New Health Care Bills

April 23, 1995

Health care reform may be dormant on Capitol Hill, but there is plenty going on in the states. This past session saw the predictable flurry of activity in Annapolis, with a bill targeting HMOs and their closed physician networks, as well as efforts to bring free-standing surgery centers under tighter control.

The HMO bill, known as the Patient Access Act, succeeded largely because its supporters were able to convince legislators that the measure rose above the clash of interests between HMOs, insurers and employers on the one hand, and physicians and other health care providers on the other, to address the concerns of patients -- the people too often left out of cost-control debates. The bill would allow HMO patients to seek specialty care outside their network if they were willing to bear 20 percent of the cost.

Having lost in the legislature, opponents of the bill now hope to persuade Governor Parris N. Glendening to veto the measure -- an effort we hope will not succeed. The vast majority of HMO patients are satisfied with their care. But no network is perfect and, when exceptions arise, it is not unreasonable to give patients a choice -- provided they are willing to shoulder some of the cost. We remain unconvinced that HMOs cannot handle the bookkeeping involved in paying out-of-network providers 80 percent of the cost of providing the service within the network. PPOs have operated under a similar requirement for several years.

The legislature also agreed to subject free-standing surgery clinics to Maryland's existing "certificate of need" process, which is designed to control the number and location of health care facilities. That was an essential move, since these highly profitable centers have been sprouting up in large numbers -- especially in suburban areas where most patients are adequately insured.

Their increasing popularity reflects their efficiency, convenience and good care. But it also puts a heavier burden on hospitals to cover the costs of indigent patients and to pay for costly medical education in the state's teaching hospitals. In addition to the wise move of subjecting these centers to the same planning process as hospitals, legislators sent to summer study proposals that would require surgery centers to contribute to these costs. We hope next year the General Assembly will also act on those measures.

It's fine for surgery centers to thrive. But they do not function in isolation from the larger health care community, and they should also share in its responsibilities.

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