Do You Have a PCP? - Are You Sure?

California Legislation in the Making - A Process Unfolding
By Charles D. Goodman, M.D., F.A.A.P.

Background
When I discovered that California Law did not guarantee that I would be notified if my primary care physician left the IPA (Independent Practice Association) or medical group, I set out to change this. With the help of Harvey S. Frey, MD, PhD, Esq., I have asked the California Legislature to change the law. We still need a sponsor, but we are well on the way. Here is the letter we sent to Sacramento as well as the proposed changes in California Health and Safety Code.

Does your state law require that your health plan notify you if you doctor leaves your IPA or medical group? I thought mine did, but I was wrong. Find out in advance if yours does. Our letter explains how important this is. If your state does not, please feel free to use our changes as a template to change the law in your state as well. Ask your elected state representative.

Don't ask your HMO, they probably either don't know or won't tell!

If you live in California, contact your state assembly representative or state senator and ask them to sponsor and support the Continuity Of Care Bill Of 2000!

If they do not know what it is, have them call me.

Charles D. Goodman, M.D.

Charles D. Goodman, M.D., Inc. Fellow American Academy of Pediatrics 23101 Sherman Place, Suite 411 West Hills, California 91307 (818) 348-1614 FAX (818) 348-0710
January 14, 2000

Dear ____________, (California State Legislator)

Continuity of care is a critical component of all health care. Equally essential is access to the specialists and emergency care for which a patient has already contracted.

Some attempt has been made in the current California Health and Safety code to provide this. I have attached a copy of the existing law for your convenience.

Physicians and patients such as myself have noted that as more doctors leave managed care, more individual practice associations and medical groups either leave an area or become insolvent, the patient often becomes a victim not only of the financial difficulties inherent in managed care, but of a gaping loophole in California's law that allows patients to have a health care service plan with no primary care physician.

It is this enormous loophole that we are attempting to close. I have personally had countless patients with no primary care physician assigned to them. When I recently discovered that my own primary care physician had left his individual practice association, I discovered how easily this could interrupt one's health care. Furthermore, when I started to see if California state law had been violated by my IPA not informing me of my PCP's resignation, I discovered it had not. I found the first of many loopholes in the portion of the code dealing with this, namely Health and Safety Code section 1373.65 that allows the health care service plan to not inform me of such changes.

Although more often than not the health care service plan does voluntarily make these changes, the number of patients such as myself and the countless patients I see in my office who never receive notification and have no primary care physician is significant.

Many have no primary care physician; others have one but have never received notification of who their new primary care physician is. Both of the scenarios occur every day, every week, in the offices of all the primary care doctors with whom I have spoken.

Having no primary care physician can cause an escalation of a disease process and or continuation of pain both of which may have a significant impact on the patient. Patients often must seek care in the emergency room when they discover this situation. On nights, weekends, and holidays, the corporate offices of the health service plans are usually closed, making it impossible to correct this problem. Patients may need a specialist referral only to find this requires a primary care physician, which he does not have. Once again, care must be sought in the emergency room at greatly increased cost and inconvenience to the patient. Not to mention that emergency care was never intended to substitute for primary care.

Dr Frey and I are both active non-paid patient advocates. We have proposed this legislation to help countless Californians who find themselves without a doctor every day. Health care service plans often point to increased costs and decreased ability to offer insurance as a reason to not reform our managed care system. In the case of this change, those health care service plans that follow the law will have no additional costs. Only those that try to benefit by not assigning a primary care physician will see the increased costs of paying for care for which the enrollee has already contracted.

We are currently seeking a bill to which we may append these changes in the code. Finding a legislator who understands the importance of continuity of care and will sponsor this bill is critical.

Please review the current attached code and the proposed changes and contact me as soon as possible. Dr. Frey and I have widespread support for this change. Time is critical, as many more patients will experience changes this year in their health care due to the financial difficulties of many managed care organizations. I ask that you call me as soon as possible with your support, possible bills to which this legislation can be amended, potential supporters, and of course suggestions on how to further clarify the code in question and assure continuity of care.

Thank you for taking the time to consider this crucial issue. So many Californians appreciate your help!

Sincerely,

Charless D. Goodman, M.D., F.A.A.P.