New law slashes HMO patients' wait time in California

In 2002, voters of California passed a law mandating that HMOs, which serve nearly 21 million people in California, offer more timely access to medical care. Now the California Department of Managed Health Care finally is ready to implement those new rules, to be unveiled Wednesday at Cedars-Sinai Medical Center in Los Angeles, according to a story in today's Los Angeles Times. California says it is the first state to set time standards for HMOs.

What will these new rules mean? Patients who seek urgent care that doesn't require prior authorization must be seen within 48 hours. Otherwise, patients must get an appointment within 10 days for general treatment and an appointment within 15 days for specialist treatment. When I've been in HMOs in the past, I could usually get into my primary care physician within about a week, so that doesn't sound like a major change. But I've waited months to get to see a specialist.

State officials say the reason it took seven years to work out the new regulations was because protracted negotiations took place with HMOs, doctors, hospitals, consumer groups and other health care activists. Merritt Hawkins & Associates found in 2009 that people in San Diego wait an average of 24 days for a routine physical with a family practitioner. In Los Angeles, patients can wait, on average, 59 days. Researchers found that the high cost of living, Los Angeles' vast poor population, and low reimbursement rates from Medi-Cal drive family doctors away from the city or into specialties that pay more.

After the rules are unveiled on Wednesday, HMOs will be given nine months to submit plans that meet the new guidelines. HMOs will be given until January 2011 to comply. After that date, HMOs can be penalized if they fail to meet required wait times.

Some doctors think these new rules could compromise medical care, as they force doctors to rush patients through their offices. Others believe this will increase costs for the HMOs, because they'll need to hire more doctors even though California is already facing a shortage of doctors. The problem could get worse if millions more uninsured people get health insurance should Congress pass new health care legislation.

In fact, the conclusion to the Merritt Hawkins study was, "The survey was conducted during a historic economic recession when physician utilization and hospital admissions are reported to be down. An economic recovery may be expected to increase physician utilization and extend appointment wait times. Boston, a city in a state that recently expanded access to health care coverage, shows the longest average times to schedule an appointment. These long wait times serve as a sign of what could occur nationally if access to health care is made more generally available through health care reform."

Clearly this country needs to train more physicians and improve access to health care. The big question is, even if the health care legislation gets passed, will the health care industry be able to serve all those that need its care?

Lita Epstein has written more than 25 books including Working After Retirement for Dummies and Surviving a Layoff: A Week-by-Week Guide to Getting Your Life Back Together.
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