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Re: Lack of Healthy Options? From: dahmd@gate.net Wed Mar 27 05:44:19 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Darach Corcoran: "Re: Lack of Healthy Options?" Previous message: mercedes: "Re: Virus alert, *NOT*" Maybe in reply to: Gary Kleinman: "Lack of Healthy Options?" Next in thread: Darach Corcoran: "Re: Lack of Healthy Options?" In article PDBurstein@aol.com writes: >We received a memo today from PrimeCare (United, of Minneapolis) our >largest HMO that as of May 1st they will no longer reimburse Ob/Gyns for >gynecologic ultrasounds. They will start a credentialing process for >obstetrical ultrasounds (fair enough, I suppose) and this is to be >supervised by an imaging group, Medical Imaging LLC, or something of that >ilk. >Excuse me, but isn't ultrasound becoming an integral part of obstetrics >and gynecology? Have we not replaced unproven operative procedures, such >as blind D&Cs, with TVS and directed biopsies? Have we not decreased the >number of unnecessary hysterectomies with better understanding of DUB and >medical therapy? It appears that we are going to become subservient to >the financial interests of our HMOs and be punished for the very >inovations which have been the exciting advances of our specialty. >Paul D. Burstein, MD FACOG >Clinical Assoc. Professor >Univ. of Wisconsin Milwaukee Clinical Campus Ask the "imaging group" if they use sonohysterography, or know how to correlate a pelvic exam with ultrasound findings. Your story is truly unfortunate but is probably the tip of the iceberg . My current favorite is that a number of HMO's in our area are telling us that we cannot perform a hysterectomy unless we first to a D and C. D and C's are *in general* a very outdated procedure for diagnosing DUB, and almost never treat it, unless you are fortunate enough to remove an offending polyp. We tell them we are unhappy that they are putting our patients at risk for additional operative risk, since we will almost certainly need to come back later to do the original, indicated, procedure, then tell them we are however quite happy to take their money by doing multiple procedures! That usually causes the "reviewer" to give pause. Finally, we just tell the patient that we disagree with the reviewer, and she can fight it out if she wishes. One 48 year old patient was recently refused a vaginal hysterectomy for recurrent carcinoma-in-situ of the cervix (3 prior cone biopsies), with symptomatic prolapse. Her reviewer told me to do another cone biopsy and put in a pessary! She was a mid-level manager for the insurance company, and despite raising hell with them, was still refused. It is getting out of control fast. Amazingly, the malpractice lawyers may actually be our saving grace by suing HMO's for practicing medicine. Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net Next message: Darach Corcoran: "Re: Lack of Healthy Options?" Previous message: mercedes: "Re: Virus alert, *NOT*" Maybe in reply to: Gary Kleinman: "Lack of Healthy Options?" Next in thread: Darach Corcoran: "Re: Lack of Healthy Options?"

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