HMO boss defends against rising criticism of industry

Larry Henry

Thursday, March 13, 1997 | 11:59 a.m.

CARSON CITY -- Instead of being heartless bureaucracies, HMOs keep medical costs low but are taking unfair flack from seriously ill patients looking to lay blame, a legislative committee was told.

"You in fact cannot cure everything," said Dr. Tony Marlon, chairman of Sierra Health Services, the state's largest health maintenance organization.

Marlon, joined by other HMO advocates, told the Assembly Commerce Committee Wednesday that the health maintenance industry is on the "ascendancy" and therefore is "ripe for blame."

Marlon is waging a public relations campaign to offset what he feels is a media bashing the industry received in recent weeks after patients told the committee that managed-care organizations deny expensive life-saving treatment and create mountains of bureaucratic red tape.

Testimony has centered on legislation sponsored by Assemblywoman Barbara Buckley, D-Las Vegas, and 39 other lawmakers to end managed-care abuses.

Marlon conceded that the industry could stand fine-tuning, but he said too much meddling will have "unintended consequences."

He and other managed-care professionals argue that the industry evolved in the early 1980s to keep costs low and that legislative tinkering, occurring here and around the country, will cause medical bills to rise.

"Have you ever seen any regulation that didn't drive up the costs?" Marlon asked in the hallway after testifying

Marlon said a provision in the bill requiring health-maintenance organizations to pay for emergency room visits that a patient decides is "prudent" will increase medical expenses by as much as 10 percent because people will go in for minor complaints rather than wait for a doctor's appointment.

He also opposes a clause making HMOs liable for damages in malpractice suits.

Reform advocate Cynthia Bunch, a Henderson nurse, said in the hallway that patients have entered emergency rooms for serious symptoms, such as chest pains, but were denied payment after the problem turned out to be something like indigestion rather than a heart attack.

She also said managed-care organizations should be legally liable if they recommend the wrong treatment.