Hmos

If you want to understand a major reason medical costs are out of control, breaking the federal budget and dividing the country, look at the types of people enrolled in XLHealth's Medicare insurance plans. Most suffer from diabetes, congestive heart failure or other long-term illness. They're like the millions of chronically ill Americans who visit doctors half a dozen times a year or more and, by some measures, account for 80 percent or more of all spending by the Medicare program for senior citizens.

If you want to understand a major reason medical costs are out of control, breaking the federal budget and dividing the country, look at the types of people enrolled in XLHealth's Medicare insurance plans. Most suffer from diabetes, congestive heart failure or other long-term illness. They're like the millions of chronically ill Americans who visit doctors half a dozen times a year or more and, by some measures, account for 80 percent or more of all spending by the Medicare program for senior citizens.

SOME HAVE argued that Maryland HMOs must pass the cost of the newly enacted 2 percent premium tax on to consumers because of the natural physics of how business costs are borne. Price is determined by what the market will bear. And competition shapes what the market will bear. The airlines, for example, suffering fuel price increases, have attempted to pass on these added costs to customers. Because of intense competition among the airlines, however, these attempts have largely failed.

Fix campaign finance to fix health care There are a number of reasons why the United States is 50 years behind the other wealthy countries in ensuring good health care for all its citizens. But surely the biggest is our country's uniquely permissive campaign finance system, which allows deep-pocket special interests to shower incumbents with money - at the same time lawmakers decide issues of direct concern to said special interests ("Under the influence," June 25). Foreigners laugh at this form of virtual bribery - and I don't blame them.

THE Supreme Court recently upheld that patients cannot sue their health maintenance organizations (HMOs), representing a victory for the health plans in what has escalated into an all-out health care war. It is no longer just a "backlash" against HMOs when legions of lawyers, fresh from the tobacco wars, are now aiming their class action laser sights at HMOs and when Congress and the state houses, with great fanfare, are calling for a wide-ranging Patients'...

Angry about losing income and power to insurance companies, the biggest organization of Maryland doctors has formed a company to explore ways to "compete effectively" against giants like Blue Cross and Blue Shield of Maryland.The 7,000-member state medical society mailed a letter this month to doctors seeking $1,000 contributions and laying out ambitious goals.The new, nonprofit company could serve as the "parent" of for-profit ventures owned by doctors, including an insurance company and a statewide network of doctors who would contract with employers and others to provide patient care, a function now performed mainly by insurers and "managed-care" companies such as Blue Cross, Mid Atlantic Medical Services Inc., Cigna and Prudential.

The governor is vetoing bills that would have forced HMOs to pay for more visits to emergency rooms and allowed Marylanders to identify themselves as "multiracial" on government forms.Those were among 11 vetoes announced yesterday by Gov. Parris N. Glendening in letters to the legislature.The governor described his decision to veto the health maintenance organization bill as "a most difficult one because the bill is an attempt to balance the interests, sometimes competing, of the major elements in our health care delivery system."

A legislative backlash is mounting against HMOs as they intensify cost-cutting efforts that hold down insurance premiums but antagonize patients and doctors.More than half the states have passed laws restricting money-saving methods of health maintenance organizations, and many others are considering legislation.The Maryland General Assembly leaped into the forefront of this trend recently by enacting three bills that protect patients' freedom to choose their doctors, allow women who have given birth to stay at least 48 hours in the hospital and toughen the requirement that HMOs pay for hospital emergency-room care for subscribers.

YOUR MARCH 20 editorial, "Curbing the power of HMOs," contained a number of factual errors. The most blatant one was your assertion that "medical decisions are made not by physicians . . . but by bean-counters. . . ."I have been a sole practitioner for 25 years in Columbia. My specialty is family practice and I belong to several HMOs (over two-thirds of my patients are members of HMOs).I have never been told how to practice medicine by any HMO.I have been given practice guidelines on selected diseases (like asthma and heart failure)

Baltimore Medicaid recipients who are enrolled in HMOs are generally satisfied with their care, according to a survey by CareData, a New York-based research company.Anthony Morgan, vice president of research for CareData, said the firm did the survey in hopes of selling reports to HMOs trying to refine their marketing. CareData provided questionnaires to 602 randomly selected HMO members who were re-registering for Medicaid.Of those surveyed, 29 percent reported they were extremely satisfied, while 60 percent were somewhat satisfied to very satisfied.

