In a show of continuing discontent with managed health care, the Maryland Senate approved a bill yesterday that would give the state authority to revoke the physician's licenses of HMO medical directors whose decisions harm patients.

The measure now goes to the House of Delegates, where it faces near-certain defeat.

The Senate's 30-17 vote for the medical directors' bill, coming a year after a similar measure's narrow defeat, reflects the pressure lawmakers feel to respond to consumer complaints about abuses by cost-conscious HMOs.

"Let's let the companies know in Maryland we expect a higher quality of care while you cut costs," Sen. Paula C. Hollinger, a Baltimore County Democrat and the bill's chief sponsor, said in floor debate earlier this week.

By law, HMO medical directors must be licensed physicians. The bill would make them subject to disciplinary action by the state Board of Physician Quality Assurance, which can suspend or revoke a doctor's license to practice medicine.

Opponents complained that the bill is unnecessary, because the Maryland Insurance Administration now has the authority, under an appeals and grievance law enacted last year, to investigate consumer complaints and fine HMOs for wrongly denying patients coverage to which they were entitled.

Sen. Thomas L. Bromwell, chairman of the Finance Committee, said having the medical licensing board oversee HMOs is like "the fox watching the henhouse."

The board is dominated by doctors, many of whom chafe at being forced to accept reduced payments by HMOs.

"There's really not a whole lot of love between doctors and insurance companies," the Baltimore County Democrat said.

Sen. Martin G. Madden, a Howard County Republican, also warned that exposing medical directors to possible loss of their licenses could have a "chilling effect" on HMOs' efforts to hold down health care costs.

Noting that health insurance premiums rose 6.1 percent nationwide last year, Madden said the bill "is just going to drive premiums higher."

But Sen. Andrew P. Harris, a physician, said doctors can lose their licenses for making bad treatment decisions, and so should HMO medical directors who wrongly deny patients coverage to save costs.

"Business is business, and medicine is medicine," said Harris, a Baltimore County Republican. "This bill is about medicine."

House and Senate leaders alike oppose the medical directors legislation, as they do another measure aimed at granting disgruntled patients the right to sue their HMOs.

A House panel already has killed the right-to-sue bill.

Legislative leaders have crafted a response to consumers' complaints about managed care. Bills have cleared committees in both chambers that would direct the Department of Health and Mental Hygiene to investigate and act on consumers' complaints about the quality of health care they get from HMOs.

The health department's Office of Quality Assurance would complement the HMO oversight provided by the Maryland Insurance Commissioner. While insurance regulators can rule on whether consumers are getting the health care their plan's coverage allows, the health department would monitor whether treatment provided by HMOs meets medical standards.

The health department office, to be run by a licensed physician, would be empowered to fine HMOs up to $125,000 and may even revoke their certificates to operate in Maryland for serious or repeat violations.

Hollinger is a co-sponsor of the bill providing health department oversight of HMOs, but she said it does not go far enough.

A bad medical director could be removed from a Maryland HMO under that measure, she said, but he or she could simply move to another state and keep working.

Pub Date: 3/25/99