Timothy Gorski, MD, FACOG
As Medical Sentinel readers may know, particularly my Ob/Gyn colleagues, many insurance companies and HMOs have instituted "prenatal wellness programs" (PWPs). Typically, patients are called or induced to call the company and a company nurse records a detailed medical history including sexually-transmitted diseases, abortions, etc. These programs are represented to patients as being "in cooperation with" or "with the participation of" patients' physicians. But physicians received only a computer printout copy of the record generated by the insurance company. The companies claim that their PWPs improve patient care, reduce prematurity rates, and/or have other medical benefits.
I believe that we ought to be seriously concerned about these programs
for the following reasons: 1. PWPs do not assist us in any way with our
care of pregnant patients. They simply duplicate a small part of our standard
of obstetric care.
2. There is no evidence that PWPs reduce prematurity rates or have any other medical benefits beyond competent obstetric care, notwithstanding claims to the contrary...
3. It has long been the policy of the companies that sponsor these new "innovative" programs to deny payment to physicians for their time spent in patient education, the provision of teaching materials, and after-hours telephone consultations. Yet, now, moneys that were once devoted to patient care are being expended on PWPs that claim to offer similar benefits outside of the patient-doctor relationship.
4. Because health insurance companies have always said and continue to claim that they do not practice medicine, PWPs do not constitute bona fide medical care. Therefore, the information gathered about our patients by PWPs is not a part of the medical record...Only information taken from an actual medical record or which is derivative of it, such as insurance claim forms, enjoys privacy privileges.
5. Products or services provided or made available by insurance companies through PWPs, for the aforementioned reasons, are not and cannot be a part of individualized medical care. In addition, ethical and legal considerations that motivate physicians to subordinate economic and commercial factors do not apply to the health insurance companies and their PWPs, so that they are free to promote, provide, or make available products and services that are not selected primarily for reasons of the health and well-being of patients. There is already some indication of this happening in that some companies are "partnering" with pharmacies and supplement manufacturers.
6. Liability issues may well arise inasmuch as PWPs represent themselves to patients as being a part of their medical care and/or that they operate "in cooperation with" or "with the participation of" their physicians...
7. The accumulation and uncontrolled use of information gathered by PWPs could have worrisome future effects. Besides its inherently personal nature, it could result in the denial of insurance coverage for pre-existing conditions...[and] other conditions that may in the future be found to have genetic causes...
It may be that health insurance company executives sincerely believe that PWPs can help physicians and reduce costs. Or it may be that PWPs are thought to be good marketing tools for them. But the implications for medical practice, quality of care, liability, privacy, and other issues are considerable.
Dr. Gorski is an obstetrician in Arlington, Texas. E-mail: email@example.com
Originally published in the Medical Sentinel 2000;5(1):21-22. Copyright©2000 Association of American Physicians and Surgeons (AAPS)