To the Editor.—As president of the Palm
Beach County Medical Society this past year, my concern was to educate people
about the quality of care they were not receiving. However, after reading
the Commentary on managed care and quality by Dr Brook,1
I would like to point out that either the managed care in southeast Florida
is a different animal from what Brook has in California, or he is not living
in the real world. I am referring to the sentence, "Physicians must now obtain
approval from colleagues to order tests or perform extensive evaluations."
Every physician that I know of who is in a managed care organization and who
orders test, workups, and treatments for his or her patients never consults with or gets approval from a "colleague." Instead, the
office staff is on the telephone for 45-minute intervals, seeking approval
for an x-ray film from an authorization person sitting in front of a computer
making sure that certain criteria are fulfilled before a test can be ordered.
This "approval process" delays treatment, creates a bottleneck, is inefficient,
and passes the costs on to physicians and their office staff, while enabling
insurance companies and managed care organizations to delay, deny, and alter
care with the bottom line being greater and greater dollars in their pockets.
Dedo DD. Reengineering Quality in Managed Care. JAMA. 1998;279(12):913. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325