INDEPENDENT REVIEWS: Doctors, Consumers React To CAHP Plan
Doctors and patients' rights advocates said yesterday that the California Association of Health Plans' new external review program "is a step in the right direction, but also a public relations gambit intended to stave off far-reaching health care reform next year." Gus Iwasiuk, former president of the Ventura Medical Society, said, "I think they're just trying to preempt bigger changes. The thing they really don't want is for the Legislature to give patients the right to sue." Pamela Hasner, founder of Patient Advocacy Management, agreed, saying, "[I]t doesn't go far enough. Patients absolutely need the right to sue to force HMOs to be responsible." Dr. John Keats, medical director at Buenaventura Hospital, said, "I suspect that [a public-relations scheme] is exactly what this is. But I don't think that is necessarily a bad thing. Anything that can restore patients' confidence in the managed care industry is a positive step." Ron Yukelson, spokesperson for Health Net, said the industry wants such protections to be given the force of law. He noted that the CAHP "helped write the law that died in committee [last session], and that the trial lawyers killed. We want to work with the Legislature in the next session to enact this legislation." But attorney Mark Heipler, who successfully sued Health Net for $89 million in 1993, said the industry's reform measures still do not define what the term "medically necessary" entails. He added that "when you're on the front line trying to help patients, you realize how they're going to be able to conduct business as usual." Bobby Pena, spokesperson for Aetna U.S. Healthcare, said, however, that "the bottom line is that this is the move the industry should be making for our members, period. The industry is constantly trying to improve itself" (Kelley, Los Angeles Times, 12/4).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.