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Has the Time Come for NCQA To Get Tough With HMOs?

MANAGED CARE October 2002. © MediMedia USA
Editor's Memo

Has the Time Come for NCQA To Get Tough With HMOs?

John A. Marcille
MANAGED CARE October 2002. ©MediMedia USA

John A. Marcille

Perhaps it's just coincidence. The National Committee for Quality Assurance issues its State of Health Care Quality report the same month that a study is published in the Journal of the American Medical Association that dismisses the idea of grading health plans. Talk about irony.

As noted in our News and Commentary department, the NCQA's release of this information has almost become a rite of autumn. There's a videoconference, scads of news releases, and generally just a whole lot of to-ing and fro-ing. At this publication we certainly take notice and report NCQA's doings, but we're also aware that the organization has detractors.

"An HMO that says 'I don't want my stuff reported' doesn't report it," Uwe Reinhardt, PhD, professor of health economics at Princeton, once pointed out to us. "Imagine General Motors saying to the Financial Accounting Standards Board, 'Actually this year was not so good so we've decided not to have a financial report.' That's roughly what the HMO industry has said, which is of course quite ridiculous."

Reinhardt's correct on both counts: It is ridiculous, and that is what HMOs have been saying, according to the JAMA study. Half of all HMOs participating in HEDIS stopped reporting their performance data in 1998 and 1999. Of those that dropped out, the HMOs that scored low the previous year were three times more likely to do so than were those who had had higher scores. JAMA's conclusion? "Voluntary reporting of quality data by HMOs is ineffective; selective nondisclosure undermines both informed consumer decision making and pubic accountability."

Pretty damning, even when taking into account that one of the authors is David Himmelstein, MD, a longtime critic of managed care. Critics have their purpose: Recent headlines indicate that those who had said that some capitalists are too greedy may have had a point.

It should also be remembered that Reinhardt, when he made that comment, was discussing the feasibility of creating a Health Care Fed, a government regulatory body that could compel reluctant plans to issue standardized quality reports. It's not too late.