March 31, 1999 Milton M. Thomas, MD Associate Medical ...

March 31, 1999

Milton M. Thomas, MD Associate Medical Director CIGNA HealthCare of Texas Two Riverway, Suite 1200 Houston, Texas 77056

Dear Dr. Thomas:

On behalf of over 115,000 physician-members of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), I am writing to urge CIGNA HealthCare of Texas to terminate the planned launch of a mandatory hospitalist program.

Your letter, dated February 18, suggests that "the hospitalist program will enhance the continuity of care for your patient". You have seriously miscalculated. A mandatory hospitalist program does just the opposite, it fractures the continuity of patient care. Furthermore, denying patients the right to choose their personal physician to care for them at the time when they are in need of hospital care will decrease satisfaction among patients and provoke outrage from physicians.

ACP-ASIM's official policy is to support hospitalist programs only if participation is voluntary. Patients must have the opportunity to discuss the potential advantages and disadvantages of hospitalist programs with their primary care physicians and must be free to choose.

The National Association of Inpatient Physicians (NAIP), the organization that represents hospitalists nationwide, also opposes mandatory hospitalist programs such as the one you propose to institute with Inpatient Medical Services, P.A.

I wrote a just-published article on the internists' perspective on the hospitalist model, and I enclose a copy of same. Many influential leaders in medicine have told me that my article got the issue just right. They share my deep concern that mandatory hospitalist programs will fundamentally reshape what physicians do, to the great detriment of patients who want a choice of physician when they get sick. Mandatory hospitalist programs are bad public policy, just as they are bad for individual patients.

Managed care organizations should be learning a lesson from their recent experiences. Some years back, managed care organizations offered patients a limited choice of network physicians, only to learn that they had neglected patients' expressed wish to choose their physician. There have been other instances in which the American public has pushed back when health plans have gone too far. I believe that you will get the same message if you persist in your current misguided effort to limit freedom of choice for patients. When patients start to realize that CIGNA will prevent them from receiving care from their regular physician when they require admission to the hospital, you will see a backlash. In this situation, you have pushed too hard to restructure health care at the expense of patients' interests, and I think you will pay a price.

Although managed care has served the public interest in some ways, some health plans seem to feel that they can do anything to the profession of medicine in the interests of cutting costs. What you are doing, in this instance and others, is to attempt to restructure health care to meet your corporate needs. Despite your efforts, the practice of medicine will survive, largely unchanged since the time of Hippocrates, precisely because it places the needs of the patient first and because it responds to universal human needs.

We urge CIGNA HealthCare to reconsider before everyone, including yourselves, suffers harm. Don't impose a mandatory hospitalist program in Texas.

Sincerely,

Harold Sox, MD, FACP President

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