The nation's PPOs are trying to persuade government officials to give them some of the managed-care business spawned by government initiatives in Medicare and other programs.
As part of the new campaign, PPO executives met in Washington last week with HCFA Administrator Bruce Vladeck. They asked that HCFA help develop legislation for Congress "to reflect another managed-care entity" other than HMOs that would be authorized to serve the Medicare population, said Gordon Wheeler, president and chief operating officer of the American Association of Preferred Provider Organizations.
That legislation would allow PPOs to assume risk the same way HMOs now do, he said. Under federal law, HMOs are the only managed-care organizations authorized to serve Medicare recipients. PPOs may provide Medigap coverage through the Medicare Select program, but they do not offer primary coverage.
In addition, many lawmakers don't know what a PPO is, according to PPO executives at a roundtable discussion at the National Managed Healthcare Congress meeting in Washington last week.
PPOs "don't have as high a profile as HMOs, but they are a form of managed care that is more accepted and utilized because they are consumer-friendly," Wheeler said.
He said Vladeck "seemed very interested in exploring a fuller PPO option" for Medicare recipients, one that would allow full and partial risk-bearing PPOs as well as traditional fee-for-service networks.
Vladeck has previously said he is interested in a PPO option for Medicare beneficiaries.
"I hope this is the beginning of a series of conversations with (Vladeck) and other policymakers," Wheeler said. He added that the AAPPO hopes enabling legislation will be submitted this summer.