ERISA Litigation and Physician Autonomy

Abstract:     
The Employee Retirement Income Security Act (ERISA) is a complex statute that dominates the managed care environment. As a result of expansive court rulings, ERISA has created a regulatory vacuum prohibiting states from regulating managed care organizations (MCOs) and limiting patient litigation against MCOs. An issue of particular interest to physicians is whether ERISA litigation has affected physician autonomy. In this article, we argue that ERISA has caused courts systematically to favor cost-containment initiatives over traditional notions of physician autonomy.

We first describe how ERISA's central provisions operate and how ERISA influences health care delivery in MCOs. We then examine trends in ERISA litigation in four areas: professional liability; utilization management; state legislative initiatives; and compensation arrangements. Our analysis demonstrates that courts have interpreted ERISA in ways that limit physician autonomy and subordinate clinical decisionmaking to MCOs' cost containment decisions. After discussing the general desirability of physician autonomy in a cost-constrained environment, we conclude that physicians should support efforts to amend ERISA. Amending ERISA would result in greater state regulatory oversight of MCOs, permit courts to hold MCOs accountable for their role in medical decisionmaking, and balance physician autonomy with legitimate cost containment needs. The current ERISA regime simply goes too far in removing oversight of MCOs.

Note: This is a description of the article and not the actual abstract.

Accepted Paper Series