Two bills that have been approved by committees of the Florida Legislature would dramatically increase HMO premiums and effectively gut HMO cost and quality controls, industry officials contend.
One bill approved two weeks ago in the Senate healthcare committee would require HMOs to accept any physician into their plans, as long as the physician agrees to the HMO's price for services.
Dubbed the "any willing provider" bill, the law would eliminate criteria such as quality and efficiency that HMOs use in selecting physicians, said Carl Homer, vice president for Blue Cross and Blue Shield of Florida.
The second bill, which has been approved in the House insurance committee, would allow HMO patients to bypass their primary-care physicians and seek care directly from specialists of their choice.
Called the "direct access" bill, the law would remove one of HMOs' greatest cost-containment devices, the primary-care physician acting as the HMO gatekeeper, Mr. Homer said.
"Both bills would lead to very large price increases for HMOs and destroy the basic concept of HMOs, which is to control costs and improve quality," Mr. Homer said. Blue Cross operates the state's second-largest HMO, with 328,000 members.
Gov. Lawton Chiles, who is expected to veto either bill if approved, said last week the bills would "seriously damage" Florida's new man-aged-competition system because the plan relies on HMOs to help lower healthcare costs.
The Florida Medical Association, which opposes major parts of Florida's managed-competition system, and several physician specialist and chiropractic organizations support both bills.
An FMA spokesman said the bills will expand access to patients and ensure that physicians aren't shut out of managed-care plans.
Mr. Homer said the Blues don't have any statistics on the number of physicians who have had their HMO applications denied, but he predicted there will be more in the future.
"As membership in HMOs grows, there will be a need for more physicians," Mr. Homer said. He conceded, however, that some specialities have an oversupply of physicians.
