When wait times for HMO care are such an issue that regulators  decide how quickly patients need to be seen in California, that speaks of a much larger and deeper problem.

I don’t pretend to know what that large, deep problem is other than that the state is broke.

I do know what “timely” means when a patient needs to be seen, whatever the acuity level is (how sick the patient is compared to others). California clearly does not.

Let’s remember that the HMO movement began in California and made its way to the East Coast in the 1990s. HMOs were going to be the solution to care delivery and cost problems. It did not work out that way.

In California, an urgent problem gets the most attention: Within 48 hours.

This is ridiculous. Urgent. Not like to… Not  it would be better for me if…Urgent. Urgent must be defined differently on the West Coast than on the East.

Here urgent usually means the same day, even if the patient is sent to an Urgent Care Center associated with a hospital the doctor uses. A bad cough that is worsening by the hour. That’s urgent. Want to wait on that? No, I did not think so. How about major sports injuries for school students? Are those urgent or specialty visits—the latter being a 15-day wait?

We still have reports of  the pandemic H1N1 influenza in the U.S, although the number of cases reported has come down significantly. The CDC told patients who had symptoms to see or speak with physicians immediately and to start Tamiflu within 24 hours of the onset of symptoms.

Now, how would the CDC advice work in California HMOs?

We don’t know that.

Regulators should not be involved in scheduling. That is at the heart of patient care. If you, an HMO or a doctor’s office, can’t schedule in a manner that responds to legitimate patient needs, go into another line of work. But…how does an HMO get a new job? Thankfully, that is not our problem.

Because the new requirements were set by regulators, no doubt they were trying to strike a balance between long waits the patients have had and what the HMOs say they can deliver.

The regulators probably gave the HMOs some wiggle room. Enlightened self-interest. They do not want the HMOs out of compliance every other day.

This is one to watch, folks. We will.

San Jose Mercury News

“California regulators will announce new rules today aimed at limiting the long wait times for patients in health maintenance organizations to see a doctor.

“In most cases, HMO doctors will be required to see a patient for a primary care appointment within 10 business days.

“Specialists will be required to see patients within 15 business days.

“Those with urgent problems requiring prompt attention should be seen within 48 hours.

“The regulations, to be announced in Los Angeles, will make California the first state in the nation to provide such consumer protections.”

Source: San Jose Mercury News, January 19, 2010