Wanted to ask what people think the role of the nurse is in this situation? Do we have a role in ensuring quality of care? How are you seeing Managed Care effect quality in your enviorment?
Saw a good article in the Wall Street Journal regarding ERISA. There are several court cases especially in the State of Texas that are challenging this law that has protected HMO's against lawsuits. The article shows that Congress as well as many states are looking at whether to pass legislation that would give consumers the explicit right to sue their HMOs over the quality of care they receive. The financial implications of the trend is considerable since if this law is repealed, it would also expose employers since they chose the HMO! This means that employers could also be dragged into court cases and law suits if there is a malpractice claim against a doctor of an HMO due to a bad outcome. The supreme court has said that ERISA was meant only to assure the uniform administration of employee-benefit plans, not to displace the role of the states in regulating the quality of the care the healthplans provide. The article gave good examples of problems that all CM should be aware of. If you want the article, it was in the April 30, 1999 Marketplace section of the Wall Street Journal.
Anne Llewellyn, Owner, Professional Resouces In Management Education, INC
www.accessrehab.com
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