Word: hmo
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...corporate interests lies near the heart of the national debate over health-care reform. In his State of the Union address, President Clinton once more pressed Congress to pass a Patients' Bill of Rights, a crucial element of which would be the right of any consumer to hold an HMO legally accountable for its medical blunders. Such unlikely allies as consumer-advocate groups and the American Medical Association support this reform. They argue that in attempting to practice cost control, HMOs end up practicing medicine. Even judges have voiced frustration. Ruling in favor of an HMO in an Oklahoma case...
When Representative Charlie Norwood, a Georgia Republican, introduced a bill last year that would have opened the door to HMO malpractice suits, the American Association of Health Plans quickly parried with a study by the accounting firm KPMG Peat Marwick predicting that the resulting torrent of suits would pump up premiums as much as 8.6%--a claim that lost some currency when, in a similar study, the Congressional Budget Office concluded that costs would rise only 1.2%, a mere $7 per covered employee per year. House Republicans, led by Dennis Hastert of Illinois, now Speaker, opposed the plan largely...
Republican control of Congress may doom hopes of federal ERISA reform anytime soon. Still, Norwood has returned with a new bill that would not only allow patients to sue but would also give them the right to appeal to the courts as soon as an HMO denies care that a doctor recommends. Norwood's bottom line: "If you practice medicine with or without a license, you have to be responsible for your actions should you maim, harm or kill...
Some HMOs are attempting their own limited reforms. Just a month before the Goodrich award, all HMOs in California agreed to submit to review by an outside panel of doctors. Fifteen states allow patients to appeal HMO decisions to a state board, though critics say the panels almost always side with the insurer...
...predicted failed to materialize. Only one malpractice suit has so far been filed. The new state review panels expected to be deluged by 4,400 appeals from unhappy patients in the first year alone, but only 280 cases were heard, and in half those the boards ruled for the HMO. Doctors in the state say HMOs seem to have become more inclined to accept suggested treatments and speed the paperwork...