Hmos

Smaller, local health plans have far outperformed large national plans in quality and consumer satisfaction, according to Maryland's annual HMO report card. The national plans included CIGNA and United Healthcare, which scored below average in at least 40 percent of the categories. But local plans racked up better grades, a pattern that began five years ago when the report card was launched. The annual report, released yesterday by the Maryland Health Care Commission, compares the state's 12 HMOs in 29 categories, including customer service, preventive medicine and care for chronically ill people.

With a deadline looming Monday, several HMOs told a legislative hearing in Annapolis yesterday that they are still unsure whether they will limit or drop their participation in the state's Medicaid program as of Jan. 1. "The funding for the whole program is inadequate," Eric R. Wagner, president of Helix Family Choice, told the House Environmental Matters Committee. "It could lead to exits [by HMOs], haphazard returns to fee-for-service and disruptions to patients." Representatives of several HMOs said another $20 million - half state funds and half federal - on top of already-recommended increases would be enough to keep the program going smoothly.

The Maryland Preferred Provider Organization run by CareFirst BlueCross Blue- Shield ranks at the top in member satisfaction in a national survey published in the October issue of Consumer Reports magazine. Based on survey responses from 83,000 of its readers, the magazine reports on customer satisfaction with 16 PPOs and 44 HMOs. CareFirst's was the only PPO in this area included. It scored 83 and topped the PPO list. The lowest rating was 68. Donato Vaccaro, research program leader for Consumers Union, which publishes the magazine, said HMOs and PPOs were included in the rankings if there were more than 150 questionnaire responses.

CareFirst BlueCross Blue- Shield, the state's largest health insurer, reported yesterday that profit in its second quarter jumped 31.9 percent, an improvement it credited largely to its exit from the Medicare and Medicaid HMO business. The insurer said its operating profit for the three months that ended June 30 was $22.2 million, compared with $16.8 million in the second quarter of 2000. Its Medicare and Medicaid HMOs together accounted for $3.8 million in losses during last year's second quarter.

Mid Atlantic Medical Services Inc., the Rockville health insurer, posted earnings yesterday for the quarter that ended June 30 of $12.0 million, or 30 cents a share, topping consensus analysts' estimates of 28 cents. That compared with earnings of $7.3 million, or 19 cents a share, in the second quarter of 2000. This marks MAMSI's eighth-straight earnings report of quarter-over-quarter improvement in earnings, after poor performances from 1996 to 1998 led to a replacement of top management.

ONLY POLITICS stands in the way of a House-Senate conference committee hammering out a patients' bill of rights that President Bush will happily sign. If both the White House and Senate Democrats focus on the good that can come from a strong patient-protection bill, compromise is likely. If either side tries to use the issue to make political points with voters, the bill will continue to languish. Both houses of Congress have agreed that customers of health-insurance plans should have guarantees that they can go to the nearest emergency room, choose their own doctors, visit pediatricians and women's specialists and participate in clinical trials for new therapies.

WASHINGTON -- After a week of intense negotiations, President Bush and the leading Republican advocate of patients' rights legislation struck a deal yesterday that may clear the way for House passage today of a bill to give HMO patients broad new rights to sue their health plans. "After a lot of labor and a lot of discussion, we shook hands in the Oval Office about 10 minutes ago," said Bush, with Georgia Rep. Charlie Norwood beside him, at a hastily called White House news conference.

The HMOs participating in the state Medicaid program have shown strong improvement on quality measures, but still don't meet all state standards, the Department of Health and Mental Hygiene reported yesterday. The state will withhold $237,000 in future payments - which total about a billion dollars a year - to the HMOs as a penalty for the unmet standards. Health officials, however, stressed the increase in immunization rates and other measures of care. "We have been successful in working with the health plans to improve performance," said Debbie I. Chang, deputy health secretary.

WASHINGTON - Democrats celebrated the first victory of their new majority as the Senate voted last night to guarantee specific benefits to HMO participants and grant them broad new rights to sue their health plans if they are denied necessary medical care. The 59-36 vote to approve the patients' bill of rights came after the Senate rejected Republican attempts to curtail health care lawsuits and limit the amount of damages that could be awarded. President Bush issued a statement immediately after the vote saying he couldn't sign the measure in its current form.