Word: hmos
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Whether any national legislation will result, and when, is most uncertain. The Republicans who control Congress will not buy Kennedy's bill, and Clinton's panel will not report for almost a year. But HMOs are coming under attack from so many directions that they can no longer shrug it off. They respond by citing membership-satisfaction polls and insist that those who complain "are being frightened by inflammatory language" about rare occurrences, in the words of Susan Pisano, spokeswoman for the American Association of Health Plans...
Nevertheless, the association is promulgating a code that prohibits its 1,000 member HMOs from enforcing gag rules and employing such practices as drive-by mastectomies, on pain of being kicked out. In what looks like an if-you-can't-lick-'em-join-'em move, the association has even announced support for Clinton's panel. Pisano hopefully predicts a "thoughtful" study--leading, presumably, to mild recommendations...
This may be an extreme position, but there is ample evidence that the bottom-line mentality is taking over. HMOs refer to the proportion of premiums they pay out for patient care as their "medical-loss ratio"--a chilling choice of words. The Association of American Medical Colleges reported last November that medical-loss ratios of for-profit HMOs paying a flat fee to doctors for treatment averaged only 70% of their premium revenue. The remaining 30% went for administrative expenses--and profit. Other surveys have yielded less alarming figures, and even among profit-making HMOs, there is a wide...
Insurers generally claim that medical-loss ratios have little meaning in themselves because of different accounting systems and are not an accurate guide to profits, which have actually been driven down lately by ruthless competition. Humana, one of the biggest for-profit HMOs, reported a drop in net income of nearly 94% for 1996 after some special charges...
Physicians Organizations are springing up across the continent either to bargain with HMOs for better terms or to offer their own health plans to employers. Last October, Primary Care LCC, a group of 170 physicians in the suburbs south of Boston, won a contract with Secure Horizons, a managed-care plan, to treat some of the plan's 40,000 Massachusetts Medicare patients. In Los Angeles, UCLA Medical Group, which began in 1992 with just two physicians, expects to have 80 by midsummer. It already has two full-time vans carrying patients from suburban doctors' offices to the star-studded...