PATIENT APPEALS: Panel of Health Care Experts Weighs In
Panel members at a roundtable convened last week to discuss health care quality endorsed patient appeals processes as a way to address patient grievances while helping health plans to improve care. The panel, sponsored by the Alliance for Health Reform and the Commonwealth Fund, met in the nation's capital to discuss "Ensuring Health Care Quality: Progress To Date, Distance Yet To Travel." Panel member Sen. Bill Frist (R-TN) pledged that patient appeals processes would be incorporated into a patients' bill of rights slated to go before Congress "early in the legislative session." John Eisenberg, administrator for the Agency for Health Care Policy and Research, urged patient appeals boards to use "evidence-based standards" when deciding cases. Dr. Kenneth Shine, president of the Institute of Medicine, stressed the importance of using a "panel of outside experts" to decide patient appeals cases. Frist noted that as "consensus has emerged on the need for independent review panels, the health care industry has moved to develop its own." Eisenberg added, "Patients' rights is an important step, but it's not enough. It doesn't get you the access you need, or the quality."
A 'Dark Cloud'?
Cary Sennett, executive vice president of the National Committee for Quality Assurance, said that public pressure on health plans to voluntarily participate in quality evaluations is "inadequate." Sennett noted the substantial costs of producing data to evaluate health plans, and said that currently, the market neither punishes plans that abstain nor rewards those that participate. Noting that fewer health plans submitted data for such evaluations this year, Sennett said that a "dark cloud" threatens "efforts to increase accountability." The NCQA plans to press ahead, and will release performance data for the first time next year in its annual State of Managed Care Quality report (Katie Donohue, American Health Line, 12/20). Click here for American Health Line coverage of this year's NCQA report.