Health Maintenance Organizations

A photo caption in yesterday's Business section misstated the position of Dennis Makielski regarding legislation in Annapolis that would force health maintenance organizations to give patients more freedom in choosing physicians. Mr. Makielski opposes the bill.The Sun regrets the errors.

WASHINGTON - Increased spending for health care is gobbling up about one-quarter of the growth in the economy, and health-related items now amount to more than three times the defense budget and twice what the nation devotes to education, a report released today concludes. The study by researchers at the Boston University School of Public Health comes as the Bush administration and lawmakers of both parties are cautiously trying to restart a national debate on how to rein in costs and cover an estimated 45 million Americans who lack health insurance.

Martin P. Wasserman, state health secretary, has named a committee to begin studying how to reform the most costly aspect of the Medicaid program -- long-term care. Recipients are disabled and chronically ill, and many are in nursing homes.The 15-member advisory group, chaired by Richard Bennett, executive director of long-term care at Johns Hopkins Bayview Medical Center, will hold several public hearings. The group is scheduled to issue a report in the fall.The effort is similar to the strategy used to draft a plan for the state's first phase of Medicaid reform, which calls for moving about 200,000 women and children into health maintenance organizations next year.

The state health department proposed yesterday to increase Medicaid premiums by 1.5 percent in November and another 2 percent in July, but managed care organizations said that may not be enough to keep them participating in the program."

Unnecessary hysterectomies are performed at rates that vary widely among managed-care health plans, according to experts preparing a new medical "report card" for consumers to use in choosing their plans.The study is the first in a series of quality evaluations that could influence the success or failure of the "managed competition" approach to health care now being developed by the Clinton administration, the specialists say.The need for hysterectomies -- operations to remove the uterus -- has long been a topic of controversy.

Spurred by mounting complaints, the state attorney general is warning members of the medical community that if they are billing HMO members directly for services covered by insurance, they are breaking the law."Consumers are getting caught in the middle of an ongoing dispute between health-care providers and the HMO industry about delays in payments by HMOs," Maryland Attorney General J. Joseph Curran Jr. said last night. "If you're a member of an HMO and you pay your bills, the HMO should pay its bills."

LET'S CHECK OUT complaints Democrats raise against a Republican Medicare package moving toward passage in the House of Representatives next week:* Democrats charge monthly premiums paid by seniors will be increased. The current $46.10 premium would rise to $54 next January and to $87 by January 2002. Individuals with incomes of more than $75,000 and couples with more than $125,000 would incur an additional surcharge. So what's wrong with that approach? Means-testing of wealthier seniors is long overdue.

Doctors Health System said it made a deal with a Hagerstown medical practice that allows the fast-growing Owings Mills firm to expand its network of physicians into Washington County.Quality Health Care IPA appointed Doctors Health as the exclusive agent for its doctors in negotiating with managed care organizations. Quality Health has 18 doctors and four nurse practitioners who serve more than 40,000 patients.Financial terms of the deal were not disclosed.Doctors Health is a 2-year-old, physician-owned company that has merged independent medical practices in a bid to give health care providers more control of patient care by giving them more leverage in talks with health maintenance organizations.

Blue Cross and Blue Shield of Maryland has started cutting hundreds of jobs as the state's largest health insurer, anticipating the start of a three-year downturn, tries to pare millions of dollars a year in expenses.The company, which has about 1.5 million Maryland customers, has told more than 100 employees that their positions will be abolished. As many as 200 jobs could be lost in the company's health maintenance organizations. And more jobs could be eliminated as Blue Cross looks to cut expenses by an estimated $7 million to $8 million this year and in each ofthe next two years.

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.

Hoping to capitalize on the public's discontent with managed care, Gov. Parris N. Glendening was to announce today that he supports giving patients the right to sue their health maintenance organizations for subpar care, according to legislators familiar with the proposal.With the announcement, Glendening steps into a fierce debate that has raged in Annapolis and Washington, pitting doctors and patients against cost-conscious managed care organizations.Patients' advocates say the measure is necessary to force HMOs to provide appropriate, if sometimes expensive, care, while insurers say such lawsuits will significantly boost the price of health care.

