Ventura County doctors and consumer advocates said Thursday that a plan by HMOs to create independent panels for patient appeals is a step in the right direction, but also a public relations gambit intended to stave off far-reaching health care reform next year.
With a pro-reform Democratic governor and Legislature poised to take power, the California Assn. of Health Plans announced Wednesday that its 22 members will form panels of experts outside their organizations over the next year to hear the appeals of patients who are denied medical care they think is necessary.
Indeed, the association supported such panels last year in the Legislature as an alternative to Democrat-backed laws to give injured patients the legal right to sue health maintenance organizations.
"I think it is a good step," said surgeon Gus Iwasiuk, former president of the 550-member Ventura County Medical Society. "But I think they're just trying to preempt bigger changes. The thing they really don't want is for the Legislature to give patients the right to sue."
A federal law generally exempts HMOs from paying damages for personal injury. But Texas has passed a carefully worded law--which held up on appeal--allowing HMO patients to sue their health plans for negligence if they do not use "ordinary care" in denying or delaying payment for treatment. California lawmakers considered a similar bill last session, but it died amid partisan debate.
Fritz Menninger, current head of the county physicians group, said doctors statewide want broader reforms, especially creation of a powerful HMO czar. The state Department of Corporations now regulates the health care plans, which provide coverage for about 17 million Californians.
"But what we really need to do is let doctors be advocates for their patients again," Menninger said. "Now, in many cases we are not, because HMOs put us in an adversarial position with our patients."
Local patient advocates say that HMOs are simply positioning themselves for legislative battles to come, but that the new appeal panels are welcome nonetheless.
"It's a positive move," said Pamela Hasner, founder of Ventura-based Patient Advocacy Management, a nonprofit group. "But it doesn't go far enough. Patients absolutely need the right to sue to force HMOs to be responsible."
The top official at Buenaventura Medical Group, the county's oldest HMO-affiliated physicians group, said creation of independent panels marks an important change in policy that is intended to head off more expansive reforms.
