Patients’ rights debate mirrors Nevada discussion

Erin Neff

Wednesday, June 27, 2001 | 11:15 a.m.

The debate over a patients' bill of rights in Washington is drawing the nervous attention of insurers, lawyers, medical professionals and the public.

But at least one component of that proposal has already been played out in Nevada, highlighting just how contentious the discourse is.

"When I read about the lobbyists and the argument over an external review panel, it's incredible," said Barbara Buckley, D-Las Vegas, the state Assembly majority leader. "This is exactly what they did in Nevada."

Two pieces of patients' rights legislation -- one sponsored by Buckley and the other introduced by HMOs -- were killed during the recent legislative session when neither side could reach a compromise.

The issue in Carson City focused exclusively on establishing an external review system for patients who dispute the ruling of their health maintenance or managed care organization. External review is also proving one of the most fractious issues on Capitol Hill.

"From the consumer perspective, they're already required to go through an internal appeal process with the HMO," said Cynthia Bunch, a volunteer lobbyist for the Nevada Nurses Association and a member of the coalition that backed Buckley's bill. "Without an independent external review, it creates the consumer perception that the process is rigged."

Buckley's bill, Assembly Bill 422, would have required the governor's Office of Consumer Health Assistance to select one of the preapproved external review panels of medical experts for each case.

The insurance-industry sponsored Senate Bill 320 would have allowed the HMO to select the a preapproved external review panel for each individual case.

"They would have to be independently identified as independent experts before they could be chosen," said Jim Wadhams, a lobbyist who represented Anthem Blue Cross/Blue Shield and the American Insurance Association. "The industry bill would have allowed the health care plan to identify which of those independent experts should handle a claim."

Peter O'Neill, a spokesman for Sierra Health Services, said HMOs wanted the ability to select the review panel to ensure the board had the medical expertise to render a judgment.

"You would want oncologists on a panel deciding something about cancer treatment," O'Neill said.

Buckley said it is "absurd" to allow an HMO to pick the external review panel, given consumer requests for a completely independent process.

"It seemed simple to me. You can't let the HMO pick the external review group," Buckley said.

She has already submitted a bill draft request for the 2003 Legislature to revive her measure.

Wadhams said requiring the Office of Consumer Health Assistance to pick the review panel is simply "eyewash."

"Proponents said that gives the appearance of additional independence," Wadhams said. "The notion, and I think it's somewhat cynical, is that the external review organization is just an arm of the HMO."

The debate in Washington is equally argumentative as trial lawyers lobby for patients' rights to sue for damages and HMOs fight equally hard against that.

External review is seen as a last step before a lawsuit. As a result, HMOs support some form of that process. But who should pick the panel is also proving a stumbling block in the national debate.

O'Neill said the discussion in Washington has led to a massive spike in Sierra Health's managed care liability rates. The premiums have risen 50 percent in the past year and deductibles have gone from $15,000 to $500,000 per occurrence, he said.

"Costs are going to get passed on to consumers," O'Neill said. "We're already seeing our costs go up and the bill (in Washington) hasn't even passed yet."

Sen. John Ensign, R-Nevada, on Monday said it is critical for the two sides to reach a compromise.

"If you want a campaign issue, kill the bill," Ensign said during remarks to the Teamsters Union convention at the Paris Las Vegas hotel-casino Monday.

Wadhams said he thinks the debate in Nevada will be settled by the bill Congress passes.

"Federal standards will answer the debate," Wadhams said.

Buckley is not so certain Congress will reach an answer and thus is ready to battle the issue in Carson City in two years.

"Maybe it's time for Nevada to have it's own right to sue (for damages) legislation," Buckley said.