Ratings of Healthcare Organizations- Part II

As we have noted in a number of articles on this site, many states have in place rating programs of the healthcare services performed by hospitals, health care facilities, doctors, nursing homes etc. This provides consumers with better information to make choices about healthcare. California has added a new wrinkle to its report card on the state’s HMOs: a detailed performance rating of leading physician groups.

California’s second annual report rates the states top 10 HMOs from poor to excellent in five categories: overall customer service; doctor service; and how well the plans help members stay healthy, get better and live with illness. The report also goes on to rate 80 medical groups within the HMOs that are providing care to about 72% of the states HMO members in four categories: overall performance; treatment and specialty care; communication with patients and timely care and service. In the second annual report only one group was given an "excellent" rating (Kaiser Permanente’s Southern California unit for its preventative care program) and two HMOs received a "poor" rating in this category (Universal Care, Long Beach and Western Health Advantage).  

This report card supplies information about medical groups within the HMO that can be used as a yardstick by consumers in making choices about HMO medical groups. They could then switch their medical group during the once a year period of open enrollment. This, of course, assumes stability in rating from one year to the next, since consumers usually have only one small window of when to change medical groups.

It should be noted that state regulators rather than consumer groups compile these ratings. Each of these groups has a different concept of how to rate the HMO.

California is also the first state to enact mandatory nurse-staffing ratios. Before this law becomes final, there will be a public hearing period where individuals and organizations will make comments about the nurse-staffing ratio. The law is scheduled to go into effect in the beginning of the year 2004, with the interim period to give hospitals time to accommodate to the changes they have to make in the staffing of these units. The premises of the law have been in the legislative planning stage since 1999. The California Nursing Association was a strong lobbying group for this legislation.

The law mandates that hospitals staff one nurse for every 6 patients in a medical-surgical unit, with a reduction to one-to-five ratio in 12 to 18 months after the law goes into effect. Intensive care units are required to have a ratio of one nurse to every two patients.

Another west coast state, Oregon, approved legislation in 2001 that required individual hospital systems to develop and implement plans for staffing requirements. The hope is that the ratios will be standardized throughout the whole system through empowering individual hospital systems to be part of the process of deciding the ratio, rather than imposing something on them.

Another issue that is getting play in national newspapers is the question of hospitals owning HMOs. The HMO dictates the hospital you attend and when they control most of the doctors and can deny patients choice, there are some who think this borders on economic monopoly, a threat to the concept of free trade.

The number of hospitals owning HMOs has dropped 33.4% from 3,277 in 1996 to 2,184 in 2000. Michigan is considering legislation that would prohibit hospitals from owning their own HMOs, due to conflict of interest in pricing and patient care, because these plans have the incentives to refer members to their own hospitals and doctors and pay these providers higher rates.  

Please see our other article on this topic- Hospitals, "Magnet" Hospitals, Physicians and Nursing Home Ratings on the Internet-Part I


Harold Rubin, MS, ABD, CRC, Guest Lecturer
posted October 13, 2002

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