First Available Appointment is Three Weeks Away? California May Require Doctors to See HMO Patients Sooner

In an ambitious and controversial move designed to unclog the state’s crowded emergency rooms, California leaders are considering forcing physicians who treat HMO patients in that state to meet strict deadlines for when those patients must get an appointment to see the doctor.

Under the new regulations being considered by the state’s Department of Managed Health Care and set to take effect in 2010, physicians would have to set patient appointments according to a time table set by state officials.

The state’s managed health care department is charged with assisting health care consumers and working toward providing “affordable, accountable and robust managed care delivery system that promotes healthier Californians,” according to its mission statement.

With millions of patients jamming into hospital emergency rooms across the United States for treatment of routine illnesses and non-life-threatening injuries, the move by California leaders to get those patients in to see their primary treating physicians faster is a positive step toward breaking the gridlock.

Appointment Deadlines Would be Set

Under the new state rules, which have yet to be approved, doctors seeing HMO patients would be forced to set appointments according to the following deadlines:

• Urgent need primary care appointments within 48 hours

• Urgent need appointments with a specialist within 96 hours

• Non-urgent primary care appointments within 10 business day

• Non-urgent appointments with a specialist within 15 business day

Physicians Oppose Deadlines

California officials recently accepted public comments on the proposed deadline plan and got an earful from the California Medical Association. The association, which represents thousands of California physicians including those at HMOs, said that forcing its members to see HMO patients by an imposed deadline would overload an already overburdened health care system.

Enforcing appointment deadlines without requiring HMOs to also increase their staffing of physicians, nurses, and other personnel would force physicians to slash the length of patient appointments in order to fit them all in, hurting patients, the association argued.

Proponents See End to ER Gridlock

But some patient rights advocates have backed the California HMO appointment deadline plan, saying the new regulations would ensure faster, more effective access to medical care while freeing up emergency rooms to treat sudden, life-threatening injuries. By shortening the waiting time for appointments with HMO primary physicians, the nonprofit group Health Access California and others say millions of Californians would no longer turn to more costly emergency rooms for medical care.

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