PATIENTS’ RIGHTS: HMO Group Backs Some Regulation
A coalition of 25 health maintenance organizations said yesterday "it was willing to accept substantial federal regulation -- much more than the Republican leaders of Congress want." The New York Times reports that the members of the HMO Group, which collectively cover more than 6 million members in 26 states, includes such HMO giants as Kaiser Permanente, HIP Health Plans and Harvard Pilgrim. The coalition of mostly nonprofit HMOs endorsed a piece of reform legislation being written by Sens. John Chafee (R-RI) and Bob Graham (D-FL). The bill includes provisions that would require HMOs to disclose information on cost, benefits and quality; mandate a "prudent layperson standard" for emergency care coverage; allow unrestricted access to specialists, including OB/GYNs; mandate independent reviews for patients who are denied care, disallow financial incentives for doctors and require that HMOs ensure "continuity of care" for patients receiving care from a particular doctor. The Chafee-Graham proposal does not include a provision allowing patients to sue their health plans for denials of care.
The Chafee-Graham bill is seen as a "compromise" between the Democratic proposals and "legislation being drafted by Republican leaders of the Senate and the House, who promise to protect patients without entrusting vast new power to the federal government." National Association of Children's Hospitals lobbyist Bruce Lesley said, "The Chafee-Graham legislation could be the basis for a bipartisan agreement. It includes the most important protections for patients, including children, while leaving out the most controversial proposals found in other bills." Daniel Wolfson, president of the HMO Group, said, "We are bewildered to see what the public thinks about our organizations and the industry now. Patients feel they are not in control of their health care. They feel powerless. Legislation could defuse that distrust" (Pear, 7/14).
AMA To Take A Stand
The American Medical Association and a number of state medical societies yesterday announced a national campaign to expose and correct abuses in managed care contracts that hamper how physicians provide care. The campaign will highlight the best health plan practices in an effort to persuade other plans to cease practices that the AMA says hurt the level of care and are unfair to physicians. Randolph Smoak, chair of the AMA's Board of Trustees, said, "We recognize that we must control costs so that all Americans receive high quality medical care that is affordable. We also recognize the progress that has been made in cost reduction in recent years. But alienating physicians and frightening patients is counterproductive. We hope our campaign is a major step toward restoring trust." Actions announced today will follow a four-step strategy. First, the AMA will identify the worst practices and worst offenders, and the best practices. Second, the AMA will put targeted health plans on notice about what constitutes both bad practices and the best practices. Third, the AMA will press the health plans to alter their practices. Finally, the AMA will pursue legislative, regulatory and judicial relief if voluntary efforts fail. State medical societies signing on include those in Florida, Ohio, New York, Georgia, California, Rhode Island, North Carolina, New Jersey, Illinois, Texas and Pennsylvania (AMA release, 7/13).
AAHP Announces Compliance With Code
The American Association of Health Plans announced today that 95% of its members are now in compliance with at least six of seven principles in the association's Code of Conduct, a set of patient-centered principles initiated in January 1998 by AAHP member companies. Moreover, nearly two-thirds report compliance with all seven areas. With near unanimity, plans that currently do not comply with all seven expect to make the necessary changes to fully comply within the next 12 months, the AAHP said. The Code includes guidelines governing patient information, appeals processes, emergency care coverage and quality control. Association President Karen Ignagni said, "This study evaluates the initial impact of the Code of Conduct and provides a benchmark for us to use in the future as we monitor the progress plans are making. The results show a substantial impact on the policies and practices of member plans when it comes to the manner in which they deliver health care -- after just four months, we're seeing real and tangible change" (AAHP release, 7/14).