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The New York Times
Jan 24, 2003
by Milt Fruedenheim
Large H.M.O. to Make Treatment Guidelines PublicKaiser Permanente, the nation's largest nonprofit health maintenance organization, said yesterday that it would publish on its Web site the guidelines developed and used by Kaiser's doctors for treatment of hundreds of diseases, "from asthma to visual impairment." Kaiser also agreed to share with the public information about the way it pays doctors, including financial incentives.
The new guidelines, which are being published as part of a settlement of two lawsuits brought by consumer groups over patient care, are not compulsory, according to people familiar with them, so doctors will still be free to deviate from them without penalty. But Kaiser patients -- and the public -- will now have access to information they can use to assess the treatment they receive and discuss it with their doctors. Patients will have to look up the information themselves on Kaiser's Web site.
Consumer advocates said the moves by Kaiser would push other managed care companies and medical groups to make similar disclosures regarding both treatments and doctors' compensation.
The actions by Kaiser are the latest example of efforts to help consumers have more informed discussions with their doctors. Health policy experts say the disclosures may also help narrow the gaps in the treatments offered for identical diseases by doctors and health plans across the country.
"This sets a new standard for the competition and the doctors," said Dr. John Wennberg, a health policy scholar who has studied disparities in care and is an advocate for medical practices with clear evidence of effectiveness. "Patients seeking information on the standards of care will have a new place to go. They could use it in negotiating with their own physician."
The announcements, which industry experts said appeared to be unprecedented, were part of a deal Kaiser made to settle a pair of lawsuits by consumer groups in California state courts four years ago.
The groups had accused Kaiser of false advertising and other violations of the California Unfair Competition Law. The plaintiffs said the H.M.O.'s ads had been incorrect when they claimed that decisions on patients' care at Kaiser were based only on medical criteria decided by doctors.
Some health plans publish recommendations for preventive measures. Empire Blue Cross and Blue Shield, for example, has recommendations for mammograms, childhood vaccinations and other health measures on its public Web site.
Many hospitals tell their own doctors about guidelines for what are called best practices. One group of teaching hospitals -- Mount Sinai NYU, Duke, Vanderbilt, Emory, Washington University and Oregon Health Sciences -- jointly own a company, EBS Solutions of Nashville, that sells medical guidelines for health plan doctors and members.
Health Net, a big California-based H.M.O., made 105 treatment guidelines from EBS available last year to its members and doctors. The EBS contract will not allow the guidelines -- which are derived from federal agencies and medical professional societies -- to be made available to the public, said Dr. Tim Moore, chief medical officer of Health Net.
Dr. Carolyn Clancy, acting director of the federal Agency for Healthcare Research and Quality, said the Kaiser disclosures conformed to the approaches recommended by the Institute of Medicine of the National Academy of Sciences: basing medical practice on evidence and sharing that evidence with the wider public.
"The more stakeholders are engaged in evidence-based medicine, the better," she said. More than 50,000 people each month gather information on the National Guidelines Clearinghouse, a Web site that publishes treatment guidelines various groups have agreed on. The site is sponsored by her agency with the American Medical Association and the American Association of Health Plans, a managed care trade group.
"This is the way we are headed," said Helen Darling, president of the Washington Business Group on Health, a group of 150 large employers. "It helps us to move toward more standardization, presumably toward the gold standard of care. It is an excellent opportunity for everybody to learn what is the best care."
The settlement was announced jointly yesterday by Kaiser Permanente and the lawsuits' plaintiffs, the Foundation for Taxpayer and Consumer Rights, Consumers for Quality Care, and the Steven Andrew Olsen Coalition for Patients' Rights.
The guidelines will be written in clear language that consumers can understand.
"Kaiser has a rigorous process for developing treatment guidelines," said Peter V. Lee, president of the Pacific Business Group on Health, representing large West Coast employers. "I would feel much more comfortable following guidelines developed by Kaiser than taking the luck of the draw on what I'd find through a Google search on the Internet."
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