Where I Stand: Passing Buckley bill will protect managed-care clients

Friday, Jan. 17, 1997 | 11:59 a.m.

ASSEMBLYWOMAN BARBARA BUCKLEY of Las Vegas never forgets the people who need help and protection. This is true not only when the Legislature is in session, but also between sessions. She's a person who lives what she preaches.

Early this week SUN reporter Art Nadler wrote about Buckley's proposed legislation to reform the way health maintenance organizations operate in Nevada. If you are an HMO client then it would be wise to watch her proposed bill because some lobbyists will do their best to weaken it if not kill it entirely. She may need your help later in the session.

Laurie McGinley, writing in the Wall Street Journal, points out that at least nine other states have legislators looking at HMO plans and other types of managed care in hopes of providing safeguards for patients. The state legislation McGinley examined would require managed-care plans to:

* Provide a sufficient number of facilities and doctors, including specialists and subspecialists.

* Allow patients to see a physician outside of the network by paying an additional fee.

* Permit patients with special needs or chronic diseases to select specialists as their primary care providers.

* Define and disclose limits on coverage of experimental treatments.

* Give patients access to all federally approved drugs and devices.

The Wall Street Journal article quoted a Blue Cross and Blue Shield association representative who said, "Sound regulations and sound standards for health plans are desirable but what we are seeing is attempts to inject the legislatures into the realm of medical policy making." This bit of medical whining probably was triggered by legislative attempts to increase minimum hospital stays for operations like mastectomies. Such minimum-stay allowances wouldn't be necessary if the health maintenance outfits hadn't put such ridiculous maximum stay-limits on childbirth and some serious operations.

Buckley's proposed bill will stop the bad habit of some health-care services denying a cure over the telephone without even examining the patient. Any denial must then be justified in writing to the patient and the health-care professional who had originally recommended him or her for care.

The proposed bill will also take the profit incentive away from the person denying or delaying medical care. No bonuses or other pay incentives can be given on the basis of how care denial increases the company's bottom line.

Buckley also zeroes in on the health care groups that penalize professionals for advocating necessary care not covered in the plan. She writes, "No health-care business shall discharge, demote, terminate a contract with or otherwise sanction a physician, RN or other licensed or certified care giver for advocating in private or in public on behalf of patients or for reporting any violation of law to appropriate authorities."

Another important aspect of Buckley's work will take a bite out of the bad practice of having patients sitting around emergency waiting rooms for hours at a time. Her bill will "Establish a prudent layperson standard for determinations of emergency medical conditions. If no response within 30 minutes from HMO/M.C. provider, prior authorization deemed granted."

The Buckley bill solves painful problems that some health-care organizations have created for their members. It's good and necessary legislation.

Television advertisers and the NFL can now breathe easier with the Patriots playing the Packers in the Super Bowl. Can you imagine the low television ratings something like the Panthers vs. Jaguars would have produced? ... SUN reader Gail Hardy of Pahrump got a chuckle out of an article that referred to Jack McCloskey as a retired reporter who worked for the Mineral County Independent newspaper in Hawthorne. Jack owned the paper and was the publisher and front-page columnist for more than five decades. ... Did you know that UHF Channel 47 now carries news reports from Asia in both English and Mandarin. According to Dr. Y. Wing Choi it also carries movies and right now Genghis Khan (1162-1227) is showing Monday through Thursday. Fridays are an excellent time to learn about China tours, entertainment and variety shows starting at 10 p.m.