A photo caption in yesterday's Business section misstated the position of Dennis Makielski regarding legislation in Annapolis that would force health maintenance organizations to give patients more freedom in choosing physicians. Mr. Makielski opposes the bill.
The Sun regrets the errors.
The state medical society is taking on powerful insurance and business groups in a legislative showdown that will help determine how much freedom patients have to choose their doctors.
Advocates for both sides will tangle today in Annapolis as legislators hear testimony on bills that would force restrictive health maintenance organizations to give patients greater choices of physicians.
The society claims to represent the interests of consumers like Lisa Smith, a St. Michael's teen-ager who fears that her HMO is going to force her to change mental health therapists in the middle of treatment.
But the HMOs say the legislation is an attempt to protect doctors' incomes and that it would make it more difficult for HMOs to hire only the best physicians. It also would drive up the cost of health care, making it less affordable for buyers like Dennis Makielski, a Waldorf home builder trying to restrain the rising price of his workers' health insurance.
The outcome of the battle in the General Assembly will be felt throughout Maryland because HMOs are growing rapidly and now provide health care for an estimated three in 10 state residents -- the third-highest percentage in the United States, according to industry officials.
Power and money, in addition to consumer interests, are at the heart of the conflict. Doctors want to regain some of the authority and income they have lost to HMOs, which control costs by holding down fees, limiting choices of doctors and restricting access to expensive specialists.
Political leaders and lobbyists generally agree that the doctors' legislation faces a tough fight. Although the medical society came close to passing a bill last year, the HMOs appear to be gaining political strength.
The Maryland Association of HMOs is backed by the Coalition for Affordable Healthcare, about 100 mostly business organizations, including Baltimore Gas & Electric Corp., McCormick & Co. and Black & Decker Corp. Co-chairmen are W. Miles Cole of the Maryland Chamber of Commerce and Ernest B. Crofoot of the state AFL-CIO.
The medical society hopes to counter the coalition's influence by presenting consumers' complaints about HMOs cutting patients off from their longtime doctors. The society has received a boost from a controversy on the Eastern Shore over a change in mental health services provided to 20,000 subscribers of the Delmarva Health Plan, an HMO owned by Blue Cross and Blue Shield of Maryland.
Many therapists and patients complain that their relationships are being disrupted by Green Spring Health Services, a Columbia company that took over responsibility for providing mental health services to Delmarva on Jan. 1. Green Spring informed subscribers that they'd have to be re-evaluated by one of the company's psychiatrists and possibly referred for therapy to a new therapist.
Lisa Smith, 17, is alarmed, says her mother. "She's just starting to get her life straight and now they're telling us she has to go to another counselor," said Carol Smith, a medical technician at an Easton hospital.
Lisa's therapist, clinical social worker Cheryl Aylor, said developing a good therapist-patient relationship is crucial.
"It takes time to learn to trust a therapist to be able to share things," she said. "You really build up an intense level of trust and support. And it takes a lot of time to heal from emotional trauma."
Officials of Green Spring say they have no intention of disrupting relationships. After patients are re-evaluated they most likely will continue with their current therapists, said Green Spring clinical services director Kirk Griffith.
HMO and coalition leaders will try to defuse the medical society's testimony by having sympathetic doctors and consumers testify against the legislation. But the HMOs' most potent economic argument comes from business people such as Mr. Makielski, president of Makielski Reed Corp.
Before he put most of his 68 workers in HMOs, the company's health insurance rates were rising as much as 30 percent a year. But the legislation threatens his savings by potentially requiring employers to offer a more expensive HMO plan that permits subscribers to choose doctors outside the HMO. Such a plan would cost roughly 15 percent more, HMO industry officials say.
There are actually several doctor-supported bills concerning HMOs. One would require HMOs to hire virtually all doctors; others would require HMOs to establish and publicize their criteria for hiring and firing doctors, and provide a grace period for fired doctors to continue seeing HMO patients.
The HMO Association and its allies oppose all of the measures, arguing they would interfere with HMOs' ability to recruit only the highest quality doctors and to control costs.
"This system works," Mr. Makielski said of HMOs. "There's no need to fix it."