Hmos Prescribe Patient Bill Of Rights Proposal Could Change Legislative Reforms
A new coalition of consumer-oriented groups and major health maintenance organizations Wednesday proposed a far-reaching patient bill of rights for the 70 million people in HMOs.
The group - which includes the nation’s largest HMO, Kaiser Permanente - said it will work for such things as emergency care at the nearest hospital, candid advice from doctors, and access to cutting-edge treatments spelled out in federal and state laws.
The announcement could represent a turning point in the debate in Congress and state legislatures over the quality of care provided by HMOs, and whether the government should set stricter standards for the cost-conscious health plans.
“This is what we really had been waiting for, a group of managed-care companies to come out and realize that there have to be some standards,” said Rep. Charlie Norwood, R-Ga. Norwood is the author of an HMO reform bill that calls for most of the same protections advocated by the coalition. The legislation may come to a vote next year.
Coalition members said their goal is to have all HMOs - about 600 plans across the country - adhere to the same set of legally enforceable consumer-protection standards.
The group outlined standards in 18 areas of patient care and health-plan management in which critics have raised concerns. Among other things, they call for providing women with direct access to obstetricians and gynecologists, and restricting financial incentives that could pressure doctors to withhold care.
Consumer protections for people in HMOs now vary greatly by state and by the size of the employer offering the health plan.
Federal consumer-protection rules apply mainly to Medicare and Medicaid patients.
About 40 percent of privately insured people are now in HMOs. The number more than doubled during the 1990s as employers turned to the plans in an effort to control insurance costs.
HMOs stress preventive care and closely monitor the use of expensive tests and procedures. Studies show that most HMO patients are satisfied. But research has also raised concern about the quality of care for chronically ill people. And there have been widely reported cases in which HMO controls kept patients from getting critical help.
In response to complaints from patients and doctors, the industry has stressed voluntary standards and self-policing. Consumer groups have argued for closer government oversight.
Kaiser’s new alignment with the consumer camp signals a significant split in the industry. It’s not clear how many other HMOs will follow. The American Association of Health Plans, a trade group, on Wednesday refrained from criticizing Kaiser, but said it wants to prevent government “micromanagement.”