California Consumer Advocate Mounts Full-Court Press On Managed Care

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Modern Healthcare

If HMOs weren’t beleaguered enough by patient reforms being pushed through Congress, they should be little cheered that one of managed care’s biggest gadflies is now a published author.

Jamie Court, director of the Santa Monica, California-based Consumers for Quality Care, gained notoriety for tactics such as dumping a load of dried beans in front of a gathering of HMO executives to criticize their “bean-counting” mentality, and for his “casualty of the day” press releases profiling individuals allegedly harmed by managed-care plans.

Little surprise then that Court’s new book is titled Making a Killing: HMOs and the Threat to Your Health, which he co-authored with Francis Smith, a senior fellow at the Institute for a Civil Society in Newton, Mass.

The 232-page tome is peppered with statistics, HMO members’ anecdotes and more blistering criticism of managed care.

The book’s conclusion: HMOs’ restrictions are harming patients and eroding community-based healthcare, while insurance regulations of the Employee Retirement Income Security Act let them do so with virtual impunity. The book calls for a variety of reforms, such as barring investor-owned HMOs and full-risk capitation, encouraging direct contracting between providers and employers, and allowing regulators to determine premiums.

Although only 32, Court projects an air of guerrilla elder statesman, someone war-weary enough to prefer writing over dreaming up outlandish stunts. “A book is the most effective way to communicate a message,” he says. “But five years ago, you had to throw bombs, because no one was paying attention” to the managed-care debate.

A matter of intentions. Princeton (N.J.) Insurance Co., a medical malpractice insurer, has a new and unique selling point for its products. It has been automatically attaching “government billing errors and omissions” insurance for its New Jersey physician customers. The free coverage, which is retroactive to claims arising from billing in the past 12 months, provides up to $50,000 in legal defense coverage for “inadvertent billing errors,” according to a company statement.

There’s a catch, though. Doctors better beware if they’re counting on the added financial support. “It does not cover claims of intentional fraud,” the company states.

The spin cycle. Responding to a recent General Accounting Office report, the American Association of Health Plans issued a press release that said managed-care enrollees have “widespread access” to clinical trials funded by the National Institutes of Health.

However, the GAO report states: “As a general rule, health insurance policies exclude coverage of clinical trials.”

The report goes on to say that most will allow exceptions on a case-by-case basis. It had no data to indicate how many were allowed, however.

In defense of the AAHP, however, the spin went both ways. The chief issue the GAO was supposed to address was whether coverage policies have resulted in a shortage of patients for clinical trials. The watchdog agency said there are enough patients for clinical trials, but buried that finding deep in the report while playing up the sexier issue of a lack of health plan coverage.

Don’t sugarcoat it. Breaking up is hard to do.

After the fanfare over the creation of Penn State Geisinger Health System, Harrisburg, Pa., in 1997, its swift, inglorious split isn’t easy to explain. So give a little credit to the folks at Milton S. Hershey (Pa.) Medical Center for not completely ducking the obvious questions. The hospital tried to cover its bases in briefing materials given to employees earlier this month when the board voted to dissolve the system. A few excerpts, which seem to apply equally well to systems that survive mergers, follow.

Q: What happens to my job?

A: Unfortunately, no one’s job can be guaranteed. The need to reduce costs is still there. The reality is that in an organization where over 60% of the costs are related to compensation, it is impossible to make substantial reductions in cost without impacting some positions. However, we also think that an organization that only focuses on cost reduction is doomed to fall into a death spiral. Therefore, we will be looking for opportunities to enhance revenues and unleash the entrepreneurial spirit of our people.

Q: What were you people thinking when you merged back in 1997?

A: There were many strategic and financial reasons for merging, and many of those reasons still exist today. However, we must not be stuck in the past and must react to changing situations and make the prudent decisions that allow us to move forward.

He plays one on TV. A commercial for a Wisconsin hospital that features an actor portraying a cardiologist who recently suffered a heart attack has an advertising expert and a real physician calling the advertisement unethical.

The 30-second spot for 294-bed Waukesha (Wis.) Memorial Hospital includes a man jogging through the countryside, recalling his recovery from a heart attack that was treated at the hospital.

In the commercial, actor Rick Romano, a Milwaukee Area Technical College spokesman, puts on a Waukesha Memorial ID badge that bears the fictitious name John Weber, M.D.

John Crowley, former head of the advertising department at Marquette University, says the ad was “a blatant falsehood. It’s deception, pure and simple.”

Milwaukee cardiologist Jack Manley says using an actor to portray a member of his profession was “unethical and an absolute falsehood. They should not do that.”

But Kathy Allen, a Waukesha Memorial spokeswoman, defends the commercial, saying that there was nothing wrong with an actor portraying events that have occurred at the hospital.

“I would feel uncomfortable if we had used a real physician,” she says, adding that using a real doctor would have been a violation of patient confidentiality.

Consumer Watchdog
Consumer Watchdog
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