Hospitals in Southern California have revealed their unhappiness with HMOs through a new report, and one of the facilities has even filed a lawsuit charging one of the plans with unfair trade practices.
HMO executives said the report is a cheap shot.
The Healthcare Association of Southern California, the state's hospital association, released a report rating hospitals' relationships with 13 health plans.
The association has prepared similar reports for the past two years, but the results were confidential. Association executives said the group decided to release this year's report in order to pressure plans to improve their performance.
But "performance" is from the hospitals' perspective. The ratings looked at such factors as how quickly plans paid hospitals, verified patient benefits, negotiated contracts and resolved disputes.
Overall, 63% of the 76 hospitals surveyed said the plans they deal with are doing less than a good job. The association considers a good or excellent rating from 80% of the hospitals to be the benchmark.
"It's hard to do anything but simply say that health plans by and large are not interested in resolving issues with providers," said Jim Lott, the association's executive vice president.
While plan executives said some of the survey information would help improve their relationships with providers, they accused the association of insinuating through the report that their business relationships undermined patient care.
"The survey implies healthcare quality is related to administrative and financial issues," said Ron Yukelson, vice president of communications for Woodland Hills-based Health Net, which received a good or excellent rating from 44% of the hospitals (See chart).
"The survey has nothing to do with patient care," said Gareth Hughes, executive vice president at Los Angeles-based Maxicare Health Plans, which had the lowest score, with only 5% rating it good or excellent.
Hughes said Maxicare's score was tied to last year's changes in state regulations ordering it to pay providers for its 93,000 Medicaid HMO enrollees only after care was rendered, rather than prepaying.
Separately, Coast Plaza Doctors Hospital, an 83-bed stand-alone in Norwalk, about 15 miles east of Los Angeles, sued Blue Cross of California, claiming the Thousand Oaks-based insurer engages in unfair trade practices.
Coast Plaza's suit, filed March 2 in Los Angeles County Superior Court, accuses Blue Cross of paying larger hospitals more than smaller providers for the same services. It seeks unspecified damages.
"This is (Blue Cross') way of saying healthcare is better with smaller hospitals out of business," said Coast Plaza board Chairman Gerald Garner.
Coast Plaza derives about $500,000 in annual revenues from its Blue Cross contract, which it canceled the day it filed the lawsuit. It is seeking punitive damages, attorney fees and higher reimbursements.
A Blue Cross spokeswoman declined comment on the lawsuit.