PacifiCare Tough Times Aired; Nurses Prep for New Rules
Managed healthcare service plans continue to receive scholarly attention, including a new examination of consumers by a University of California, Berkeley, research team. And their findings seem to stroke health plans that follow the line of Kaiser Permanente, which has approximately 314,000 members in Orange County.
Professor Helen Halpin Schauffler and her colleagues found that health maintenance organizations that follow a staff/group model, like Kaiser, received the fewest consumer complaints. Overall, 34% of members reported problems with a Kaiser-style HMO, compared with 43% for preferred-provider organizations and 46% for network HMOs such as Santa Ana-based PacifiCare Health Systems Inc.
In staff/group model HMOs, doctors see patients from one HMO exclusively. Besides Kaiser Permanente, other examples of the model cited by the researchers include Group Health Cooperative of Puget Sound in Washington state and the former Harvard Community Health Plan in Massachusetts.
The Berkeley group surveyed a total of 1,201 randomly selected adults with health insurance. Overall, they found that 42% of the respondents reported one or more problems with their managed care organization, ranging from billing errors to limited access to specialists to denial of treatment.
As for the other models, PPOs, where doctors contract with insurance companies to provide services at a discounted fee, ranked second in overall consumer problems, according to the study. Researchers found, however, that most reported PPO problems were related to administration issues like billing and understanding benefits, rather than access to healthcare.
Independent provider association/network HMOs, which usually require primary care physicians to act as care gatekeepers, ranked third in the study. Those respondents’ most common complaints involved difficulties in getting referred to specialists and difficulties in selecting a doctor or hospital, according to researchers. They added that network HMO members reported a higher rate of being forced to switch doctors.
Results from the study will be published in the January issue of Medical Care, a trade journal. The California HealthCare Foundation, the California Managed Health Care Improvement Task Force and the California Wellness Foundation provided study funding.
BusinessWeek Airs PacifiCare Ills
Meanwhile, PacifiCare was the subject of “This HMO Needs Resuscitating,” a news analysis in the Jan. 8 edition of BusinessWeek. The piece recaps some of the company’s problems, including being placed under administrative oversight by Texas insurance regulators, shareholder lawsuits and changes in the management suite.
New PacifiCare Chief Executive Howard Phanstiel told BusinessWeek that the company would face a couple of “very tough years” before it could be straightened out. Phanstiel, among other things, told the magazine that PacifiCare was somewhat na & #271;ve in not changing its business model from fixed-payment to contracts where it shares risk with hospitals and doctors.
The piece also notes that PacifiCare has been struggling with the consequences of its decision to pursue the Medicare health maintenance organization market in the 1990s. Among other things, the article indicates that healthcare expenses for Medicare patients have been going up 10% to 11% annually, while premiums have been going up around 2% annually, and linked that to PacifiCare’s recent earnings difficulties.
Nurses Set OC Town Hall
The California Nurses Association is scheduled to hold a “town hall” meeting March 21 at the University of California, Irvine. The meeting will include brief presentations by Kay McVay, the association’s president, and Jill Furillo, its director of government affairs, followed by testimony from local nurses.
Meeting topics include a new association-sponsored state law that requires minimum, specific nurse-to-patient ratios in hospitals. The state Department of Health Services will issue proposed nurse staffing ratios within a few months, but the association says that a battle is heating up with hospitals over what those ratios will be.
Nurse-patient ratios are scheduled to go into effect in January 2002, but a portion of the law that restricts activities of what the association calls “unlicensed, minimally trained personnel” has been in effect since January 2000.
Bits and Pieces:
Cardiac Science Inc., Irvine, got approval from the Australian Therapeutic Goods Administration to market its hospital bedside defibrillator-monitor in that country. Cardiac Science also said it sold 50 of the Powerheart monitors and some accoutrements, resulting in $333,500 in revenue VitalCom Inc., Tustin, implemented its PatientNet wireless network at the Mid America Heart Institute of St. Luke’s-Shawnee Mission Health System in Kansas City, Mo. VitalCom also said it signed a distribution agreement for PatientNet with Nihon Kohden America Inc., Foothill Ranch. Nihon Kohden will purchase, market and sell PatientNet to hospitals that aren’t already being served by VitalCom Madison Technology Systems Inc., Aliso Viejo, said it received a U.S. patent for a “smart card” system. The system, which includes a patent-pending Web-based medical record storage site, is intended to allow consumers to control access to all their medical records in one database Drs. Robert Maloney and Franklin Lusby opened the Maloney-Lusby Vision Institute in Irvine. The practice specializes in laser eye surgery.
