It Isn’t All Confrontation and Competition, Thankfully

John A. Marcille

Confrontation and cooperation: Both have their place. Senior editor Frank Diamond's cover story on the relationship between hospitals and health plans highlights the confrontational or competitive end of the spectrum.

In the aftermath of the Balanced Budget Act of 1997, Washington's inexpertly crafted milk-Medicare measure, the relationship between HMOs and hospitals has become downright stressful. Not so stressful as the HMO-physician relationship, mind you, but stressful nonetheless.

This story involves a familiar theme: escalating costs and dwindling financial resources. The answer, as far as HMOs are concerned, is to squeeze every penny of waste out of hospitals. The hospitals say the Balanced Budget Act has already taken care of that — and, by the way, could HMOs please keep physicians under tighter reins?

The market will most likely work out a solution to this problem eventually but, in the meantime, duck. Hospitals are beginning to challenge HMOs' denials of care more aggressively. Plans hold the leverage in this contest, but can they really afford to do battle with institutions that have such strong community ties?

If both sides are in fact inching toward war, then they do so with much reluctance, realizing that this is a confrontation that no one can win.

Competition seems to have become such a basic part of managed care, it's nice to be able to print an article on HMO cooperation. Regional cooperation and standardization of reporting forms, of credentialing, and of basic guidelines (such as immunization) can remove at least a little of the paperwork burden on physicians and actually improve data collection and analysis at the cooperating plans. Patient care seems to improve when these systems are instituted.

Also regarding cooperation, check out the article describing a pharmacist-run anticoagulation clinic that both physicians and patients seem to like.