Examining HMOs: Physicians and patients push for changes in healthcare policies.

• Author: Sommers, Jeanette
• Position: Feature Story

Is this doctor's sentiment just an isolated case, or are more and more physicians and their patients beginning to feel that Utah's HMOs are too controlling?

According to a recent report by the Utah Department of Health, which surveyed over 3,400 HMO members of the six Utah commercial HMO's (Altius Health Plans Inc., Cigna Healthcare of Utah, IHC Health Plans Inc., Intergroup, Regence BlueCross BlueShield of Utah and United Healthcare of Utah), IHC is by far the largest HMO with enrollments exceeding 393,000. It ranked highest in overall member satisfaction, particularly in its care for children, teens and pregnant mothers. The report also indicated that 94 percent of Intergroup members say they are satisfied, while all other HMO's scored in the average range.

Although the report indicates that HMO members feet satisfied overall, there is no question that passions are percolating among some doctors and patients who are unhappy with the management and policies that regulate their lives. As HMO's contract with doctors and hospitals to offer services at lower out-of-pocket costs, some members and their physicians don't appreciate the trade-off and complain that healthcare organizations have lost sight of the doctor-patient relationship.

One neurological surgeon on the Wasatch Front says he objected to IHC's physician kickback bonus plan being too focused on increasing production rather than caring for the patient. The incentive is to "move'em in, move'em out," he quips. "I'm sorry, but I don't like to treat my patients that way. If you come in for a sore throat and you want to tell me how Suzie's doing in school, then I want to have a minute to stop and chat with you and see how things are going."

Some physicians feel the system is set up to put profits in the pockets of the HMO's and that it limits doctors' options in offering treatment. They point to the fact that a certain number of activities and procedures are expected to be performed by physicians each month in order to generate the revenue required by the healthcare company. One Orem doctor in family practice was angered not only at being evaluated on how well he met his HMO's productivity criteria, but also to see it published monthly to other physicians in the plan.

Some physicians are rebelling and others are just plain intimidated by the threat that if they leave, their HMO will take them to court and sue them for breach of contract. A Utah County doctor says one of her colleagues...