CAPITATION FEES: Wilson Rejects ‘Pay-Up-Front’ Bill
Gov. Pete Wilson Tuesday vetoed a bill that would have "force[d] HMOs to pay for patients up front." Currently, HMOs do not pay doctors "capitation rates" until after an HMO member visits the physician for the first time, "which, for healthy people, could be months or years away." But physicians say "they should receive the monthly payments starting" as soon as the HMO member chooses them as their primary care physician. State Assemblyman Bernie Richter (R-Chico) said his bill would have required HMOs to pay "the fee rather than force doctors to negotiate capitation in 'complicated and complex' contracts between physicians and the health plans." The Chico Enterprise-Record reports that AB 227 was endorsed by the California Medical Association and other patient and physician groups who argued that doctors need the capitation payments up front to "help offset some of their costs." Connie Barker, lobbyist for the California Psychiatric Association, said, "Some of those patients see the doctor often, and some seldom or never, but the average utilization per capita of the doctor's services enables him or her to provide health care to the group affordably." Richter said initial opposition by the state Department of Health Services, Department of Corporations and California Association of Health Plans was eventually withdrawn after he amended the measure, paving the way for Wilson's support. But in his one-sentence veto message, Wilson said, "The timing of contractual payments is appropriately a matter of negotiation between the contracting parties, not the Legislature." Richter called the veto "insane" and "unbelievable," blaming it on Wilson aides "who don't know anything anyway" (Gardner, 9/16).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.