Many MCOs Already Observe Requirements Included in Patients’ Rights Legislation, Papers Note

Many of the changes included in the patients' rights bill (S 283) passed by the Senate last week have already been implemented by insurers facing "rampant consumer resentment," the Washington Post reports (Goldstein, Washington Post, 7/1). For instance, two-thirds of HMOs do not require approval from a health plan nurse before a person can be admitted to a hospital or see a specialist, and many health plan members can appeal denials of care to independent review panels (Freudenheim, New York Times, 7/2). In addition, some plans also allow members to see a dermatologist, allergist, cardiologist or orthopedist without permission. Managed care company officials, such as Aetna's chief medical officer, William Popik, say that consumers, rather than state laws or the possibility of a federal law, have prompted the changes. Frank Sloan, director of Duke University's Center for Health Policy Law and Management, said, "Congress doing what it's doing now is picking up somewhat late in the game" (Washington Post, 7/1).

Cost to Consumers
These changes have not come without a price, the New York Times reports. Health care costs have "spiral[ed]" upward as hospitals and medical groups have gained more "bargaining clout" with MCOs and as direct-to-consumer drug advertising "has unleashed consumer demand for costly medications" (New York Times, 7/2). In addition, many people have switched from HMOs to more costly PPOs, which allow them to see physicians outside an MCO's network for a higher charge (Washington Post, 7/2). As the economy slows, more costs are shifted to consumers. Analysts say that less wealthy individuals can increasingly afford only the more restrictive health plans, while more affluent consumers "are paying for their freedom of choice" (New York Times, 7/2).

Setting a Standard
Despite the industry changes, the Senate-approved patients' bill of rights would not be "entirely moot" if it becomes law, because some of the legislation's provisions are not "commonplace" among health plans, the Washington Post reports. Few MCOs pay for routine costs of care when members participate in clinical trials, and not all MCOs have adopted policies intended to avoid forcing "very ill patients" or those near the end of a pregnancy to "abrupt[ly]" switch doctors when the provider leaves a network. The bill approved by the Senate would require both these policies. Mark Hall, a Wake Forest University faculty member who is studying the managed care industry, added that a patients' rights law would "prevent health plans from watering down benefits" and would establish "a single, clear uniform" standard of care (Washington Post, 7/2).