The District of Columbia's two medical societies have killed, for the moment at least, an attempt by a local health care monitoring agency to conduct a voluntary, experimental program offering Medicare and Medicaid patients another opinion on whether to have recommended surgery.
The National Capital Medical Foundation, established under federal law to monitor medical practices, failed yesterday to meet the deadline for submitting a proposal to conduct a "second opinion" study in the District of Columbia after the two medical groups declined to participate.
The foundation's board of 15 physicians and three public members had voted 12 to 4 to seek U.S. funds for a study if the D.C. Medical Society and the Medical-Chirurgical Society of the District of Columbia agreed to participate.
Second opinion programs are believed by some health professionals to reduce the amount of surgery performed and thus to reduce total medical expenditures.
The federal study initially is designed to encouraged second opinion programs in locations across the country. Another study is planned later to evaluate the performance of the programs to see if surgical rates are affected and if the cost of operating the program produces equal or greater savings.
Dr. Warren Strudwick, a surgeon, responded to the foundation's request on June 20 on behalf of the D.C. Meidical-Chirurgical Society and said that the consensus of opinion within the group was not to participate.
He listed several reasons, including the increased burden the program would put on inner city doctors compared to doctors in Washington suburbs who would not be included, the presence of other checks on unnecessary surgery, the necessity of establishing a bureaucracy to administer the program, and a lack of clarity in the metods to be used. Struckwick also said that many patients and some doctors would feel obligated to obtain a second opinion, which would "disrupt doctor-patient relationships."
Although the D.C. Medical Society has not formally responded to the foundation's request for participation, the group's president, Dr. Raymond Scalettar, said yesterday that his group was also opposed. Schalettar said that the concept of the study is "basically and in itself inflammatory . . . It's just one more demeaning epithet that had been talked around glibly."
Scalettar said that substantial checks and balances already exist to prevent unnecessary surgery. "We do not believe that such a study is necessary and that it will fall into a realm of a self-fulfilling prophecy," Scalettar said adding that the "net effect is a further reduction in confidence (of patients in doctors) of which we don't need any more."
A number of voluntary second opinion programs are in operating in New York, Massachusetts, Michigan, New Hampshire, Vermont and some other states, Aetna Life and Casualty, one of the largest commercial health insurers, began offering its 125,000 Washington are subscribers another doctor's opinion on surgery at no exrra charge last January. The D.C. Medical Society also refused as a group to participate in that program.
A controversial program in New York City sponsored by two unions reported reductions of 16 per cent to 17 per cent in surgery by requiring a second opinion before elective - or non emergency - surgery was performed.
Dr. Norman Fulle, executive director of the National Capital Medical Foundation, said that the group's board felt that if a study was to be done, "it had to include all doctors." Approximately 2,000 of the 4,000 eligible physicians in the District of Columbia belong to the foundation which revies medical practices to try to eliminate unnecessary procedures, tests and hospitalization.
Fuller said that the foundation viewed the program as educational. "It's really a consumer study," Fuller said. Patients would not have had an obligation to follow the second opinion, he said. The foundation was proposing to use only board-certified surgeons for its second opinions.
Fuller predicted that the study would be done sooner or later by the foundation, either with U.S. funds or without them."It's going to be done," Fuller said. "There's no doubt about it. When it's going to be done in this area, I don't know . . . The main thing is the participation of the physicians, which we haven't got. But I'm not sure that they're unalterably opposed."