Friday, December 25, 1998

Federal government delays release of Medicare HMO report cards

By PHIL GALEWITZ

Associated Press

NEW YORK -- Need help telling one Medicare HMO from another?

Good luck.

For 18 months, the federal government has collected data on more than two dozen key performance measures for all Medicare health maintenance organizations. But it has withheld the results over concerns about the reliability of the information and the challenge of presenting the findings in an understandable form.

Without an HMO report card -- similar to efforts published for commercial plans -- seniors have no information to compare the quality of care the plans provide. They can only compare by price or by benefits that vary little in most markets.

Seniors' need for information about health plans has never been greater as a rash of health plans dropping Medicare on Jan. 1 is forcing about 440,000 members to change their HMO. About 6 million of the 40 million Medicare beneficiaries are enrolled in an HMO.

"There's a lot of senior citizens who simply can't fend for themselves ... and don't know which plan to choose," said Angelina Caldwell, 65, of Harrison, N.Y. She had to change health plans this month when Oxford Health Care stopped serving Medicare members in her community.

Officials with the U.S. Health Care Financing Administration, which oversees the federal Medicare program, now say they will release the first Medicare HMO report card in January over the Internet at www.Medicare.gov. Later, the findings will be distributed through senior citizen advocacy groups, and in Medicare handbooks that will be sent to all enrollees next fall. A toll-free telephone number will be established to field consumer queries.

Not wanting to inundate seniors with information, the first report will only compare how well the plans deliver in seven areas, including breast cancer screening and eye exams for diabetics.

In conjunction with the report card, the government will also release the results of a consumer satisfaction survey of 125,000 Medicare HMO members, the largest such poll ever done.

Employer coalitions already publish HMO report cards to help workers on commercial plans, and about a third of the states have produced such studies as well. The efforts all aim to make health plans more accountable and give consumers objective data to base their choice.

Medicare officials acknowledge they've been cautious in preparing the report since Congress required it early 1997. One reason is because previous efforts that graded commercial HMOs have been challenged for their accuracy, and observers questioned whether they actually confused consumers rather than helped them.

Two big problems with the early HMO report cards is that the data submitted by the plans has usually not been audited, and a number of HMOs chose not to participate.

The Medicare program believes it has overcome those hurdles. The Medicare data is audited and all 284 plans are required to participate.

"We have done a lot of scrubbing to make sure the information is reliable, and design the report so it is put in proper context," said Michael Hash, deputy administrator for the financing administration. For example, the report will explicitly tell consumers the significance of certain indicators such as frequency that members visit their primary care doctor.

Medicare is paying the National Committee for Quality Assurance, an HMO watchdog group, $6.2 million to collect the performance data from 1997 to 2000. The Committee, which also accredits HMOs for several states, has produced report cards on commercial plans for two years.

Margaret O'Kane, president of the National Committee, said the government faces the difficult balancing act of trying to product a report card with timely information, but also one that is accurate and presented in a fashion that will be easily understood. "What they will release early next year will look primitive," she said. "But it is a start."

Other HMO industry observers are more adamant for the government to move faster to help seniors.

"We encourage the government to move more rapidly to get this information to the public," said David Lansky, president of the Foundation for Accountability, a Portland, Ore.-based consumer health group.

After all the effort to product the first Medicare report card, doubts remain over whether seniors will use it.

"We are not anticipating this will have a great impact," said Mary Sellers, a spokeswoman for Humana Inc., one of the larger Medicare HMOs. "Typically, seniors get recommendation from family and friends and use their own personal experiences."

Even Diane Archer, executive director of the Medicare Rights Organization in New York, is skeptical: "The data is very limited and has only limited value."