Bill would hit HMSA for test delays

April 28--Lawmakers are scheduled to debate a controversial measure today that would make Hawaii Medical Service Association legally responsible for deaths or other harm as a result of undue delays in diagnostic tests.

House Bill 2740, which would establish pre-authorization standards for all Hawaii health insurers, was heard Wednesday by a conference committee, but deferred until 10 a.m. today as legislators try to come to a compromise on a final version of the bill.

Legislators drafted the measure after the Honolulu Star-Advertiser wrote a story in January about a new policy at HMSA that requires most of the roughly 3,000 physicians in its network to go through Arizona-based National Imaging Associates Inc. to approve diagnostic imaging exams, including MRIs, CT scans and other cardiac-related procedures for 720,000 members. Before the policy began on Dec. 1, most doctors were given a waiver that allowed them to skip the pre-authorization step.

The pre-approval policy has stirred opposition from many Hawaii doctors who say it is delaying critical imaging tests, resulting in harmful consequences for patients.

HMSA said the bill is flawed.

"In its current state, the legislation does not account for situations under which the physician may have contributed to the patient's delay in receiving health care during the pre-authorization process," HMSA said in an email. "Decisions on medically necessary care of our members have always been done in partnership between the physician and the plan. At times there may be disagreements, but we all strive to resolve those differences to the benefit of the member."

Rep. Romy Cachola, (D, Sand Island-Kalihi-Airport), who introduced the measure, said, "There is really a need for (the bill) because we don't want to play with people's lives. It's not about the doctors. It's not about HMSA. It's about what is best for the patient."

Sen. Roz Baker (D, West Maui-South Maui) and Della Au Belatti (D, Moiliili-Makiki-Tantalus), the heads of the conference committee on the bill, didn't return calls for comment.

Meanwhile, the Hawaii Medical Association, representing 1,900 physicians, said in a news release Wednesday that HMSA should issue a moratorium on its pre-authorization program to "examine other local alternatives that do not risk the well-being of patients."

"Here in Hawaii, patients' lives are apparently being exposed to unnecessary risks because of this new HMSA policy," said Dr. Scott McCaffrey, HMA president. "In medicine moments matter. The HMA does not object to evaluating a test as appropriate, but we are concerned that extensive levels of scrutiny can delay a patient's care, sometimes days to weeks, causing unintended health consequences."

The HMA has assembled a task force of physicians from its specialty societies, including neurology, neurosurgery, orthopedics, cardiology and OBGYN, to come up with solutions.

"I am confident that, working in the spirit of aloha, we can find cost- effective alternatives to this challenge that do not put the patient at risk nor interfere with the efficiency of Hawaii's medical provider workforce," McCaffrey said.

After Cachola introduced the bill in January, he experienced firsthand the delays resulting from the pre-approval process.

He received a letter in March from National Imaging Associates saying that his heart test had been denied because the reviewer was "unable to make a medical necessity determination (based) on the information given" by his doctor. He had the test done anyway and is planning to pay for it himself.

"I don't play with my life. If we have to pay, we have to pay," he said. "I never thought I'd be part of this process ... or that it would affect me. I hope and pray that they do something for the sake of the patients."

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