Davis Backs Proposal to Protect Patients’ Rights

Gov. Gray Davis threw his support Wednesday behind legislation that would bring relief to patients caught in the middle of contract squabbles between health plans and hospital and medical groups.

Hospitals and medical groups would be required to keep seeing their patients--even after an HMO contract terminates--until patients can choose a new plan through their employer’s once-a-year open enrollment process.

The governor’s support virtually ensures passage of legislation this year. Bills containing elements of what the governor wants have separately passed the Senate and Assembly, but sponsors have been waiting for the governor’s position before reconciling them.

Until now, contract disputes forced most patients to find new doctors in the middle of their contract year. The problem gained prominence earlier this year when the Sutter Health network temporarily ended its contract with Blue Cross of California, displacing some 50,000 patients in Northern California.

Davis’ proposal would not apply to doctors who have individual contracts with insurance companies. But regulators estimate that up to 90% of all care provided to members of health maintenance organizations comes from doctors in medical groups.

“There’s a strong realization that we should be moving forward on patient rights,” said Daniel Zingale, director of the Department of Managed Health Care. “Californians value the progress we’ve made and expect us to continue moving forward.”

The governor supported several other patient protections:

* Health plans cannot disrupt existing doctor-patient relationships for children younger than 3, pregnant women, people with terminal illnesses and patients who have scheduled treatments before a contract terminates.

Current law only applies to patients with acute or serious chronic conditions, pregnant women in the second or third trimester and those with high-risk pregnancies.

* Medical groups and doctors must devise plans for transferring patients’ medical records if a plan becomes insolvent.

* Health plans must give patients 60 days notice before terminating a contract with a physician, medical group or hospital. Currently, they are required to give 30 days notice for broken contracts with primary care physicians and medical groups, not specialists or hospitals.

Health plan representatives said they support Davis’ goal but need to review the details.

“We know there have been disruptions in networks, and it’s incumbent upon all of us to make sure that those disruptions don’t harm the patients,” said Walter Zelman, president of the California Assn. of Health Plans.

If approved by the Legislature, the patient protections would take effect Jan. 1, and would apply to new or renewed contracts only.

Regulators said health plans, medical groups and hospitals would be required to negotiate, in advance, the reimbursement rates that would apply after their contract terminates. Some legislators had wanted the state to set those rates.

The California Medical Assn. said it supports Davis’ suggestions. But its chief executive officer, Dr. Jack Lewin, said the Legislature also must address what doctors see as a lack of negotiating clout with health plans.

Authors in the Senate and Assembly praised the governor’s action.

“I’m delighted he’s weighing in on the issue,” said Sen. Jackie Speier (D-Hillsborough). “The disruption in the doctor-patient relationship is dangerous.”

Assemblywoman Helen Thomson (D-Davis) said the legislation might put pressure on all sides to renew their contracts and avoid problems altogether.

“Everything we do is a building block,” she said.