A SMALL DOSE OF HMO PRESENT IN CAPE

People may not know what HMOs are, but they know they don't like them.

Carl Wagner, an Atlanta resident in Cape Girardeau visiting his parents, initially said he had the right definition.

"I know what an HMO is," he said. "I want to say it's like health insurance. It's a plan where you pay in. I'm in an HMO."

There was a pregnant pause. "I guess it's harder to explain than I thought."

A health maintenance organization is a group that contracts with medical facilities, physicians, employers and sometimes individual patients to provide medical care to a group of individuals. This care is usually paid for by an employer at a fixed price for patients.

HMOs are already in Cape Girardeau, though in a relatively small dose. There have been discussions about a stronger HMO presence. At least one hospital administrator opposes the idea.

In fact, HMOs have created such controversy they have prompted Congress to push for a patients' bill of rights to safeguard access to specialists and emergency room care and to appeal medical decisions that patients disagree with.

These are rights that some feel HMOs jeopardize.

"I have no use for HMOs, unless they're a whole lot different than the ones I had to deal with in California," said Shirley Hobbs, a Cape Girar-deau restaurant owner. "Anything you had to do almost took an act of Congress to get done. I know they're talking about getting them here, and I dread it."

Investors or patients?

HMO detractors like Hobbs say they are bad for health care. They say the for-profit corporations let responsibilities to stockholders take precedence over patients. They claim HMOs directly and indirectly control the amount of health care the doctor is allowed to administer.

Critics of managed care say people have been injured or even have died because they were denied necessary care by cost-conscious HMOs.

The two Cape Girardeau hospitals, St. Francis Medical Center and Southeast Missouri Hospital, have signed contracts with HealthLink Inc., a St. Louis-based HMO. HealthLink has 917,000 members who currently use their preferred provider organization, HMO and worker's compensation networks in Missouri, Illinois and Indiana. While calls to HealthLink went unreturned Friday, the company's Web site -- www.healthlink.com -- promises cost-effective, efficiently managed, high-quality care.

Mary Dunn, executive director of SEMO Business Group on Health, said her group works with the medical community to attain the best health care quality at the best price. She said that there are, in reality, still no HMOs in Cape Girardeau.

"Both hospitals have signed contracts with Health Link so we have two HMO facilities, but we do not have an HMO network," she said. "Right now, if some businesses in Cape provide their employees with HealthLink, then they can get treated at the hospitals. But they would likely have to go to St. Louis or someplace like that where there is a network to get a doctor to see them."

Hospital official opposed

St. Francis Medical Center president and CEO Steven C. Bjelich said St. Francis signed a contract with HealthLink in 1998, but only in an effort to work with the business community. Bjelich said the contract represents only a small percentage of revenues and patients.

But Bjelich said HMOs have been ineffective.

"I think HMOs have failed to improve the quality of care," he said. "I think they have only been successful in reducing the actual payments made to cover the costs of providing care by doctors and by hospitals."

Southeast Missouri Hospital administrator Jim Wente declined to comment on the issue, a hospital spokeswoman said. Doctors' Park administrator Sarah Holt did not return phone calls Friday.

Dunn said that there have been preliminary discussions to start a network in Cape Girardeau.

"But no one's in a rush," Dunn said. "HMOs have gotten some very bad press, and we want to be very informed and we want the people to be very informed. There are good HMOs out there."

She said her group, which is made up of 40-45 local businesses, is not afraid of HMOs coming to Cape Girardeau.

"I think our group is interested in joining with the medical community and exploring it," Dunn said. "But people shouldn't be afraid. There is not going to be an HMO product forced on everyone. The medical community is going to have to approve of it, because you can't have a medical product if the medical community refuses to join."

Bjelich said he is not aware of any discussions to bring HMOs to Cape Girardeau and no push to keep them out. But he doesn't see a place for them here.

"I'm not sure I'm seeing the benefits," he said. "Americans prefer to have the choice of provider, and when that is restricted, Americans resent it. If we could see a tangible improvements, then maybe. But to simply reduce payments to the hospitals and physicians just makes it difficult to continue our mission of serving our community."

Bjelich said he thinks the medical community is already doing a good job without HMOs.

"I believe the health care needs are being met by the physicians and the hospitals in this community," he said. "The introduction of managed care to this community will not improve the health care in our community in any way that I can see."