Here is how members of Maryland's delegation on Capitol Hill were recorded on important roll-call votes last week:Yes N: No X: Not votingHouse: Health coverageThe House passed, 216 for and 210 against, a Republican bill (HR 4250) to improve patients' rights in health maintenance organizations. In part, the bill requires HMOs to cover most emergency-room care, enables patients to choose their own pediatricians and obstetrician-gynecologists, sets up HMO boards to resolve patient complaints and removes "gag orders" that prevent doctors from advising patients on more costly treatments.

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.

An online service that would give consumers instant access to records on Maryland physicians is shaping up to provide far more information than originally envisioned, but the public may have to wait nearly two years to tap into it by computer.In recent weeks, the momentum behind the idea has shifted from the state physicians board to Annapolis, where legislators are rewriting the proposal in elaborate fashion.Senate President Thomas V. Mike Miller, who rarely sponsors bills, has proposed the "consumer health information act" to streamline public access to many state health records.

MILLIONS of working Americans now covered by employer-provided health insurance policies will be able to change jobs without losing coverage even if they or members of their families have continuing medical problems. In addition, the self-employed will get tax deductions of up to 80 percent on the cost of their health insurance premiums and tax breaks will be offered on long-term care coverage.These reforms, part of a pre-convention burst of legislation on Capitol Hill, are often described as modest, realistic, incremental.

Martin P. Wasserman, state health secretary, has named a committee to begin studying how to reform the most costly aspect of the Medicaid program -- long-term care. Recipients are disabled and chronically ill, and many are in nursing homes.The 15-member advisory group, chaired by Richard Bennett, executive director of long-term care at Johns Hopkins Bayview Medical Center, will hold several public hearings. The group is scheduled to issue a report in the fall.The effort is similar to the strategy used to draft a plan for the state's first phase of Medicaid reform, which calls for moving about 200,000 women and children into health maintenance organizations next year.

Hoping to capitalize on the public's discontent with managed care, Gov. Parris N. Glendening was to announce today that he supports giving patients the right to sue their health maintenance organizations for subpar care, according to legislators familiar with the proposal.With the announcement, Glendening steps into a fierce debate that has raged in Annapolis and Washington, pitting doctors and patients against cost-conscious managed care organizations.Patients' advocates say the measure is necessary to force HMOs to provide appropriate, if sometimes expensive, care, while insurers say such lawsuits will significantly boost the price of health care.

MILLIONS of working Americans now covered by employer-provided health insurance policies will be able to change jobs without losing coverage even if they or members of their families have continuing medical problems. In addition, the self-employed will get tax deductions of up to 80 percent on the cost of their health insurance premiums and tax breaks will be offered on long-term care coverage.These reforms, part of a pre-convention burst of legislation on Capitol Hill, are often described as modest, realistic, incremental.

Doctors Health System said it made a deal with a Hagerstown medical practice that allows the fast-growing Owings Mills firm to expand its network of physicians into Washington County.Quality Health Care IPA appointed Doctors Health as the exclusive agent for its doctors in negotiating with managed care organizations. Quality Health has 18 doctors and four nurse practitioners who serve more than 40,000 patients.Financial terms of the deal were not disclosed.Doctors Health is a 2-year-old, physician-owned company that has merged independent medical practices in a bid to give health care providers more control of patient care by giving them more leverage in talks with health maintenance organizations.

Sixteen years ago, Ruth Donati went to work as a receptionist for a group of five pediatricians in Towson. It took the equivalent of one and half people to do the paperwork for the practice, using an old punch card machine.Since then, the office has modernized; Dr. Felix Kaufman, one of the pediatricians, says the doctors have spent $100,000 on computer systems. And the practice has joined Premier Medical Group, which is taking over a chunk of the administrative chores.So it doesn't take one and a half people to handle the paperwork any more.