Tuesday, March 25, 1997

HMO will let consumers rate hospitals, surgeons

By STEVE SAKSON AP Business Writer

NEW YORK (AP) - One of the nation's leading HMOs will allow members who have an operation to rate the hospital, surgeons and nurses in a report card that will be given to other patients facing the same surgery.

The program by Oxford Health Plans Inc. is designed to improve the performance of surgical teams and let patients choose teams that have the most experience, highest success rates and best bedside manner.

Oxford, which serves about 1.7 million members, mostly in the Northeast, will unveil the program Tuesday as part of an overhaul designed to address one of the most frequent gripes about managed care - a lack of choices.

"We're giving people more power to make their own decisions in health care and we're giving them the tools to make those decisions," Oxford Chairman and Chief Executive Stephen Wiggins said Monday.

Another sore spot the company will target: the frustrating process of getting claims or medical information from anonymous HMO clerks on the phone.

Each Oxford member will get a "personal service agent" - a single person to call whenever they have a question who will be responsible for getting them an answer within 24 hours.

Enrico Madonna, an Oxford member from the borough of Queens who was part of a pilot program last year, said, "With one person they know your situation without you having to re-explain it every time."

Oxford's new surgery program asks surgeons to set up teams of medical professionals - anesthesiologists, physical therapists and nurses, for example - to provide a specific service at a preset fee. Examples include delivering a baby, performing a heart bypass or doing a hip replacement.

Oxford has already set up more than 200 teams and hopes to establish an additional 500 this year.

Patients will pick their team after reading several report cards.

For instance, those considering a balloon angioplasty to clear their heart arteries of cholesterol will be able to find out how many of these procedures each team has performed, and how many were successful.

A man considering whether to have a cancerous prostate gland removed will find out what percentage of a surgeon's patients suffered incontinence or impotence after the surgery.