Jan. 6, 2000 (Washington) -- Foreshadowing a bruising congressional battle over managed care regulation, HMOs are claiming that a recent national report on medical errors equips their argument against the current "patient protection" legislation. Instead, they suggest that Congress take a much broader look at the medical establishment in the upcoming debate over the patients' bill of rights.
At the industry's kickoff press conference for the year, Karen Ignagni, president of the American Association of Health Plans (AAHP), a managed care trade organization representing many of the nation's major HMOs, emphasized that the "[medical errors report] should expand the discussion about what constitutes true patient protection."
Last November, the Institute of Medicine (IOM) made national headlines by reporting that preventable medical errors are the nation's 8th leading cause of death. With this in mind, Ignagni says, "The entire [patient protection] debate has missed the mark." Up until now, the debate has focused on protecting patients from the health plans themselves. But the HMOs may not be the only bad guys; the IOM report suggests that patients likely need to be shielded from the entire medical establishment.
The hotly contested patients' bill of rights passed by the House last October focused almost solely on measures affecting the health insurance industry. The bill grants patients the right to sue their health insurance companies in state courts. It also requires that HMOs establish external, independent medical review boards for disputed care issues. Plans would pay the costs of reviews, and panel decisions would be binding. Under the bill, a patient could still sue an HMO if a board ruled against them, but that suit would go to federal court.
The recent IOM report, however, offers health plans a higher-road tack against this legislation. One of health plans' main arguments against the bill has been cost concerns. Ignagni claimed, for example, that enactment of the bill passed by the House would force companies to reconsider whether they will offer employee health coverage.
But the AAHP faces a tough challenge, as the American Medical Association has pegged final passage of the House bill as its top Washington priority for the coming year.
Ignagni expressed more sympathy than doctors or hospitals have shown for the mandatory reports that the IOM recommended for errors resulting in serious injury or death.
But the IOM doesn't see a federal legislative debate as central to achieving its recommendations. "The major role really is at the local level," William Richardson, PhD, chairman of the IOM committee that wrote the report, tells WebMD. "This is really a systems problem and not a bad apple problem."
"We do call for some modest federal action," Richardson says. "We called for a center on patient safety at the national level ... [but] it's not a regulatory function." The mandatory error reports, he notes, would be required by states.
This being a presidential election year, the House and Senate negotiations toward a final managed care bill may be especially volatile.
For example, to the opposition of many physicians, Rep. Thomas Bliley (R, Va.), chairman of the House Commerce Committee, plans to push "quality" legislation that would open a national databank to the public that contains physician malpractice settlement and disciplinary action information.
Meanwhile, HMOs are stepping up their efforts to get out of the cellar of public opinion. "This year for us is going to be a year of change," Ignagni told reporters. In a memo last November, she told plan executives, "We need to focus more time and energy on whether [the] operating rules and business practices [of HMOs] meet the fundamental test of public understanding."