MARYLAND: Senate Approves Medical Director Oversight Bill
In a 27-19 vote, the Maryland state Senate yesterday gave "preliminary approval" to a bill "that would give the state authority to discipline [HMO] medical directors if they make coverage decisions that are harmful to patients," the Baltimore Sun reports. The bill, introduced by state Sen. Paula Hollinger (D), would make HMO, hospital, nursing home and other health institution "administrators subject to oversight" by the state Board of Physician Quality Assurance. If the board "found fault with policy or supervisory decisions, the director could face the same sanctions as a doctor who failed to provide proper medical care -- from a reprimand to the loss of his or her medical license." The Sun notes that Maryland law requires medical directors to be physicians.
Managed care industry lobbyists are urging senators "to reject Hollinger's bill on the final vote." Robert Enten, the lobbyist for the Maryland Association of HMOs, said Hollinger's bill "would have a chilling effect on what the industry has done to maintain quality health care at an affordable cost." The Sun reports the "HMO lobby predicts that few doctors would remain as administrators in a state where they risked punishment for their coverage decisions." Insurers further "suggested that the doctor-controlled board -- 12 of its 15 members are physicians -- would be especially hard on the administrators because doctors often dislike their coverage decisions." In addition, the Maryland Chamber of Commerce and some unions are "opposing the legislation." Champe McCulloch, Chamber president, wrote yesterday in a letter to Hollinger, "Placing medical directors under (the board) will inhibit their ability to manage care, causing the inflationary spiral to accelerate." During debate yesterday, state Sen. Thomas Bromwell (D) "led the criticism" of Hollinger's proposal, saying it "goes too far." Instead, Bromwell supports legislation that would create a "system to appeal coverage decisions to the Maryland insurance commissioner." This measure, backed by the state's HMO industry, "also won preliminary approval in the Senate yesterday."
A Needed Protection
Hollinger and other backers contend her bill "would give patients another venue, in addition to the insurance commissioner, to protest coverage decisions." Joseph Schwartz, a lobbyist for the state medical society, said the measure would give patients "a place to complain if the treatment [was] substandard." A final Senate vote "is expected this week", and the Sun notes that a House version "is pending in committee." Hollinger won Senate support for her bill last year, "but the industry managed to derail it in the House" (Daemmrich, 3/25).