HMOs: L.A. Times Looks At ‘Quest for … Balance’

      An editorial in today's Los Angeles Times says that last week's decision by a jury to award $1.75 million "to a veteran physician who said he had been fired for spending too much time and money on his patients (see CHL 4/7) is just the latest sign of a deep erosion in" the public trust between patients, employees and HMOs." According to the Times, "HMOs and state legislators should view the verdict as underscoring the need for sharper oversight of HMOs and better protection for both consumers and their physicians." The Times notes that while the HMO industry says the public's poor perception of managed care is due to the repetition of HMO horror stories, "this sort of anecdotal evidence would be a lot less important to the argument over HMOs if consumers had unfettered access to real data on the quality of their medical treatment." However, "HMOs do not allow existing data -- especially on outcomes of various treatments -- to be made public."

Next Steps
      The Times says "California state legislators could help restore public trust by mandating review boards to which patients could appeal if they were denied treatment recommended by their doctors." However, it says the HMO appeals measure approved Wednesday by the state Senate Insurance Committee is "precisely the wrong kind of review measure" because it would "allow the health plan to select the reviewer, exclude from review any treatment that costs less than $2,000, not require the HMOs to pay for treatments recommended by the reviewer and exclude Medi-Cal and Medicare recipients." Calling the bill "evasive and spineless," the Times says a better choice is a bill by state Sen. Herschel Rosenthal (D-Los Angeles) "that endorses a process closer to the 'unbiased, third-party review' recommended earlier this year by Gov. Pete Wilson's managed care task force" (see CHL 2/20). The Times concludes that "[a]n honest, independent review process would help protect doctors as well as patients" (4/16).