Patients’ bill of rights not reflected in California HMO evaluation plan

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The Dallas Morning News

DALLAS _ Blue Cross of California said that a plan to reward doctors based on patient satisfaction has nothing to do with legislation pending in Washington. The action this week, just as Congress readies for another round of debate on the patients’ bill of rights, has some questioning Blue Cross‘ motive.

California’s fourth-largest HMO will base its incentive program entirely on customer satisfaction and other quality measures rather than controlling expenses, said Michael Chee, spokesman for the company that insures 2.2 million Californians. Other forms of payment will continue.

“Our hypothesis is that this might be a beginning of a trend, and we are the first to make this significant shift,” Chee said Wednesday.

Blue Cross will award doctors groups bonuses based on patient satisfaction, monitored through quarterly surveys and exit interviews, and quality of care.

The patient survey is used by health groups nationally, including several in California. Health groups across the country have made similar shifts in recent months.

Blue Shield, a non-profit health plan based in San Francisco, started a performance review system in January, said Dr. Jeffrey Rideout, chief medical officer.

“If what they announced pushes us all along, that’s fine and I’m happy they did it,” Rideout said. “This is not igniting a new fire. It may be highlighting one that should be accelerated …”

Blue Cross of California’s announcement came as the House of Representatives is set to pound out its version of the patients’ bill of rights. The Senate last week approved a bill that would allow patients to sue their HMOs in federal court over disputes about benefits, co-payments and contracts, and permit state lawsuits if patients were harmed because they were wrongly denied medical coverage.

“There’s not much substance here, it’s mostly hype. You’re going to see a lot more of these type of announcements as the patient’s bill of rights gets closer to the president’s desk,” said Jamie Court, executive director of the nonprofit Foundation for Taxpayer and Consumer Rights in Santa Monica, Calif.

Blue Cross counters that the new plan has absolutely nothing to do with the pending patients’ bill of rights, and the timing is purely coincidental, Chee said. A California law passed in January allows patients to sue HMOs for unlimited damages, and Chee said Blue Cross has been working on their new program for a year.

Some health care industry watchdogs say the actions in California are steps in the right direction, and expect other insurers will follow.

“To some extent there’s a trend going on here, and it’s a sign of managed care plans, maybe belatedly, getting the message (that) making customers mad is not a good way to stay in business,” said Michael Miller, policy director for Boston’s Community Catalyst, a national health care advocacy group.

Although it’s unclear what the financial implications of this will be, Miller said this will provide incentives to reward for high patient satisfaction and quality health care.

The move was praised by a spokeswoman for Senate majority leader Tom Daschle, who championed the patients’ bill of rights in Congress. Spokeswoman Molly Rowley said “the timing is interesting.

“It’s great that under the white-hot light of public attention some HMOs are paying more attention to patient satisfaction, but self-regulation alone is not enough,” Rowley said.

Tom Angelich, of Angelich Insurance Company in central California, said his office fielded a few calls from its nearly 1,000 Blue Cross policy holders.

“It’s going to take about six months to see what’s going to happen,” Angelich. said.

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