Health Maintenance Organizations

Maxicare Will Cut 100 Jobs: Maxicare Health Plans Inc. said it will eliminate about 100 jobs at its corporate headquarters in Los Angeles. The company, which in March filed for protection from creditors under Chapter 11 of the federal bankruptcy code, said it is reducing staff, effective July 28, because it operates substantially fewer health maintenance organizations. Maxicare has sold more than 20 operations since early 1988.

Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen. The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15. Patients seeking urgent care that does not require prior authorization must be seen within 48 hours.

PacifiCare Health Systems Inc., which operates one of the nation's largest health-maintenance organizations, on Monday issued scorecards for its medical groups in California, a move company officials say is aimed at stoking competition and improving physician services to consumers. The firm's so-called quality index marks the first time an HMO has made rankings of its medical groups available to the public.

Winding up in the emergency room is bad enough. But the California Supreme Court ruled Thursday that patients no longer have to worry about getting billed for emergency treatment charges that their HMOs fail to pay. Health maintenance organizations and patient advocates hailed the decision as an important protection against gouging by hospitals and physicians. But doctors said it would encourage greedy HMOs to underpay them and that that could put emergency rooms in jeopardy.

A new state program that went into effect this month requires HMOs and health insurance plans to provide free, comprehensive annual physicals to millions of New Jersey adults. The New Jersey Health Wellness Promotion Act, described as the first of its kind in the nation, requires many insurers to provide a 17-point "Healthful Life Program" aimed at encouraging more healthful living and catching problems early. Already, creator Dr. Donald B.

The 1.4 million California seniors who belong to Medicare HMOs are getting more bang for their buck this year, reversing a two-year period during which benefits had eroded, according to a new study released today. "We're finally seeing some good news," says Dr. Mark Smith, president of the California Healthcare Foundation, an Oakland-based philanthropic group that along with Consumers Union produces the annual survey. "The past two years haven't been easy for seniors."

Lawyers saying they represent 32 million members of managed health care plans have launched the largest legal assault yet on HMOs, filing class-action lawsuits against five of the industry's biggest players. The suits are expected to further pound the managed health care industry on Wall Street and add to its image problems--even though it is far from clear whether the lawsuits will result in substantial damage awards or even survive initial legal tests.

The financial troubles of Maxicare, at one time the largest for-profit health maintenance organization in the United States, do not mark the beginning of the end of the troubled HMO industry. Rather, Maxicare's troubles merely clear the decks for the emergence of a strengthened movement in government and industry to force medical consumers into HMOs.

PacifiCare Health Systems and Health Plan of America on Tuesday announced a proposed merger that would form one of the three largest health maintenance organization in California, company officials said. The merger would give Cypress-based PacifiCare the foothold in Northern California that its rivals, including FHP International Corp. in Fountain Valley, have sought.

Contrary to many expectations, older heart attack patients enrolled in health maintenance organizations received better medical care than similar patients treated by private doctors, according to a new study from the UCLA Medical Center and the Santa Monica-based RAND Corp. The results, announced Saturday in Seattle at a meeting of the American Federation for Clinical Research, reinforce studies over the past decade.

The nonmobile, hard lump had been on my sternum (the bone in the center of the chest) for many months. As a physician, I had figured it was costochondritis -- an inflammation -- from years ago that had hardened with age. A CT scan, however, stated otherwise: "Consistent with metastatic carcinoma or lymphoma. . . . " That meant the lump was likely due either to a cancer that had spread throughout my body or to a cancer of the lymphatic system, which manifests in different locations.

Gov. Arnold Schwarzenegger's administration has moved to ban physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay. Such bills, which patient advocates call a consumer abuse, are the product of a protracted feud between insurers and healthcare providers, principally emergency room doctors, radiologists and anesthesiologists.

In 2002, California's HMO czar, Daniel Zingale, declared, "The days are over when they could make patients wait and wait for healthcare." Zingale was heralding a new law that required his department to ensure that HMO patients received timely appointments with doctors. The law was spawned by the case of a 74-year-old woman who died from an aneurysm in a Kaiser Permanente waiting room while pleading to see her physician.

Many Californians enrolled in healthcare plans are receiving inadequate preventive care, a government report said Thursday. The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.

A highly unusual battle erupted in a San Diego courtroom Friday, with parents of a severely premature baby seeking to force healthcare giant Kaiser Permanente to move their son to a better-equipped hospital in hopes of saving his life. In the morning, Superior Court Judge Kevin Enright gave Kaiser's San Diego hospital 24 hours to transfer 7-week-old Andrew Balaka-Long to a higher-level neonatal intensive care unit outside the Kaiser network.

Eight months after pledging to put the brakes on retroactive cancellations of individual health insurance policies, the state agency that regulates HMOs said Tuesday that new rules were taking longer than anticipated because of the variety of health plans involved. Cindy Ehnes, director of the California Department of Managed Health Care, pledged in December to introduce regulations aimed at stopping most retroactive cancellations of individual coverage. The department held a public hearing Jan.

The short, bearded man in a gray, double-breasted suit walked swiftly through a Long Beach medical clinic, pivoting often to point out cosmetic flaws that might mar the image of the health-care organization he spent a lifetime building. The clinic's young managers obediently took notes as Dr. Robert Gumbiner pointed scornfully to some tattered telephone directories, wheelchairs that obstructed a hallway and two pictures hung askew in a waiting room.

Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators. The California Department of Managed Health Care said it will levy a $3-million fine against Kaiser, the largest HMO in the state, with 29 medical centers and more than 6 million members.

State regulators Monday postponed a hearing originally set for this week on complaints against Blue Cross of California, because its parent company has requested a more detailed agenda. The hearing now is set for Aug. 7 in Los Angeles. The state Department of Managed Health Care, which oversees HMOs, said last week that it had received more than 1,600 complaints from policyholders and doctors in less than three years against Blue Cross, the state's largest health insurer.