By PORTER McNEIL

Medical Act rewrite fails; 1987 review still scheduled

NEXT YEAR is the year of review for all acts relating to the licensing and regulation of the medical professions. But the Illinois State Medical Society (ISMS), Gov. James R. Thompson and various senators didn't want to wait. They attempted to short circuit the process for reviewing the laws, which automatically expire at the end of 1987.

The ISMS and others put together a 73-page rewrite of the entire 1923 Medical Practice Act and called it the Medical Practice Act of 1986 (S.B. 2202). The act would have implemented many of the 1985 recommendations made by the Governor's Task Force on Medical Discipline which urged the medical professions to police their members more thoroughly and weed out incompetent practitioners.

But suddenly revealed among the proposed provisions was an unexpected section, the so-called "Informed Physicians Bill." It triggered a chain reaction of attacks by legislators, consumer groups and business critics who said the provision would lead to price-fixing and higher health care costs. The controversial section called for the establishment of a Medical Services Contracting Board to consult with physicians on terms, conditions and rates of contracts between physicians and those who underwrite payment of doctor's bills — employers, Preferred Provider Organizations and Health Maintenance Organizations. Opponents, including Common Cause, the Illinois State Chamber of Commerce, the Illinois Manufacturers' Association and the Illinois Public Action Council, claimed that the proposed board and its consultation service would lead to price-fixing among Illinois physicians. At the request of state Sen. Emil Jones Jr. (D-17, Chicago), the Federal Trade Commission (FTC) analyzed that section of the bill. To the chagrin of bill advocates, the FTC issued a critical opinion, charging that the section was "designed to shield activities that typically are forbidden by anti-trust laws .... Under this proposed system, the price of health care is determined not by competition in the marketplace but by agreement among competitors, subject to the limited review of a governmental authority.'' Some opponents also felt that by trying to rush the bill through, the ISMS and others were trying to avoid the scrutiny of public hearings planned for next year on the health care professions, including medical malpractice.

Proponents rejected the price-fixing accusation, including Sen. Judy Baar Topinka (R-22, North Riverside), one of the bill's sponsors along with Sens. John A. Davidson (R-50, Springfield) and Jack Schaffer (R-32, Crystal Lake). Sen. Topinka argued that physicians simply don't have the time or expertise to choose the best health care contract available. Topinka admitted that the informed physicians section was pro-physician, but she pointed out that the bill also included substantial physician disciplinary measures that they would not like.

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Speaking for the provision, Jeff Miller, spokesman for the governor, told a Senate Insurance, Pension and Licensed Activities Committee that in the current "health care revolution," physicians are bombarded, even threatened, by insurance companies wanting them to sign contracts. He added that seeking advice from the board would be strictly voluntary for physicians. Yet Miller also explained that doctors did not need the new section. He said, if doctors now want to band together to discuss contracts they can do so; they don't need a law to engage in such activity. Timing more than substance seemed to doom the entire bill in 1986.

'... it is not shocking' that proponents
would try to rush a 'doctor's cartel' bill through
in a 'back-alley fashion'

Since 1979, when the legislature passed the Regulatory Agency Sunset Act (P. A. 81-999), a timetable has been in effect for reviewing all acts relating to the licensing and regulation of professional groups. The act also created the Select Joint Committee on Regulatory Agency Reform (the so-called sunset committee) to perform the sunset reviewing task. The sunset committee has since been abolished but not the timetable nor the review process. The health care professions have been set for review in 1987.

The original idea was for the sunset committee to comb through the statutes, searching for irrelevancies and redundancies to eliminate, and to hold public hearings, seeking consensus on new ways to keep up with the changing nature of various professions. Although the General Assembly abolished the sunset committee, other legislative and executive bodies review the licensing statutes with or without a timetable. Some of them include the House State Government and Regulatory Review Committee, the Senate Insurance, Pension and Licensed Activities Committee, the Illinois Department of Registration and Education and the Bureau of the Budget. But many feel that some professions, such as the those in health care, deserve special review attention by special sunset committees, whether temporary or permanent.

This was brought up with a good
six weeks to go [in the session] . . . There was
absolutely no desire to deceive; everybody
knew what was out there'

Opponents to this year's proposed rewrite of the Medical Practice Act felt that the sunset process was violated by what they viewed as a callous snubbing of open and public debate on the act. "I really am deeply offended at the procedure," said state Sen. Dawn Clark Netsch (D-4, Chicago). "To take the principal profession out [of the sunset review scheduled for 1987] and casually rewrite their law . . . is a total subversion of the legislative process .... It makes really kind of a shambles of the sunset review process .... I think it is absolutely unconscionable."

Executive director of the Illinois Public Action Council, Robert Creamer, said that "it is not shocking" that proponents would try to rush a "doctor's cartel" bill through in a "back-alley fashion." "It is our view that [proponents] would like to get this whole rewrite process over so that the real problems of medical care quality are not part of that [1987 sunset] debate."

But Topinka took a different view, claiming that there were two committee hearings and a two-hour conference that addressed the bill. "This bill has been kicked around so much that I don't think anybody really doesn't know what's in it," she said. "That is almost unheard of in this legislative body .... This was brought up with a good six weeks to go [in the session] .... There was absolutely no desire to deceive; everybody knew what was out there." Topinka said the current act is too outdated to wait another year. "I didn't realize the thing was that moldy. It is just not pertinent," she said. "Because it has been amended over the years you get this crazy quilt patchwork of things. I really feel sorry for these [health professionals] people." Since S.B. 2202 did not pass, the General Assembly and members of the public will have an opportunity to proceed with the scheduled 1987 sunset review of the acts relating to the state's health care professions. To facilitate the process, the House and Senate passed House Joint Resolution 198, which sets up a temporary sunset committee for the 1987 review.

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