Judge halts release of medical groups’ records by state agency

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The Associated Press

A judge agreed Wednesday to temporarily halt the state Department of Managed Health Care‘s planned release of medical group’s financial information.

The state gathers financial information from HMOs and physicians’ groups to ensure their financial health. The department recently adopted regulations that detail what information will be made public.

But the California Medical Association sued the state earlier this month to keep that information private, saying it could give HMOs an advantage when medical groups are negotiating for new contracts.

Sacramento County Superior Court Judge Gail D. Ohanesian blocked the department from releasing some of the information until a Nov. 30 hearing. The judge allowed the state to continue to collect the information from medical groups.

DMHC director Daniel Zingale said the department can still release the pass/fail rating that can let consumers know if their doctors’ groups are in financial trouble.

“What we won’t be able to release is the explanation behind the ratings,” Zingale said. “If your medical group failed to get a good rating, you won’t know if it failed by a dollar or a million dollars.”

But CMA says releasing the financial details would have devastating effects for physician groups and their patients.

“We need to prevent bankruptcies, not to expedite these groups’ demise, and that’s what would happen if the DMHC regulations went into effect,” said Dr. Jack Lewin, the chief executive officer of CMA.

The information the CMA wants to protect includes profit and loss rates, the health plans with which CMS has contracts, how many of the group’s patients are in managed care, Medicare or Medi-Cal, and cash flow.

While it supports the rating system for medical groups, CMA officials said, the group wants to keep the details private.

The California Nurses Association, the Foundation for Taxpayer and Consumer Rights and Health Access, a coalition of more than 200 consumer and community groups, voiced their support of the state in this case.

Beth Capell of Health Access said public disclosure of the medical groups’ financial situation would protect consumers.

“We’re delighted that the department can release the pass/fail standings, but we also want the detailed information,” said Capell.

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