Meeting Minutes: November 3, 1993

Motion

The meeting was called as a result of a petition stating:

"In view of the very short time available to make a selection of the new medical plans, and in view of the limited and sometimes contradictory information available, and in view of the limited list of Primary Care Providers in the Point of Service Option, we request, according to the Bylaws of MU, Article III, Section 1, that a general faculty meeting be called, with all possible haste, on the Columbia Campus to consider the following motion:

The faculty of the University of Missouri-Columbia request that the implementation and sign-up dates for the new medical plan be delayed for six months in order that there may be appropriate clarification and correction of the present documents and plans."

Attendance

Chancellor Kiesler called the meeting to order in Jesse Auditorium at 3:35 p.m. Approximately 175 faculty members were present.

Chancellor's Remarks

Chancellor Kiesler stated that the new health care plan was in response to galloping cost increases (15 percent per year) and the need to keep them under control. He stated that there would be savings under the new plan this year and that GenCare Sanus had contracted for three years, during which time rates would remain flat. (This statement was later contradicted by Vice-President McGill, who stated that increases in premiums would be limited to eight and three-fourths percent per year.)

The Chancellor stated that the lower salary one made the more important such cost controls were, and that a local union (i.e. Local 45), had endorsed the concept. It was also important that the University Hospital survive in this venture. The next fiscal year would see a savings of over three million dollars. New developments since the motion was submitted: a) extension of deadline to December 1; and, b) the introduction of the option of remaining on the current plan with a $250 deductible.

The Chancellor alluded to the inaccurate article in the Missourian that morning and hoped that it had not confused anyone. Unlike the POS and HMO, which one can change only once annually, one could opt out of the $250 deductible plan at any time. Recent issues of "Health Spectrum" and Mizzou Weekly had attempted to answer concerns. A letter signed by the Chancellor and Dean Bryant has been sent to local physicians inviting them to join the POS or HMO or both; the offer also extends to them usage of University Hospital. The remaining concern was whether physicians would be willing to accept the discounted fee schedule.

Faculty Remarks

Professor Andrew Twaddle then made the motion stated in the call for the meeting. He remarked that he had long been an advocate of managed health care. What troubled him was the lack of intelligibility in the documents provided us. GenCare Sanus should have time to prepare adequate descriptions, the University should have time to make corrections, and the faculty and staff should have time to make informed decisions. Professor Twaddle showed a number of transparencies, the texts of which appear here as Appendix I. He alluded to the problem of defining emergency care versus urgent care, and the treatment in emergency rooms especially when out of the area, and gave several other examples of oral statements contradicting written materials. Further problems exist with faculty on leave or out of the area while off payroll (nine-month contract). He gave an example of a couple with chronic problems who would be faced with greater out-of-pocket costs under any version of the new system than is the case currently, even the HMO being more expensive than the current $l,000 deductible plan (see Appendix II). He stated that the new plan as it now stood was a moving target which one could not reasonable be expected to sign up with.

Professor Gordon Kimber then rose to second the motion. He remarked that he too wished to see health care costs contained. He faulted the new plan for the lack of precise information, and deplored the lack of widespread participation by the medical community. As an example of ambiguity and contradiction he cited recent uncertainty as to whether Boone Hospital Center was or was not in the POS plan. GenCare Sanus referred to the documents as "the best information we have at the present," but stated that the final plan would not be known until January 1, 1994. We were all being asked to sign a blank contract.

Vice President McGill admitted problems of communication, but said that there was an attempt to get things corrected. New material was in preparation as he spoke, and would be sent out next week, probably by U.S. mail. He admitted that Boone Hospital Center had indeed wanted to withdraw from POS, but now was firmly in it. He alluded to the possible future inclusion of birthing centers.

Chancellor Kiesler referred to future one-on-one question and answer sessions and stated that he had received a number of communications from persons who wanted the plan not to be delayed, and wanted to start saving as soon as they could.

There ensued a general discussion, the more salient points of which are reproduced in these minutes.

Professor Doug Randall asked that the table (Appendix II) be published, and McGill said that he would do so, adding other comparative tables.

Professor Ed Metzen elicited the correction that GenCare Sanus had not indeed promised a flat rate, but still wanted to know how such caps could be enforced. McGill answered that reduction of paperwork was one way.

Professor Joanne Heisler asked whether there was any chance for an HMO with Boone Hospital. The Chancellor said, "No".

Mr. Olen Brown expressed appreciation for having the additional option of remaining with the present plan but wondered why it was restricted to the $250 deductible plan. He received an inconclusive answer.

