PROMISES, PROMISES HMOS DESERTING AMERICA'S SENIORS.

Byline: Steve Vlasich Local View

RECENTLY, 18 health maintenance organizations (HMOs) announced they would drop an additional 933,000 senior citizens who canceled regular Medicare benefits when they were persuaded to join private insurance Medicare HMOs. When these latest cancellations become effective Jan. 1, 2001, almost 2 million seniors will have been dumped by HMOs nationwide.

According to Karen M. Ignagni, president of the American Association of Health Plans, the Medicare HMOs feel ``overregulated and underpaid by the federal government.''

Medicare reimbursements to HMOs vary from county to county based on cost structures it experiences for Medicare members who remain in its for-fee service program. The industry trade group said this represents a tangled method of reimbursement that pays too little in some parts of the country while fueling profits in others. Those dropped will come from parts of the country where reimbursement is considered inadequate, leaving senior skeptics to perceive this as a cold business decision and one calculated to squeeze more money from government coffers.

Approximately 40 million seniors are covered by Medicare, which offers freedom of doctor choice but pays only 80 percent of approved charges after a deductible is met.

Some 6.4 million Americans have abandoned Medicare in favor of Medicare HMOs, lured by extras such as low-cost prescription drugs, vision and dental plans and low copayments not available to them under conventional Medicare. Seniors see these extras outweighing downsides that include using only HMO-contracted doctors, longer waits for appointments and the approval process required for many expensive procedures.

As the shifting ground of managed health care becomes unsteady under their feet, seniors have begun to wonder who, if anyone, is happy with this brave new world of medicine and health care.

As they look back at the way health care was practiced, more and more mourn the passing of the ``Dr. Welby'' era when doctors were perceived as more patient, more understanding and thorough. Today, many seniors feel they are walking into a medical revolving door with the doctor looking more at his/her watch rather than at them.

Those seniors who quit Medicare for Medicare HMOs like the price advantages but very little else. Many have expressed displeasure over the lack of warmth and the generally harried, assembly line feel of today's doctors' offices.

In their defense, doctors argue that since Medicare has cut their fee reimbursement, they have been forced to enlarge their patient caseload, thereby adding to patient delay and inconvenience. Unspoken is the thought that too many patients may possibly overwhelm a doctor's ability to handle large numbers and still maintain a high level of professional care.

Insurance companies that vigorously courted seniors at recruitment seminars to encourage them to abandon Medicare and join their HMO senior plans are becoming disenchanted with this newly captured target market as witnessed by the wholesale cancellations.

When the senior market became open for them to harvest, they used sophisticated marketing programs to lure seniors to sign up. Seminars at Southern California neighborhood restaurants became the favorite venue with a free lunch given for a few hours of time. Capping it off was the bonus of a hot pad holder, pen, scratch pads and a handsome plastic bag to carry the loot home. Sales managers brought rank-and-file HMO members to give glowing testimony of the folksy, down-home style of the HMO and signed up seniors by the thousands.

In the end, when the bottom line was not as robust in some trading areas as others, the insurance companies simply walked away and left the seniors to fend for themselves. After all, seniors were merely inconvenienced; insurance companies were hurt on the bottom line.

Many hospitals are operating under patient capacity with some in danger of closure or already closed. Same-day surgical suites that discharge patients at the end of the day have proved popular with Medicare and insurance companies and have added to the malaise of many hospitals. The hospital industry has struck back with an aggressive television media campaign featuring a concerned nurse who urges viewers to call or write the federal government in an effort to secure more government reimbursement.

One of the leading hospitals in the Valley announced the closure of its renowned hyperbaric program due to severe underfunding by Medicare. Northridge Hospital Medicare Center shuttered its 15-year-old department on Aug. 1 because Medicare cut its reimbursement by 33 percent.

In another cost-related move, Northridge - which is owned by Catholic Healthcare West of Southern California - is battling Blue Cross for additional reimbursement for patient care. Barring a last-minute settlement, the entire Catholic Healthcare Organization will let its contract with Blue Cross expire Aug. 15 when it comes up for renewal.

We who have lived through the Great Depression, major wars, economic and natural catastrophes, raising our families and suffering the loss of good friends and members of our families do not need to go bungee jumping with our health care. We feel we have earned the right to peace and contentment as we grow older.

Scrambling around for another health care plan is not something that another million seniors need, want or deserve. Medicare should hold the feet of the insurance companies to the fire and make them live up to the implied promises made at the recruitment seminars. When the going got tough for the insurance companies, the tough insurance companies got going, right out of the lives of almost 2 million seniors.

Noted philosophers have said that one of the hallmarks of advanced civilizations has been that they gave to their senior citizens respect and gratitude. Fixing this crisis ought to be the first priority item on the newly elected president's desk come January. It would be a tangible sign of both gratitude and respect.