Quality of HMO Care

Re “Measuring the HMOs,” editorial, Oct. 3: In an attempt to set quality standards for itself, the health care industry created its own quality evaluation organization, the National Committee for Quality Assurance. With NCQA’s very first survey, Blue Cross scored below standard. Blue Cross sued NCQA to prevent it from releasing this information to the public. Blue Cross insisted that it didn’t want the results released, because the survey was flawed. I suspect the real reason was that they didn’t want to lose market share. How can we trust an industry which sues its own survey organization?

There are no “standards of health care quality” because of the crazy-quilt of insurers offering health care coverage. If there was one insurer providing coverage for everyone, there would be one standard. There are 44 million Americans without any medical care coverage at all. This country needs universal health care.

MELVIN H. KIRSCHNER MD

Van Nuys

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The editorial attempts to point out the difficulty in judging the various quality surveys that rate HMO performance. It starts with the premise that the ratings produce inconsistent results, citing Kaiser Permanente of Northern California as an example. According to The Times, “recent” surveys in Newsweek and U.S. News & World Report produced conflicting results. Kaiser Permanente in Northern and Southern California actually received the highest ratings from both Newsweek (Sept. 28) and U.S. News & World Report (Oct. 5). The U.S. News point spread, for example, gave Kaiser Permanente South and North 94 and 82 points (out of 100), respectively, while the next rated California HMOs were half that score.

We agree that improvements can be made. We will continue to be at the forefront of that effort--working with the Pacific Business Group on Health and the California Cooperative Healthcare Reporting initiative to bring increased standardization of measurement and reporting of HMO quality and service to consumers. The new Performance Measurement Coordinating Committee and the vice president’s Quality Forum will work to bring order on a national level.

Most HMOs are stepping up to the plate to be measured and publicly reported. But there is little if any comparable quality data available for “unmanaged care.” Given the organized structures of HMOs; the regulatory, purchaser and consumer requirements and expectations for quality in HMOs; and increased standardized public reporting of HMO measures of performance, I am convinced that, in general, consumers receive and experience higher quality of care in HMOs than in the non-HMO health care world.

JOEL D. HYATT MD

Assistant Medical Director

Clinical Services, Kaiser

Permanente Southern California