ERISA litigation and physician autonomy

The Employee Retirement Income Security Act (ERISA), enacted in 1974 to reg ulate pension and health benefit plans, is a complex statute that dominates the managed care environment. Physicians must understand ERISA's role in t he relationship between themselves and managed care organizations (MCOs), i ncluding how it can influence clinical decision making and physician autono my. This article describes ERISA's central provisions and how ERISA influences health care delivery in MCOs, We analyze ERISA litigation trends in 4 areas : professional liability, utilization management, state legislative initiat ives, and compensation arrangements. This analysis demonstrates how courts have interpreted ERISA to limit physician autonomy and subordinate clinical decision making to MCOs' cost containment decisions. Physicians should sup port efforts to amend ERISA, thus allowing greater state regulatory oversig ht of MCOs and permitting courts to hold MCOs accountable for their role in medical decision making.