VENTURA COUNTY: L.A. Times Chronicles ‘HMO Backlash’
In a three-part series that began Sunday and ended yesterday, the Los Angeles Times' Ventura County edition looks at the county's experience with the managed care revolution of the last decade. In "The HMO Backlash," Times staff writer Daryl Kelley examines doctors' and patients' reactions to HMOs, a physician group trying to make it in the managed care arena and how experts recommend curbing the backlash against managed care.
- "Critical Condition" -- Sunday's piece describes how doctors, hospitals and patients have grown tired of managed care. "[A]n increasing number of Ventura County doctors -- and a growing groups of physicians statewide -- are risking their livelihoods to go it alone in this age of cut-rate managed care medicine." These doctors "say they have dumped the most restrictive HMO contracts because the soul of their profession is at stake." Patients too "are balking at restrictions that deny or delay care they are convinced they need." And under managed care, patients are "increasingly ... paying more out of their own pockets to see doctors of their choice." Even hospitals are shying away from managed care contracts now "because they can squeeze no profit out of them." Dr. Samuel Edwards, administrator of Ventura County Medical Center, summarized the general sentiment toward managed care: "Today, nobody's happy. Doctors are angry because they used to be the seat of all power, and now they're stuck rationing care. Hospitals don't like it because they've had to cut their costs and push their patients out the door. And patients say they're getting worse care" (7/26).
- "Quality Control" -- The second part in the series profiled the county's oldest HMO-affiliated doctors group, Buenaventura Medical Group. Founded in the 1950s, Buenaventura is "an archetype HMO provider of health care" and "stands as a good local example of how and why managed care has grown locally over the past decade." Through efficient rationing of health care -- only providing medically necessary treatment -- Buenaventura "has helped cut costs" and "made health care more affordable and available to more people." While some patients complain the bottom line in the HMO is saving money rather than lives, Buenaventura medical director Dr. John Keats says that "managed care, when done properly, rewards physicians for keeping their patients healthy. To deny care will cost you money in the long run." Most patients say they are "satisfied" or "very satisfied" with their overall care through Buenaventura. Reflecting the key trends of managed care, Buenaventura has in the past few years added nurse practitioners and physicians assistants to its staff of doctors. And the group also "uses peer committees for 'utilization reviews' to decide whether special patient treatments requested by doctors are really necessary" (7/27).
- "Seeking A Cure" -- The last of the three parts details how patients, doctors and lawmakers are working for HMO reform. HMO critics say that "[p]atients need to be their own best advocates by insisting on effective treatment and asking their doctors whether they make more money if they provide less care." For their part, "[d]octors need to reject -- or question ethically -- HMO contracts that force them to see too many patients and pay them more for not treating patients with costly care." And legislators "need to change state and federal law so patients can sue HMOs and health insurance companies -- not just doctors -- for policies that contribute to the death or injury of patients." The article also details efforts to spur collection of data on health plan quality and how some consumers want the right to sue their HMOs for denied coverage (7/28).