Further Meetings with Coventry
Steve R. Eckstat, D.O.
A third meeting was held on Monday, July 1, 2002, with Mr. Michael Teachout, CEO of Coventry Health Care of Iowa, and Dr. Jerry LeMar, Medical Director of Coventry Health Care of Iowa, to further discuss issues relative to the cost effective practice of medicine. The big issue of course is that of proton pump inhibitors and Coventry's policy of denying prescriptions for these medications unless the patient meets fairly strict and rigid guidelines. Furthermore, even when the patients have met these guidelines they are then told after 8 weeks that the medication is no longer appropriate and are refused prescriptions once again. Through our meeting Mr. Teachout and Dr. LeMar came to realize that this may not be the most appropriate way to approach cost containment issues relative to the high cost of proton pump inhibitors. Although it may say in the PDR that continued use beyond 8 weeks is not appropriate for most proton pup inhibitors, it is certainly community standards as well as national standards to continue the use of proton pump inhibitors for many individuals who cannot tolerate a less expensive form of therapy. Years of experience have proven the safety and effectiveness of long-term therapy on proton pump inhibitors. Certainly it is this denial of these prescriptions that has created havoc in all of our offices. After much discussion it was suggested that a more rational approach to appropriate treatment as well as cost containment issues would be to require prior authorization for initial prescriptions for proton pump inhibitors and allow those already taking them and doing well to continue their use. Certainly the vast majority of individuals with abdominal pain secondary to ulcers or GERD will do well with H2 antagonists, and this form of treatment is both effective and less costly. If the patient fails a trial of the H2 antagonist then they can be given a proton pump inhibitor, and of course if they fail on that they would most likely need to be referred to Gastroenterology for further evaluation. Once the physicians reacquaint themselves with the use of H2 antagonists they may very well find that these have been and still are quite effective medications for both peptic ulcer disease and reflux. Physicians may wish to retry some of their patients currently on proton pump inhibitors on these less expensive medications. This approach is less intrusive, certainly less aggravating for the patient and the physicians and their office staff and will most likely lead to more cost effective management of these particular patients.
Further discussion ensued relative to other areas of medicine where we might work together with the managed care companies to practice more cost effective medicine. One of these areas is the use of MRI. Realizing that every patient with a back ache does not need an MRI we may choose to meet with experts in the field of back pain and come up with a rational criteria for the evaluation of back pain and the appropriate use of expensive high tech diagnoses and treatment. Other areas of medicine can an will be discussed in the future meetings.
It was felt though these discussions that an open dialogue has been created and that by working together weigh the payers and the practitioners we can come up with more rational and less intrusive ways to manage the cost of medicine as well as continue to provide the best medical care we can offer. Mr. Teachout and Dr. LeMar agreed to take these ideas back to their corporate office for further discussion and we will have further communications and meetings to discuss these very important issues of quality care in the face of cost constraints. It is also our hope that meetings such as these will become a model for further meeting snot only with Coventry, but with other carriers to keep an open dialogue between all the players in providing quality care for our patients.
