Health Care

Boutique hospital a pain to the others
Austin American Statesman 12/23/02

A new surgical hospital in Austin will bring more choice to consumers, new business opportunities to doctors and high blood pressure to administrators of established hospitals.

Although hospital officials in Austin are not thrilled about sharing their patients with the Surgical Hospital of Austin when it opens in Rollingwood in March, their reaction has been restrained -- at least publicly.

Some of their brethren across the country wasted no time greeting the owners of other "boutique" hospitals with a swift kick instead of a warm handshake.

Community hospitals fear these hospitals, often specializing in more profitable medical procedures, will skim off the cream -- the patients most able to pay -- leaving them with a larger burden of the poor and uninsured. Paying patients help subsidize the care of those who can't pay, hospital officials say. They contend having fewer paying customers costs everyone more, including taxpayers.

Though some patients might prefer a hospital that specializes in certain procedures, health care works best in communities when hospitals collaborate, said Lisa McGiffert, a senior health policy analyst at the Southwest regional office of Consumers Union.

"If you were really coordinated, you could have a very cost effective system," McGiffert said. "What we have here is competition."

Ruling assures more Texans the right to challenge HMOs
The Houston Chronicle 12/18/02

AUSTIN - Health care consumers scored a victory in a final court ruling affirming the right of Texans to appeal denials of care to an impartial review panel.

The 5th U.S. Circuit Court of Appeals reversed its earlier decision and ruled that federal law does not override a state law protecting consumer rights with health insurers.

Announcing the win for Texas on Tuesday, Attorney General Greg Abbott noted state lawmakers "unequivocally" intended to give consumers a right to challenge decisions of HMOs over what constitutes "medically necessary" treatment. In the past five years, 2,529 Texans have exercised that right and more than half have prevailed over their HMOs, according to the Texas Department of Insurance.

"Cool," said Consumers Union health policy analyst Lisa McGiffert, when told of the ruling. "This is a significant victory for consumers. This appears to give them access to a very important tool available to other Texans."

McGiffert estimated the ruling affects at least 3 million Texans whose rights were in dispute.

She also noted that a recent Consumers Union study showed independent reviews overturned 55 percent of all HMO decisions. Reviews were in patients' favor in 70 percent of cases that claimed mental health care denials.