STATEWIDE STUDY CRITICIZES HMOS FOR DELAYS AT DOCTORS’ OFFICES
The Press Democrat
The two largest health maintenance organizations in Sonoma County – – Kaiser Permanente and Health Plan of the Redwoods — received generally favorable ratings in a patient survey conducted by the new California Department of Managed Health Care, although the agency found problems with patients finding primary care physicians and finding long waits at doctors offices.
Kaiser Permanente’s Northern California division, with 123,000 members in Sonoma County, scored “good” ratings in four of five categories. HPR, with 80,000 members, had good ratings in three categories.
The HMOs were graded in 57 areas that fell into five categories: Overall service, communications with doctors, treating acute illness, dealing with chronic illness and promotion of wellness education.
Only Kaiser of Southern California had good ratings in all five categories. The first-ever report, which rated 17 health maintenance organizations, is intended to be an annual score card for consumers to review when choosing health plans.
It is available on the Internet at www.hmohelp.ca.gov.
The Department of Managed Health Care was created by state Legislature in reponse to increasing patient complaints about HMOs and to the shakey financial condition of medical groups that contract with HMOs for medical services.
Dr. Bob Schultz, Kaiser Permanente’s medical director, said Kaiser views the ratings as “reflection of the work in improved service and access that we are continuing to perform.”
HPR chief executive officer John Baxter said he was heartened that HPR received the highest score among Sonoma County HMOs for its ability to get care for members and on customer service. The survey found 60 percent of HPR respondents gave the HMO the top ranking in that category. Northern California Kaiser got a score of 58 percent, PacifiCare 53 percent and Health Net 56 percent.
While patients reported good relationships with their doctors and HMOs overall, the survey showed broad dissatisfaction across all HMOs when consumers were asked specifically about how long it took to get an appointment and the length of office waits.
Allegations of intentional delays in patient access to doctors is at the heart of a 1999 lawsuit filed by the Foundation for Taxpayer and Consumer Rights, a consumer advocacy group, against all California Kaiser operations.
The suit, pending in San Francisco Superior Court, alleges Kaiser implemented cost controls that made it difficult for patients to see their doctors. Kaiser has acknowledged that administrative practices discouraged patient visits and has said it has made changes to correct them.
In the state survey, Northern California Kaiser received high marks from patients for childhood immunizations, services for pregnant women, care for heart problems and diabetes control.
HPR patients rated the HMO highest for its asthma treatment programs, blood pressure control, for handling complaints quickly and the absence of paperwork.
Of HMOs operating in Sonoma County, Kaiser, Health Net, Cigna and Lifeguard earned good ratings in four out of five overall categories. Earning three of five were HPR, PacifiCare, Aetna, Blue Shield and Blue Cross.
In general, most HMOs had their lowest ratings in the area of chronic illness, which included indicators such as treatment for asthma, diabetes and high blood pressure. Most also earned poor ratings for their treatment of mental illness and sexually transmitted diseases.
A pamphlet summarizing the Web site information will be available at HMO and doctor’s offices, pharmacies and by calling the patient advocate’s office (213) 897-0579.
