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APA is giving a mixed appraisal to a draft consumer bill of rights that will go to President Clinton for review and final release by Thanksgiving.
The draft was issued by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry following months of work and a series of open meetings and public hearings. The commission’s report, which requires the President’s approval, was reviewed during two days of open meetings last month in Washington, D.C.
Although the final report may serve as the basis for future legislation or regulations, it will not itself have the force of law.
The October meetings of the full commission were preceded by subcommittee meetings and public hearings. APA President Herbert Sacks, M.D., spoke to the Subcommittee on Consumer Rights, Protections, and Responsibilities at a September hearing in Chicago, urging the commission to recommend nondiscriminatory coverage of mental illness (Psychiatric News, October 17.)
The bill of rights is the first of a series of reports that the commission plans to issue between now and next March.
The draft version of the commission’s Consumer Bill of Rights and Responsibilities in Health Care is "a valuable, but unfortunately, an incomplete document," wrote APA Medical Director Steven Mirin, M.D., in a letter to the commission’s cochairs, Secretary of Health and Human Services Donna Shalala and Secretary of Labor Alexis Herman. Mirin expressed particular concern about the report’s failure to address clearly the issue of parity health insurance coverage for mental illness and the inadequacy of its recommendations for protecting confidential medical records.
Although the confidentiality recommendations are not strong enough, APA supports the recommendation letting states mandate stronger confidentiality protections for medical records than would federal law.
The commission consisted of more than 30 members, including consumers, insurers, academics, and health care providers. Former APA president Herbert Pardes, M.D., and former APA secretary and deputy medical director Steven Sharfstein, M.D., who sat on the commission, discussed the bill of rights with Psychiatric News.
"I think the commission is a welcome development because it provides an opportunity to redress the balance a little bit in the direction of quality and consumer rights," said Pardes, who is dean of Columbia University’s medical school. "I think the President and Donna Shalala and Alexis Herman should be applauded for having the commission in the first place. Having said that, a number of things concern me."
Although the bill of rights may not have been the place to address mental health parity, Pardes observed, "it is reasonable for the commission to make some kind of statement to the effect that mental health parity should be a goal ultimately achieved by the nation."
The bill’s position on continuity of specialty care is inadequate, said Pardes. It gives patients who involuntarily change health plans only 60 days to make the transition from their current provider to a new one.
While it may be impractical to assure continuity for everyone seeing a specialist, that right should be accorded the severely chronically ill, Pardes contended. This should apply "whether for someone with cancer with a year to live or for someone with severe, chronic mental illness."
Confidentiality is a tough issue, said Pardes. "I don’t know what the right balance is, but I think we have to be very careful with patient information. Information purported to be nonidentifiable should be noniden-tifiable. The consumer should have no worry that it could be linked to him or her if you say it can’t be. While I would tilt to protecting the consumer, I understand there are pressing instances when one needs to have access to some information."
The bill’s support for an ombudsman who would serve as an internal patient advocate within health plans is positive, said Pardes. It is also important that the final report released by the President support the right to insurance coverage for federally approved clinical trials, he said.
"I would hope that the business of advocating for consumer quality is a continuing effort," Pardes remarked. "Not everything the commission will do is in the bill of rights." APA should continue to press its concerns as future commission reports are formulated, he said.
The chapters in the commission’s draft report "speak to issues that are of major concern to psychiatric patients," said Sharfstein, who is president, medical director, and CEO of Sheppard Pratt Health System, Baltimore. Although the language is "very broad," it does not expressly exclude people with psychiatric disorders, he commented.
There was "ongoing opposition to saying anything about expanding benefits," Sharfstein said. Despite this, there were spirited discussions surrounding nondiscrimination against patients and the right of appeal. Both these areas are of central interest to people receiving psychiatric care, he said.
Both he and Pardes pressed the case for "the right to continuity of care by a specialist," Sharfstein said.
The consumer bill of rights "is going to say something that’s not there right now," Sharfstein said. Although lacking force of law, it provides a moral framework that policymakers, including President Clinton and Congress, may take as a point of departure.
"The democratic process will pick up on this and drive health system change from there," Sharfstein said. "[The report] will improve [the process] by enhancing efforts toward mental health parity and strengthening confidentiality."
The commission’s recommendations are an overdue shift "from a focus on cost to a focus on quality," concluded Sharfstein.