Under a bill introduced earlier this year in the Missouri State Senate, HMOs would be required to accept into their network any qualified health care provider.
The Missouri senate’s only physician, Marvin Singleton (R-Joplin), sponsored the measure. He says it would allow patients to continue seeing their preferred physician, even if their HMO plans change.
“What we’re dealing with in this bill is an attempt to say, ‘folks, we need to look at the issues of patients’ safety, quality, satisfaction and choice,'” says Singleton.
Legislative research staff have estimated Singleton’s bill would increase the cost of providing health care coverage to Missouri workers by as much as $11.4 million.
Singleton thinks the research staff estimate is too high. Including more doctors in managed care plans would foster competition, he says, which would result in lower costs.
Catherine Edwards, executive director for Missouri Association of Health Plans, disagrees. She estimates patients’ premiums would rise between 15 and 29 percent if the bill were passed, because HMOs could no longer reject health care providers with histories of expensive services.
Blue Cross/Blue Shield of Missouri also considers the bill likely to increase costs. Under the bill, notes BC/BS spokeswoman Deborah Wiethop, providers could no longer control competition by negotiating discounts with HMOs.
BC/BS is one of 16 health insurance organizations in the state-sponsored employees group health plan known as the Missouri Association of Health Plans. BC/BS serves 2.3 million people statewide, and a large number of its members are in the Columbia-Jefferson City area, making the firm a potent lobbying force.
Choice, Continuity of Care
One important reason for introducing the bill, Singleton says, is to give choices to rural Missourians, including his constituents in Joplin. HMOs in such communities offer little choice, especially among specialists, because so few practice in rural areas. “Patients aren’t getting what they’re paying for,” Singleton says.
Consumers in that situation can already purchase policies that include all health care providers, notes insurance agency owner James Coyne. Not many do, of course, because the cost is higher and benefits may be limited. Nevertheless, Coyne thinks the existing plans are to the consumers’ financial advantage, because the health care providers agree to a pricing structure upfront.
But nurse-practitioner Beth Lonberger of Urology Consultants shares Singleton’s concern about patients’ continuity of care. Too often, she says, a patient is forced to change physicians in mid-treatment because a doctor once covered by the patient’s plan is no longer on the list of authorized providers.
“If they have to move to a different physician, the continuity of their care can be greatly interrupted,” Lonberger says.
BC/BS spokeswoman Wiethop says her plan members would not necessarily have to change doctors. According to Wiethop, the firm looks at cases on an individual basis. “It’s not a guarantee, but we would be willing to look into it.”
After a minor amendment, Singleton’s bill was placed on the informal Senate calendar. Though tabled for now, Singleton hopes it up again for discussion soon.
Kathryn Handley is a reporter for the Columbia Missourian newspaper. Email [email protected].