NO HMOS 'EXCELLENT' IN STATE BOTH HEALTHNET AND KAISER GET 'GOOD' RATING IN SURVEY.

Byline: HARRISON SHEPPARD

Sacramento Bureau

SACRAMENTO -- California's nine largest health maintenance organizations are generally performing well on national standards for medical care but still are falling short of exceptional service, according to a state rating report released Thursday.

Not a single HMO received the highest rating in the annual report by the state's Office of the Patient Advocate, which reviewed everything from percentage of patients screened for various types of cancer to patient follow-up care.

While no HMO received an "excellent" rating, Woodland Hills-based HealthNet and Kaiser Permanente's Northern California and Southern California regions received "good" ratings.

The remaining six HMOs received "fair" ratings.

"If I'm a health plan, if I'm a medical group, that's going to get my attention," said S. Kimberly Belshe, the state's Health and Human Services secretary.

"Because you know what? I want business. And it's going to create incentives for me to do a better job so that I can be the one plan or one of a handful of plans that has the four stars.

"So this kind of information is absolutely indispensable to driving change in the health care system and improving performance."

The $500,000 study -- funded by fees health providers pay to the state -- also assessed individual medical groups.

A handful of medical groups received top ratings, but several also received "poor" ratings. In Los Angeles County, five medical groups were rated "excellent" -- but 21 were rated "poor."

No groups based primarily in the San Fernando Valley were rated excellent -- although eight in the Valley were rated "poor."

But several consumer and doctor organizations criticized the state's methodology in the rating -- and said the results actually should have been worse.

"This report paints a picture of the for-profit HMOs that is far rosier than the reality that most patients and doctors who deal with and experience HMOs on a regular basis have seen," said Dr. Anmol S. Mahal, president of the California Medical Association.

Mahal said the survey is based primarily on data collected by the HMOs and medical groups themselves and should also have included input from doctors and nurses and more data from patients.

Beth Abbott, a project director with Health Access California, said it is worrisome that no HMOs in California received the top rating -- and have shown little improvement from last year's survey.

"It's nice ... but are we actually helping people make better health care choices?" Abbott asked. "It's hard to say. It doesn't look like it is."

"It's not clear to what extent medical groups and HMOs are looking at this and saying 'Oh, my God, we rank in the bottom quartile; we have to do something about this."'

Prevention rated

The nine largest HMOs represent 95 percent of the state's HMO enrollees.

Ratings for the survey assessed how the HMOs met a series of national standards for care and were rated by their patients.

Factors included preventive measures with diabetes patients, steps to control patients' high blood pressure and cholesterol, and types of follow-up steps for patients with mental illness, heart attacks and other conditions.

The patient survey looked at factors such as how members rated their HMO's ability to communicate, provide customer service and provide quick appointments.

Few are 'excellent'

The report card also evaluated more than 200 medical groups throughout California. In the San Fernando Valley, roughly 10 groups were evaluated, and most scored were rated either "good" or "fair."

Five medical groups in Los Angeles County received "excellent" ratings: Cedars-Sinai Medical Group and Kaiser Permanente's groups in South Bay, Bellflower, West Los Angeles and Baldwin Park.

Dr. Michael Nelson, medical director for the Facey Medical Group, which has 10 locations in the San Fernando Valley, Santa Clarita and San Gabriel Valley, said health organizations take the survey seriously.

Facey Medical Group was rated "good" in meeting national standards, but was rated "fair" in the patient survey.

Patients must wait

Nelson said he believes the lower patient rating was due, in part, to a shortage of doctors that resulted in patients having to wait longer for appointments.

"I look at that as a challenge and an opportunity," Nelson said. "Our biggest problem has been accessibility -- getting patients in as soon as they feel they need to see us.

"Maybe to some degree, it's a measure of success. It's certainly something we are geared toward improving through physician recruitment."

Dr. Joel Hyatt, assistant regional medical director for Kaiser Permanente Southern California, said the organization was pleased to be among the top-ranked HMOs and medical groups.

He said that one reason no HMOs received the top rating is that the categories sometimes change from year to year and organizations must adjust their practices.

He said that a few years ago, after the state added blood-pressure control to its list of measures, Kaiser scored below 50 percent. Kaiser focused on the issue and was rated the highest among the nine HMOs in this year's report card.

"That's the pressure of public reporting," he said. "It focuses a spotlight on areas that should be of interest to consumers."

harrison.sheppard(at)dailynews.com

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SOURCE: State Office of the Patient Advocate