Physician, Not HMO, Deserves the Credit

Regarding “Medicare Recipients Rate HMOs” (Feb. 15): The general public needs to know that like myself, most primary care physicians are contracted with all the HMOs that were listed in your article. The HMO takes 20% to 25% off the top of the premium paid by the government for each Medicare beneficiary, and the rest is given to the contracting independent physicians organization or medical group.

It is the primary care physician (family physician or internist) who should be given credit for the overall rating. Unfortunately, the HMO gets all the credit for the hard work and effort that the family physician does on behalf of the patient. All of my patients are treated exactly the same way, regardless of whether they have insurance; therefore, rating HMO plans is not accurate.

Not only is this a problem, but now the HMOs and independent physician groups have removed the primary physician from involvement when the patient requires hospitalization in order to make more profit. Who knows the patient better than the family physician? Once the patient returns to my care after discharge from the hospital, often patients are not properly instructed, and are either given the wrong medications or, worse, given medications that should not be mixed with previous medications.

I hope that Medicare patients begin to complain to their contracting HMOs about the fact that physicians who know them best can no longer take care of them when hospitalization is required.

--DR. RICK CHAVEZ

Hollywood

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As anyone can see in the table included in “Medicare Recipients Rate HMOs,” there is some variation in approval ratings among the various health plans--for example, between HealthNet and Cigna, but not much.

What tables and articles like this miss is the fact that the quality of care is not dependent on the insurance company but, as it has always been, on the quality of the doctors and other health care providers.

The differences between the health plans are, for the most part, details of coverage--for example, whether routine vision care (exams for eyeglasses) is covered or not. Some plans pay for things like knee braces and some don’t. This is not what the patients generally are worried about. Access to primary care providers, specialists and other medical services are determined not by the insurance company, but by the medical group or individual health care providers. For the most part, health insurance companies are all about the same.

What the patient should look for is not so much which plan his or her employer provides, but which doctors and hospitals he or she chooses. This is truly what determines the quality of care.

--DR. PATRICK A. MAUER

Los Angeles