[Congressional Record Volume 144, Number 24 (Tuesday, March 10, 1998)]
[Extensions of Remarks]
[Pages E337-E338]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                HMO QUALITY DATA: LET THE PATIENT BEWARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Tuesday, March 10, 1998

  Mr. STARK. Mr. Speaker, as the nation moves increasingly toward 
managed care, a high priority must be to give the patient/consumer 
reliable, accurate information on the qualify provided by HMOs.
  On February 26 the chief medical officer of the Medicare agency 
testified that the popular HEDIS data used to measure how well HMOs

[[Page E338]]

are doing in a variety of areas is, in some cases, very inaccurate and 
misleading. I've asked the Health Care Financing Administration to give 
us more information on this problem and the extent of the errors.
  There are private groups which accredit HMOs and use HEDIS data to 
help measure those plans. The leader in these private groups is the 
National Commission on Quality Assurance. But it is all very confusing 
to the consumer. The following shows why.
  The October 13, 1997 issue of US News and World Report rated 223 HMOs 
using data largely from the National Commission on Quality Assurance's 
HEDIS system. The rating also showed whether NCQA had given full or 
partial accreditation to those HMOs.
  Using the HEDIS data on things that people care about, like 
immunization rates, mammography rates, etc., US News ranked plans as 
Above Average or Below Average--but the NCQA accreditations had 
relatively little to do with how plans did on the US News ratings. For 
example, NCQA denied accreditation to 2 plans that US News found among 
the best, but denied none among the plans that US News found the worst. 
Following is a table my staff did showing the results.
  What can be done to make this babble of ratings more useful to the 
public?


                                     How NCQA Accreditation Compares to U.S. News and World Report Rankings of HMO's
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                               1-Yr.      Prov.
                        U.S. News ranking                         Full Acc.     Acc.     Acc.\1\     Denied     Review    N/A \4\   P/S/E \3\    Totals
-----------------------------------------------------------------------------------------------------------------\2\------------------------------------
****............................................................         41         15          0          2          0          6          0         64
***.............................................................         46         30          7          1          1          5          6         96
**..............................................................         47         30          0          1          1         16          8        103
*...............................................................         13          7          1          0          1          5         10         37
Not ranked......................................................         14          0          0          0          1          7          5         27
      Totals....................................................        161         82          8          4          4         39         29       327
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Provisional accreditation; plan meets some standards; can move up if review after one year shows improvement.
\2\ Initial status determiend but under review.
\3\ Initial status Pending/review Scheduled/rating Expired.
\4\ Accreditation information not available.
 
 Source: U.S. News and World Report, October 13, 1997.


  One of the most important things would be to ensure that these 
private accrediting and rating groups, which are paid for their 
services by those they rate, are true to the public interest. I have 
proposed legislation, H.R. 800, which would require that the boards of 
accrediting organizations like NCQA and JCAHO include public interest 
representatives and public meetings.
  So much money is at stake in the quality ratings of managed care 
plans, that I do not believe the ratings should be directed in private 
and by boards of directors who include representatives of the interest 
being evaluated.

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