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Re: Insurance "recommendations" for practiceFrom: ainsron (ainsron@sbcglobal.net)Mon Jul 24 11:31:49 2006
I agree with you, I would be pissed too. Are other carriers an option? Can your ACOG district offer any assistance on reviewing this piece of trash? Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn Montgomery, MD Sent: Wednesday, July 19, 2006 6:46 AM To: Multiple recipients of list OB-GYN-L Subject: Insurance "recommendations" for practice Listers, I am pissed and I apologize in advance because y'all are my closest sounding board... I received a booklet in the mail from the medical malpractice insurance company that covers most of us in Montana. The booklet is titled, "Insurance Recommendations for Obstetrical Practice". Under the title on the cover page is says, "There are only two options for delivery: An easy vaginal delivery or an easy cesarean section". The booklets starts off by making the following statement, "Failure to abide by the insurance recommendations in the absence of the patient's written consent will not affect coverage provided under a policy then in effect, but may result in non-renewal of the policy or renewal with an exclusion of the coverage for obstetrical care". The booklet then lists basically all types of obstetric management and situations and provides very matter of fact direction on how each of these situations should be managed. Dictums are provided - no acceptable alternative, one way, period. Further, the booklet contains NO references or bibliography. Some examples of the "recommendations" -"it is inappropriate to discuss serum screening in terms of "false positives". Rather this should be offered to all pregnant women in order to determine whether or not they are at increased risk for Down's syndrome, and the absolute magnitude of this risk." -"cesarean section is almost always the appropriate route of delivery for lack of progress in labor, unless criteria for outlet forceps are met." -"all singleton breech fetuses (24+ weeks gestational age) should be delivered by cesarean section." -"VBAC - Elective induction is contraindicated. The only acceptable oxytocin regimen is a starting dose of 1mU/min, increasing by 1 mU every 30 minutes." The following quote is included, "Remember that most cases of uterine rupture will be heralded by the appearance of new, significant variable decelerations. A low threshold for intervention in the presence of such decelerations, even with good variability and accelerations, in mandatory in the VBAC patient". -"When misoprotol is used with a living fetus, which is potentially viable exutero, the following precautions are mandatory: The dose is 0.25 mcg vaginally The dose cannot be repeated more frequently than every 4 hours Elective induction with misoprotol is contraindicated" These are only a very few examples of the mandates listed on 25 pages. I am personally offended by the fact that an insurance organization, to whom I pay thousands of dollars in premiums is providing mandates, not suggestions, on the management of patients that I trained to care for over many years of residency, fellowship and practice. Further, it has been beat into me by every mentor worth his/her salt that management should be based on review of the most current literature. Many of the recommendations included in this booklet are not necessarily substantiated by our body of literature, but rather based on legal case history. As such, we are being coerced into practicing medicine based on law rather than medicine. I was further personally offended by the fact that a booklet like this is issued without the inclusion of references or bibliography - probably because most of it would be referenced in West Law. It is time that the fricking attorneys stayed up watching a tracing at 2:00 am like I did last night. Lynn
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