Trying to impose controversial new rules on health maintenance organizations, a House committee in Annapolis approved legislation yesterday that is intended to ensure patients' freedom to choose doctors.
The heavily lobbied bill would require health maintenance organizations to offer patients the opportunity -- for an unspecified added cost -- to see doctors outside of the HMO.
Although the House Economic Matters Committee overwhelmingly approved the bill, it faces strong opposition from the HMO industry and from doctors who had sought such legislation but were dismayed by some amendments.
The full House and the Senate must act on it.
The committee chairman, Del. Michael E. Busch, an Anne Arundel County Democrat, termed the legislation a "very, very significant step" in the General Assembly's health care reform efforts. Other bills affecting hospitals and independent surgical centers await action.
Other provisions of the bill, sponsored by Montgomery County Democrat Kumar P. Barve, are intended to:
* Protect minority communities by urging HMOs to take the ethnic makeup of areas into account when hiring doctors. Many black doctors complain that they are having a hard time getting hired by HMOs.
* Help doctors in their dealings with HMOs. One provision of the bill would prohibit HMOs from withholding portions of their fees. It's a common practice that some doctors say discourages them from authorizing specialty care and expensive tests for patients.
Mr. Busch said fee withholding, which HMOs do partly to discourage doctors from recommending unnecessary services, is "just not a good way of practicing health care."
Another provision of the bill would help doctors by requiring HMOs to act on their employment applications within 60 days. Doctors say they sometimes don't hear back from HMOs.
Another provision would bar HMOs from firing doctors solely because they appeal for services on behalf of patients.
But a lobbyist for the state medical society said amendments approved by the committee raise strong doubts about whether the bill really helps doctors and patients very much.
Attorney Joseph A. Schwartz III said the provision requiring HMOs to permit patients to see non-HMO doctors is weak because it lets HMOs decide how much to charge patients for that privilege.
He said the ban on fee withholding could be subverted by another provision authorizing bonuses. They could be used the way "withholds" are to discourage doctors from prescribing some services for patients, he said.
Opponents of the legislation reacted differently. The Maryland HMO Association sharply criticized it, saying the bill could backfire on consumers by raising their insurance costs.
Geni Dunnells, director of the association, said an increasing number of HMOs already are offering consumers the choice of doctors embodied in so-called point-of-service plans, which the legislation would require.
Because point-of-service plans cost more than conventional HMOs consumers could end up paying more for health insurance, she said.
Business groups, which had formed a coalition with the HMOs to oppose the legislation, could "live with" the point-of-service provision, said Champe C. McCulloch, president of the Maryland Chamber of Commerce.
Raymond J. Brusca, vice president of benefits at Black & Decker Corp. in Towson, had been an outspoken opponent of this kind of legislation, but he later urged members of the coalition to accept the committee's effort at compromise. Noting that employers can require workers to pay the extra cost, he said that Black & Decker has successfully used point-of-service plans for several years to provide health care to 24,000 employees nationwide.