Study: HMOs in Nevada are below average

Monday, Jan. 29, 2001 | 10:40 a.m.

Nevada health maintenance organizations as a whole perform below the national average in nearly every quality and performance category, a state study says.

State officials, however, say that because two methodologies are used nationwide to prepare reports -- an administrative method relying on claims filed and a hybrid method utilizing a sampling of claims -- Nevadans should not be alarmed that its HMO statistics are not up to par.

The Nevada HMO Quality Indicators annual report, a study based on 1999 data -- the latest available -- found that the nine HMOs operating in Nevada that year finished below the national standard in six of the seven quality categories. The report was presented Friday to the State Board of Health.

"Because of the differences in the methodology, the states with larger HMOs use the hybrid method and tend to have higher numbers," Tina Perry, a health resource analyst for the Nevada State Health Division, said.

"One thing the board may decide is to require all (Nevada) HMOs to use the same methodology," Perry said.

Nevada significantly trailed the national average in breast cancer screenings, with 63 percent of HMO members in Nevada getting them, compared with 74 percent nationwide, as well as in cervical cancer screenings, 50 percent versus 72 percent; eye exams for diabetics, 29 percent versus 45 percent; emergency room visits, 128 per 1,000 members versus 146 per 1,000; and children's access to primary care practitioners, with 75 percent versus 85 percent nationally.

Nevada was just slightly under the national average in adult access to preventative health care, with 90 percent versus 91 percent. The only category that Nevada topped the national average was in Caesarean sections, with the procedure being used in 24 percent of live births in Nevada versus 23 percent nationwide.

The 1999 state figures changed little from the 1998 numbers, the study said.

Toni Hagey, director of health services for PacifiCare, said local HMOs face a big challenge just collecting the data for these reports because of an ever fluctuating population.

"Not only is there a lot of migration into state and cities in both the north and the south, but also a lot of migration within the cities," she said. "Doctors move offices regularly."

Also, Hagey said, Las Vegas is "a tough population" to persuade to take advantage of preventative care, even when it is paid for by insurance.

"We did mailings to our diabetic patients, telling them of the need to have their eyes examined," Hagey said. "Those efforts were expensive but paid off." The plan had the top rating for eye screenings for diabetics in 1999.

"However, we called every woman in our plan between ages 52 and 69 who had not gotten breast cancer screenings to encourage them to get the exams. We had only a small boost in that area."