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New Rules for HMO’s in California: Call back patient…immediately.

Patients in health maintenance organizations in California should see their waiting times for doctors’ appointments reduced and even their telephone calls to physicians answered promptly under sweeping new rules that, for the first time, establish time standards in medical services.  And if this project is successful, look for a national roll-out over the next few years.
California regulators said the state would be the first with such time requirements, which demand that H.M.O. patients be seen by a general practitioner within 10 business days of requesting an appointment and a specialist within two weeks.
Doctors must return a patient’s call for treatment within 30 minutes and be available 24 hours a day. People with urgent needs must be seen within 48 hours. The rules, authorized by a 2002 state law but delayed by years of bureaucratic wrangling, will be unveiled Wednesday and phased in over the next year.
But even champions of the new rules acknowledge they may result in higher premium fees if, as expected, H.M.O.’s hire more doctors or incur other costs to meet the time demands. The need for more doctors could worsen if Congress extends insurance to 30 million more Americans.  Full text at The New York Times.

The New York Times reports that patients in health maintenance organizations in California should see their waiting times for doctors’ appointments reduced and even their telephone calls to physicians answered promptly under sweeping new rules that, for the first time, establish time standards in medical services.  And if this project is successful, look for a national roll-out over the next few years.

California would be the first state with such requirements, which demand that H.M.O. patients be seen by a general practitioner within 10 business days of requesting an appointment and a specialist within two weeks.

Doctors must return a patient’s call for treatment within 30 minutes and be available 24 hours a day. People with urgent needs must be seen within 48 hours. The rules, authorized by a 2002 state law but delayed by years of bureaucratic wrangling, will be unveiled Wednesday and phased in over the next year.

But even champions of the new rules acknowledge they may result in higher premium fees if, as expected, H.M.O.’s hire more doctors or incur other costs to meet the time demands. The need for more doctors could worsen if Congress extends insurance to 30 million more Americans.  How do you like that plan, doc?

3 comments

  1. Do you know the Bill number, or Cal Health & Safety code or Business & Professions Code section so we can read the statutory language?

  2. The new rules will simply be added to every physician’s HMO contract — probably without compensatory increases for the additional costs imposed by this bill.

    As California’s physician shortage worsens, look for MD’s to simply start dropping off of HMO insurance panels — primary care docs first.

    Docs can only pedal so fast. Ramrodding additional patients into physician’s schedules means shorter appts, lower quality care.

    California’s real problem is its physician unfriendly environment. Low reimbursements, intrusive insurance practices, and high cost of practice and living make california an undesirable place to practice.

    Even to moving to california is difficult. To get a medical license takes 16 months and costs around a thousand bucks… so one can’t even plan to move to California in any reasonable length of time.

    I have been offered several jobs in Cali, but for the above reasons have turned them down. Given the cost of living, the pay was always miserable vs everywhere else … and no one is ever sure if the state will actually remain solvent or what the legislature is going to do.

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