Senate OKs medical oversight bill Measure would allow state to act against HMO administrators

Final vote this week

Insurers, other critics say move would place burden on industry

March 25, 1998|By JoAnna Daemmrich | JoAnna Daemmrich,SUN STAFF

Responding to complaints of penny-pinching by HMOs, the Maryland Senate gave preliminary approval yesterday to a bill that would give the state authority to discipline their medical directors if they make coverage decisions that are harmful to patients.

The measure, fiercely fought by health maintenance organizations and other insurers, would make the administrators subject to oversight by a state regulatory board by expanding the definition of "practicing medicine."

Maryland's Board of Physician Quality Assurance has the power to investigate and discipline doctors. Under the bill introduced by Sen. Paula C. Hollinger, a Baltimore County Democrat, the board could consider complaints against the medical directors of HMOs, hospitals, nursing homes and other institutions.

If the board found fault with policy or supervisory decisions, the director could face the same sanctions as a doctor who failed to provide proper medical care -- from a reprimand to the loss of his or her medical license. Medical directors in Maryland must be physicians.

"Every one of us and our families at some point in our lives needs health care," Hollinger said. "We don't want to lose a family member because someone has denied them care."

The Senate approved the bill, 27-19 with one abstention, after a heated debate over the best way for the state to regulate managed health care.

A final Senate vote is expected this week. A House version is pending in committee.

Sen. Thomas L. Bromwell, a Baltimore County Democrat, led the criticism yesterday that Hollinger's proposal goes too far. He argued that patients would fare better under legislation creating a system to appeal coverage decisions to the Maryland insurance commissioner.

That measure -- which has the support of the HMO industry -- also won preliminary approval in the Senate yesterday.

"This is setting up a dual, costly system," Bromwell said of the Hollinger proposal.

Regulating HMOs has become an increasingly popular cause in the General Assembly in recent years because of complaints about stingy and insensitive care.

Hollinger's bill also cleared the Senate last year, but the industry managed to derail it in the House.

This year, the HMOs are hoping that the grievance bill will stall momentum for regulation that they see as more burdensome. After yesterday's vote, HMO lobbyists stepped up their efforts to urge senators to reject Hollinger's bill on the final vote.

"This would have a chilling effect on what the industry has done to maintain quality health care at an affordable cost," said D. Robert Enten, the lobbyist for the Maryland Association of Health Maintenance Organizations.

The HMO lobby predicts that few doctors would remain as administrators in a state where they risked punishment for their coverage decisions.

"It's in everyone's best interest that HMOs have top-qualified [administrators] making these decisions," Enten said. "I don't believe you will find anyone worth his or her salt who is going to risk losing their license."

Insurance lobbyists also suggested that the doctor-controlled board -- 12 of its 15 members are physicians -- would be especially hard on the administrators because doctors often dislike their coverage decisions.

The Maryland Chamber of Commerce and some unions are opposing the legislation as well. They argue it would drive up the cost of managed care -- for both businesses and consumers.

"Placing medical directors under [the board] will inhibit their ability to manage care, causing the inflationary spiral to accelerate," Champe C. McCulloch, the chamber president, said in a letter to Hollinger yesterday.

But Hollinger and the bill's supporters argued it would give patients another venue, in addition to the insurance commissioner, to protest coverage decisions.

"It gives someone a place to complain if the treatment is substandard," said Joseph A. Schwartz, lobbyist for the state medical society.

Pub Date: 3/25/98

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