GPs in a bind over ‘micromanaging’ by ‘medical middlemen’

Some general practitioners say their ability to offer quality care to their patients has been hindered by the rules set by managed care organisations. (Reuters pic)

PETALING JAYA: A medical association has urged the government to review the role played by managed care organisations, saying their “quasi-regulations” are taking a toll on private general practitioners (GPs).

Dr Steven Chow, treasurer of the Federation of Private Medical Practitioners’ Associations Malaysia, said the rules set by managed care organisations made it difficult for GPs to provide patient care.

These rules include limiting a patient’s right to choose their doctor, restricting medical conditions that doctors can treat, and prohibiting ultrasounds or blood tests from being done.

Managed care organisations are third-party entities that help companies or private healthcare providers manage administrative matters related to claims and payments.

Chow said some rules enforced by managed care organisations conflict with existing laws and regulations, citing the example of policies that restrict conditions that doctors can treat and be reimbursed for.

“This is potentially a violation of the Private Healthcare Facilities and Services Act 1998 and related regulations from 2006,” he said.

Chow said there were also rules barring the receipt of payment for specific medications, even though these medicines are registered with the National Pharmaceutical Regulatory Agency and prescribed by a medical doctor.

“This interferes with the statutory right of the doctor to prescribe,” he said.

Dr Chang Chee Seong, a GP, said the rules set by managed care organisations had led to the provision of medical care being driven by cost rather than best practices.

He said his ability to offer quality care to his patients had been hindered by price caps imposed by such managed care organisations.

Another GP, Dr S Madhusudhan, said he was restricted to providing basic treatment and not permitted to conduct further diagnostics on his patients.

On Aug 5 last year, the Malaysian Medical Association (MMA) voiced concern over the inadequate regulation of managed care organisations in their operations and activities.

Dr Muruga Raj Rajathurai, then president of MMA, raised concerns over the substantial registration fees that some managed care organisations imposed on private clinics to become panel clinics, which could reach as high as RM5,000 per instance.

He also said these organisations obtained revenue through “fee-splitting”, an illegal practice in medical services, either by reducing GP consultation fees or claiming a portion of these fees through deductions from the final settlement.

Muruga said such issues had been raised with the health ministry since 2015, “yet no corrective action has been taken”.

Guidelines set out by the health ministry for managed care organisations stress the importance of “conforming to professional standards, maintaining patient confidentiality, and ensuring equitable billing practices”.

They also detail the consequences for infractions, including fines and imprisonment, and set out the protocol for sharing information and keeping it up to date. - FMT