HMO LIABILITY: CA Docs Wary of Surrendering Authority
Even as the Legislature "appears poised to pass a bill to make HMOs liable" for medical coverage decisions, California physicians have distanced themselves from the measure, American Medical News reports. Unlike their colleagues in Texas, Missouri and Georgia, California physicians "worry that such a law could create more problems than it solves." California Medical Association President-Elect Dr. Marie Kuffner said, "If you say an HMO is liable (for malpractice), you are saying that it makes medical decisions. Our view in California -- and it should be every doctor's view -- is that the physician makes the medical decisions." Instead, the CMA advocates a bill that would hold HMO medical directors liable, in this way "preserving physicians' authority." In addition, physicians fear that HMO liability will derail the "unusually low $250,000 cap on noneconomic damages under the 1975 Medical Injury Compensation Reform Act." The Assembly this month already voted to lift the cap on damages for malpractice and allow annual increases tied to inflation. But even if the cap is left unchanged, making HMOs liable could let trial lawyers "make an end run around MICRA," warned David Lerman of the Los Angeles County Medical Association. Consumer groups, however, are firmly on board. "Without the threat of damages, patients will continue to have no leverage against billion-dollar HMOs," said Jamie Court, executive director of the Consumers for Quality Care. American Medical News reports that HMO liability is only one of the torrent of 65 managed care bills that have passed either the state Senate or Assembly in June, after the agenda was "backlogged by eight years of resistance" under former Gov. Pete Wilson. Bills that would create dependent and binding external review processes sailed through both houses and a compromise measure is expected to pass. HMOs even jumped on board, said California Association of Health Plans spokesperson Corey Black, noting that in an effort to head off sweeping changes, HMos are starting to "support moderate bills." However, HMOs strongly oppose the liability bill and another that would allow members to choose out-of-network physicians. For their part, Kuffner said that doctors are not backing bills that would batter the HMOs. She said, "Doctors in favor of HMO liability and similar measures are saying, 'Let's kill managed care and then we'll be back in the saddle again.' [But], It's not going to happen" (Page, 6/28 issue).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.