ANNAPOLIS – Can’t get through to your HMO doctor? Do you wait two hours to see the doctor once you have an appointment? Do you think you didn’t have a test run because of its cost?
Sen. Paul Pinsky, D-Prince George’s, wants to help managed care patients who have these and other problems.
Pinsky, noting that Maryland ranks fourth nationally for the number of its citizens under managed care, has introduced legislation to do the following:
* Prohibit HMOs from offering financial incentives to doctors for not prescribing additional tests and services.
* Establish maximum patient-to-doctor ratios to ensure that providers are always available to meet patients needs.
* Set a maximum 30-day waiting period between calling the doctor and the actual appointment.
* Protect doctors’ right to speak out against budget-driven policies that do harm to patients.
“Budget decisions shouldn’t be driving health care policy, patient care should,” Pinsky told the Senate Finance Committee Thursday during a hearing on his bill.
Among those who testified in support of the legislation were doctors from Silver Spring, Havre De Grace, Hyattsville and Glen Burnie. In addition, the Maryland Chapter of the American Association for Pediatrics, the Maryland Dermatological Society and the Medical and Chirurgical Faculty of Maryland testified in favor of the bill.
Dr. Mark Goldman, a physician in Hyattsville and primary care provider for an HMO for 18 years, said the bill sets reasonable guidelines and has great public value.
In written testimony, Goldman stated, “I need to be able to work in an environment where I can provide medical care which meets patient needs and expectations and also meets my own professional standards.”
Those opposed to the bill include the Maryland Association of Health Maintenance Organizations, the League of Life and Health Insurers of Maryland and the Health Insurance Association of America.
Robert Enten, a lobbyist for the Maryland Association of Health Maintenance Organizations, said parts of the bill were introduced in previous legislation and the rest is micro management.
“The health commissioner already has existing authority to regulate in this area,” Enten said.
Physicians who know of cases in which an HMO did not act in accordance with quality care standards should report them to the regulatory agencies, rather than complain to the Legislature, he said.
Enten argued that the number of complaints is proportionately quite low.
“The Insurance Administration did a survey from March 1995 to March 1996 of provider complaints against HMOs. There were 1,112 complaints made by providers,” he said. “There are 2.1 million people under managed care in Maryland. There were a total of 57 complaints against the quality of managed care. The health department received a total of 12 in 1995 and 16 in 1996. Is it easier to complain to the General Assembly or to file a complaint to a regulator?”
Deborah Rivkin, a lobbyist for the League of Life and Health Insurers of Maryland, said the maximum patient-to-doctor ratios don’t make sense.
“The doctor has no idea what kind of patient you are,” Rivkin said. “This bill suggests — not intentionally, suggests – – certain regulation for HMOs, but other patients don’t have the same regulations.”
Pinsky said he thought the legislation would get a favorable report from the committee, but was not confident of its fate in the House of Delegates.
“The Senate Finance Committee has been supportive of this type of HMO legislation in the past,” Pinsky said. “A number [of bills] have gotten out of the Senate, but been amended or killed in the House.” -30-