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GHAA VOICES "STRONG CONCERNS" ABOUT INTERPRETATION OF JAMA STUDY

 WASHINGTON, Aug. 13 /PRNewswire/ -- Group Health Association of America, the national trade association for health maintenance organizations, has sent the following letter to the Journal of the American Medical Association in response to an article being published in the August 18, 1993 edition:
 To The Editor:
 Group Health Association of America has strong concerns about the conclusions drawn in an August 18, 1993, article in the Journal of the American Medical Association.
 The article, "Patients' Ratings of Outpatient Visits in Different Practice Settings," which all but ignores recent studies, uses 1986 data and claims that members of HMOs were less satisfied with their visits than patients in other settings.
 The distinctions the authors use to divide patients into various categories are artificial, and make it impossible for the reader to understand which patients were, in fact, HMO members.
 We believe the journal's interpretation of the study is flawed. The study:
 1. Is based on information from patients who visited the doctor over a nine day period in 1986. It is safe to conclude that most patients made only one visit during the period evaluated.
 2. Contains almost no information on more recent findings. These findings, such as a July 1992 Consumer Reports survey including more than 20,000 HMO members, a December 1992 National Research Corporation survey of 90,000 health care consumers, and a 1992 government-funded study of 12,000 Medicare beneficiaries, constitute a body of evidence that in most cases shows HMO members as satisfied as their counterparts covered by traditional insurance.
 3. States that regardless of size, "within (solo practices) and multispecialty group practices), there were no statistically significant differences between prepaid and fee-for-service patients' ratings of specific visits features that were observed consistently in all three cities (from which the sample was drawn)."
 Thus the authors themselves draw our attention to the fact that the findings cannot be generalized to draw sweeping and potentially politically motivated conclusions.
 4. Shows that 98 percent of patients rated their overall visit as "excellent," "very good," or "good."
 5. Does not consider the very real possibility that HMO enrollees would rate their visits differently if asked about features of coverage that HMO members generally find most satisfying (and fee-for-service patients find frustrating), such as amount of paperwork and out-of- pocket costs associated with office visits.
 In other words, the deck was stacked against HMOs because 1) the authors did not look at features of HMO coverage that are generally favored by the public, and 2) the authors did not define precisely who the "HMO members" were.
 The HMO industry strongly agrees with the authors that instruments for measuring patient satisfaction and other indicators of high quality care should be a part of health care reform. Group Health Association of America and its member HMOs have been leaders in the development and use of specific health care performance measures. Moreover, as one author knows, because he worked with GHAA on an early satisfaction form now in widespread use, GHAA and its member HMOs have been in the forefront of these efforts for some time.
 HMOs care about satisfaction among their members and realize that it is a key component in quality of care and quality of service. Employing *principles of total quality management, HMOs routinely measure the satisfaction of their members and use the data to make needed improvements. This is the right thing to do as a health care provider and it is a good business practice.
 As health care reform evolves, there will be much data -- including the results of patient satisfaction surveys -- being made available to assist employers and individuals in choosing a health care plan. The public interest demands that the data made available are clearer and more dispassionate than that provided by JAMA today."
 -0- 8/13/93
 /NOTE TO EDITORS: The JAMA article referenced above was circulated with a release embargoed until 3 p.m., Tuesday, Aug. 17, 1993./
 /CONTACT: Susan Pisano, 202-778-3245, or Don White, 202-778-3274, both of GHAA/


CO: GHAA ST: District of Columbia IN: HEA SU:

TM -- NY102 -- 2787 08/13/93 22:01 EDT
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