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Published Wednesday, July 11, 2001, in the San Jose Mercury News
Blue Cross changes rewards
PATIENTS EMPHASIZED
OVER COST CONTROLS
IN NEW HMO POLICY
BY JOHN WOOLFOLK
Mercury News
Amid growing public pressure to put patients' needs above profits, Blue Cross of California announced Tuesday that its HMO will reward doctors for patient satisfaction instead of curbing their costs.
The move by Blue Cross, the state's fourth-largest health maintenance organization serving 2.2 million Californians, marks a radical policy departure in the often-reviled for-profit managed health care industry. Other for-profit HMOs are expected to follow.
``This has been one of the primary criticisms of the managed care industry for the past several years, that cost controls are considered barriers to patients in terms of the quality of their experience,'' said Blue Cross spokesman Michael Chee. ``We're eliminating that barrier.''
The policy shift, which offers doctors a generous 10 percent bonus for satisfying customers, drew skeptical praise from physician groups who have sharply criticized the managed care industry for its focus on cost-cutting.
``Rewarding quality and patient satisfaction is a good idea, and we want to work with health plans to do that,'' said Paul Warren, spokesman for the California Medical Association, which represents 35,000 doctors and is suing Blue Cross over medical payments it says are too low.
``But let's face it, when Blue Cross holds a big press event on a new initiative looking for a lot of positive publicity, that's partly what it's about.''
The announcement from Blue Cross signals a growing industry sensitivity to its battered image as heartless misers. Audiences roared in approval when actress Helen Hunt cursed HMOs in the hit 1997 film ``As Good as it Gets,'' for which she won an Oscar. Congress is now at work on a ``patients' bill of rights'' that would let consumers sue their HMOs.
Chee said the HMO began pursuing the policy change a year ago, before the Congressional action, but acknowledged the pressure on the industry from years of bad publicity.
HMO patients have frequently, and publicly, accused the managed care industry of limiting treatment to contain costs while disregarding the patient's best interests.
Blue Cross is believed to be the first for-profit managed care network system to offer incentives based upon customer satisfaction instead of profit.
``For-profit health companies are in the business to make money,'' Warren said. ``The reason they're changing is that it's not working for them at the bottom line. That's why we have a patients' bill of rights, because they have never lived up to the promises they made.''
Non-profit health care systems, including Kaiser Permanente, the state's largest, say they've been rewarding patient satisfaction all along and said they were pleased to see a for-profit competitor follow their lead.
``I think it's about time,'' said Dr. Robert Pearl, executive director and chief executive of the Permanente Medical Group, the nation's largest, which includes Kaiser Permanente and Kaiser Health Plan.
``Kaiser Permanente has been evaluating physicians solely on the quality of service, and we don't believe that using financial incentives to get physicians to act in inappropriate ways is what's best for medicine.''
The new Blue Cross policy is in effect immediately, but applies only to the company's HMO customers. It will be phased in over the next year as contracts with its 200 member medical groups are renewed. About a half-dozen medical groups are using the new system now, Chee said.
Blue Cross will retain the framework of paying doctors a fixed sum based upon their number of patients, an industry formula known as capitation. Blue Cross will pay them bonuses of up to 10 percent of that fee to reward them for patient satisfaction. Because that fee varies considerably throughout the Blue Cross network, company officials wouldn't estimate the average size of the bonus.
Medical groups would receive the bonuses based upon a patient survey developed by the Pacific Business Group on Health, a San Francisco-based coalition representing major businesses that are major health care buyers.
Patients now can reward their doctors for prompt and courteous service and good bedside manner.
``The questions all revolve around the patient's encounter with the physician and the physician's office,'' Chee said. ``How long it took to get an appointment, how easy it was to get a referral to a specialist. Do you feel your needs were met? Does your doctor provide appropriate care, in your opinion?''
Victor Corsiglia, a doctor and former president of the San Jose Good Samaritan Medical Group, a Blue Cross member, said it will be difficult for the company to develop a good questionnaire that gets to the real issues.
``What are you going to measure?'' Corsiglia asked. ``Whether the doctor looks you in the eye when he talks to you?''
Blue Cross, he said, should go beyond checklists and examine outcomes, treatment plans and whether there were complications.
``I'd never turn down money,'' he said, ``but this is going to be difficult to implement in the way it should be.''
Joycellen Floyd, a family practitioner in Milpitas, agreed that a good review doesn't necessarily mean quality care.
``You can have someone who's a hand-holder, but his outcomes aren't good,'' Floyd said. ``Or, you can have someone good, but curt and brusque -- I doubt he'd be the one to get the better review.'' |