Ms. Katherine Lyman asked for additional information on the HMO and asked if the motion passed, what would happen during the interim. The Chancellor stated that there was a cost of $300,000 a month for each month of delay. McGill stated that a lot of people wanted to get started now especially on HMO. President Russell has said we must proceed. The Chancellor clarified that the intent of the motion was that everything remain as is for another six months.

Professor Don Sievert reminded the faculty that the Faculty Senate at UMKC had also requested a six month delay. He also said that the prospect of receiving information only after sign-up was unsatisfactory, as was the answer, "we cannot deal with specifics," because we are all specifics. He was concerned about treatment of emergencies due to chronic conditions, and the necessity to call a "gatekeeper" before seeking emergency treatment. He has requested that all questions raised at the information sessions be answered in writing, not only the most common questions. The Chancellor in reply spoke of the necessity of good patient satisfaction and feedback loops. In return Professor Sievert spoke of constituting a standing committee to monitor the system after it got off and running. The Chancellor and McGill said that would be okay.

Professor Bruce Biddle spoke of returning from leave, and not knowing how his medical costs would have been covered under the new plan. He said he could not figure out how his medical costs would be covered if he were on vacation with a nine month contract, or at a convention with a non-life threatening condition, or if he were overseas. In Korea there might be some way of contacting a physician here before seeking medical attention, but what if he were in Tibet? The Chancellor admitted it was a problem needing clarification and McGill stated that these questions would be addressed in material later to be distributed. McGill finally said that in POS the treatment of emergency/urgent care would be the same here or elsewhere, in HMO there would be a $15, not $5 co-pay for urgent care, and one could contact a local physician after treatment.

Professor Walter Johnson stated that Boone Hospital Center tried very hard to negotiate a HMO and did not know who (GenCare Sanus or the University) had nixed the idea. He found everybody to be in the back seat and no one driving.

Professor Victor Estevez brought up the matter of Dialysis Clinics of Columbia; were they in HMO, POS, or out of network? As of 3:00 p.m. the day before Dialysis Clinics had not been contacted. Professor Estevez had been informed by GenCare Sanus that dialysis elsewhere would be out-of-network. McGill had no information.

Ms. Kathy Basnett found even an eight percent increase in premiums excessive if staff were to receive three percent raises. She was concerned about constantly escalating medical costs, and whether the university could control them. She reiterated the point that we are expected to make decisions before being properly informed. She questioned why we now had to go through a "gatekeeper" to continue seeing a specialist whom we had already been seeing.

Professor Loren Nikolai wondered about the University Hospital being overloaded with the HMO, given the long waits even now encountered. Dean Bryant responded that the University Hospital was even now trying to anticipate the problem.

Professor Eugene Lane observed that the crowd was thinning and called the previous question. The two-thirds vote required for cutting off debate passed by show of hands without dissent. Thereupon the original motion passed overwhelmingly by show of hands.

The meeting was adjourned at 4:45 p.m.

Respectfully submitted,
Eugene N. Lane, Recorder

Appendix I

Reasons for Postponing

Implementation of New Health Plan

1. To give the University and GenCare/Sanus time to prepare accurate descriptions of the options available to us.

a) The documents distributed are contradictory regarding the coverage's and the out-of-pocket costs for each option. They need to be rewritten to be internally consistent and accurate.

b) When asked about vaguenesses and contradictions, representatives of the University administration and the provider organizations have either given assurances that directly contradict what they have put in writing or stated they did not themselves know the answer.

c) Either way, the result is that faculty and staff have no way of knowing what the meanings of the various options are. The contractual prerequisites of free, informed consent have not been met.

2. To give the University an opportunity to make corrections in the provisions of the health plan options that will benefit faculty and staff.

a) The University administration has said that they have provided a package that offers more comprehensive coverage at a lower cost to faculty and staff than those in the existing program.

b) It is not clear to many of us in what way the new coverages are more comprehensive. We need to be informed of what coverages are found in the new options that are not found in the existing program.

c) While it is clear that the new program will save the University money in its operating budget, it is not clear that most faculty and staff will save money in the personal budgets for medical care.

1.Premiums are lower in all new options than for the existing program.

2.Co-insurance and co-payment in all but the HMO option are higher than in the existing system.

d)Total cost to persons enrolled will go up substantially in most cases.

3. To give faculty and staff sufficient time to study the options and make informed decisions.

a) We think it will take several weeks to months to get a benefits package that provides coverage as comprehensive as that provided under the current system.

b) We think it will take several additional weeks for the University administration and GenCare/Sanus to prepare written documents that accurately and clearly describe the benefit structure and the full costs of the proposed system to faculty and staff.

c) We think it reasonable that faculty and staff have two months to consider their choices after those revised documents have been distributed.

d) To persist in the implementation of a new program without going through these steps would at best be taking a cavalier attitude toward what for some of us will be literally life and death decisions. At worst, ...