Kaiser Permanente and Mid Atlantic Medical Services Inc. ranked highest in an annual report of managed-care insurers published yesterday by the Maryland Health Care Commission. The report acts as a guide for consumers hoping to make sense of the region's vast array of insurers. For 12 years, the commission has produced the "report card," which offers rankings on such matters as breast cancer screening, diabetes care and the quality and efficiency of behavioral health care. The scores are determined from a combination of questionnaires filled out by the companies and from health plan records.

Kaiser Permanente posted the most top scores in the state's annual HMO "report card" published yesterday - as it has done for most of the past decade - but two others, Coventry and UnitedHealthcare's M.D. IPA, were close behind. Officials at the Maryland Health Care Commission, which prepares the annual consumer guide, said HMOs had been improving their performance since the state began making the data public, leading to a narrowing of differences. "The state average has gone up, and the plans move in tandem," said Joyce Burton, the commission's chief of health plan quality and performance.

WASHINGTON -- Most American workers prefer traditional health plans to a new system aimed at giving consumers greater control, as well as responsibility, for their medical care, a study from a Washington research group said yesterday. Given a choice, only 19 percent of employees would choose a so-called consumer-directed plan over health-maintenance organization and preferred-provider organization plans, according to the Center for Studying Health System Change. About 2.7 million Americans, or 4 percent of those who obtain health insurance through their employers, are enrolled in the new plans, which offer tax benefits and more treatment choices in exchange for greater out-of-pocket expenses and risk.

Health maintenance organizations, known for their low-cost medical care, were all the rage 10 years ago. Now consumers are bailing out of HMOs in record numbers as their costs have risen faster than high-deductible health insurance plans that offer more doctor choices and services. In particular, HMOs have lost ground to a kissing cousin, the preferred provider organization. The least restrictive of managed-care plans, PPOs allow health plan members to go outside an insurer's list of doctors and services but at a greater cost to the consumer.

Choices among health insurance plans used to be pretty simple. Once, almost everyone had old-fashioned indemnity insurance that let people go to any doctor or hospital they wanted. But as health care costs began to increasingly bite, employers began shifting workers to HMOs, managed-care plans that restricted choices. HMOs, or health maintenance organizations, all worked pretty much the same. They had networks of doctors and hospitals with whom the insurer had negotiated discount rates.

Other HMOs can also absorb the premium tax Congratulations to CareFirst BlueCross BlueShield for not increasing its HMO premium rates after the General Assembly removed the HMOs' unwarranted exemption from the 2 percent premium tax all other insurers have been paying for years ("CareFirst declines to pass on tax to customers," Feb. 22). As city Health Commissioner Peter L. Beilenson explained in his recent column "Make HMOs justify increases" (Opinion Commentary, Feb. 16), all the HMOs have very substantial profit margins, pay their top executives exorbitant amounts and could easily absorb the 2 percent assessment just as CareFirst has. We strongly urge all of them to do so. It is very unfortunate that Insurance Commissioner Alfred W. Redmer Jr. took the unusual, and wholly unjustified, step in January of pre-approving rate increases for the HMOs.

A nonprofit group of Maryland health maintenance organizations has filed a lawsuit against the state commission that regulates hospital fees, contending that the commission has allowed hospitals to overcharge HMOs for services and that it violates state administrative procedure.The Maryland Association of Health Maintenance Organizations' (MAHMO) lawsuit against the Health Services Cost Review Commission, filed yesterday in Baltimore Circuit Court, also charges that the commission violated the "due process rights" of HMOs by failing to adhere to established procedures in setting hospital rates.

The four health maintenance organizations owned by Blue Cross and Blue Shield of Maryland saw their combined enrollment drop 6 percent last year, according to financial statements filed with the state insurance commissioner.The loss of nearly 16,000 members occurred despite a Blue Cross effort to increase its market share in a hotly competitive market. The insurer is counting on its HMOs to shore up its future as a leading provider of managed care. To stem the loss, the Blues pared back premium increases and trimmed medical costs.

Extending the battle over the impact of the new HMO premium tax, a Baltimore County Democrat urged her state Senate colleagues yesterday to support a measure blocking insurers' ability to increase rates without regulatory review. The state insurance commissioner should be required to look at "soaring profits" and lavish executive pay, and to hold a public hearing before allowing health maintenance organizations to increase premium rates, Sen. Delores G. Kelley told the Senate Finance Committee.

SOME HAVE argued that Maryland HMOs must pass the cost of the newly enacted 2 percent premium tax on to consumers because of the natural physics of how business costs are borne. Price is determined by what the market will bear. And competition shapes what the market will bear. The airlines, for example, suffering fuel price increases, have attempted to pass on these added costs to customers. Because of intense competition among the airlines, however, these attempts have largely failed.