Saturday, December 26, 1998

Government poised to release Medicare HMO report cards

By PHIL GALEWITZ

Associated Press

NEW YORK -- America's senior citizens are on the verge of learning how their Medicare HMOs measure up.

Since early last year, the government has collected data on more than two dozen performance measures for all Medicare health maintenance organizations. Next month, it plans to release some of the findings.

Critics say the government should have moved faster to produce the study, but Medicare officials say they delayed disclosure because of concerns about the reliability of the information and because of the challenge of presenting the findings in an understandable form.

The Health Care Financing Administration, which oversees the federal Medicare program, 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 groups and in Medicare handbooks that will be sent to all enrollees next fall. A toll-free number will be established to field questions.

Without a Medicare HMO report card -- similar comparisons have been published on commercial HMOs -- senior citizens have no information to compare the quality of care the plans provide. They can compare only price and benefits, which vary little in most markets.

The need for such information has never been greater: Health plans are dropping Medicare patients on Jan. 1, 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.

Because the government did not want to inundate seniors with information, the first report card will show how well the plans performed in seven of the 32 areas for which data was collected. Those areas include how well the HMOs made sure women were screened for breast cancer and diabetics received regular eye exams.

The government will also release the results of a consumer satisfaction survey of 125,000 Medicare HMO members, the largest such poll ever done.

Employers 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 are all aimed at making health plans more accountable and giving people objective data on which to base their choice.

Margaret O'Kane, president of the National Committee, said the government faces the challenge 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."

There are still doubts over whether seniors will use the report card.

"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."