, the trip to the shopping center.
Highmark Direct is not the insurer's first foray into retail. The Pennsylvania insurer has six Member Service locations that help members with questions about their plans.
While Highmark Direct will focus mainly on helping non-members, Steven Nelson, vice president of consumerism and retail marketing at Highmark, says the stores will also offer education programs and assist current members with core services.
Nelson says Highmark Direct will answer questions, such as what's an HMO, what's a PPO, how do deductibles work, and what are health savings accounts.
Highmark's new stores will include services found in retail spaces, such as self-service kiosks, as well as a video conference room that will allow consumers to speak with a call center representative to answer specific questions.
Nelson says the two Highmark Direct stores are a way for the insurer to learn more about consumer engagement. The storefronts are part of a larger movement at Highmark to improve member touch points, such as call centers, consumer relationship marketing techniques, and member portals and Web sites.
If these stores are successful in educating and engaging prospective and current members, one wonders how long it will take before health insurers find other ways to use retail spaces. One possibility is implementing disease management programs in the stores. Rather than wait for claims data from providers to find at-risk members, health insurers could collect biometric data at retail spaces and better keep track of patients. The retail spaces could even take the form of retail clinics.
Imagine how these services could improve disease management programs and provide a more complete picture of the individual member than claims data can offer.
As this example shows, retail spaces could become more than places to retain and acquire members. The possibilities are endless, but the ultimate question will be whether those advantages are cost-effective enough to offset a mall storefront.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
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