MMS and HPHC Modify Prior-Notification Program

by Tom Walsh

The compromise arising from months of talks among MMS leaders and Harvard Pilgrim Health Care (HPHC) was welcome news for those determined to simplify doctors' administrative burdens and curb rising health care costs.

It wasn't easy, and the job is not complete. And, as with most compromises, not everyone is completely happy with the result, at least for now. Yet the discussion between HPHC and the MMS on modifying the health plan's controversial prior-notification program for many outpatient radiological procedures may set a tone for resolving such differences in the future. The MMS was very clear that physicians have a key role in medical decision making and that the unilateral imposition of programs such as this is unacceptable to the community at large. more