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HMO offers customers a chance to rate care

Oxford Health Plans, which will announce its entry into the Tampa market this morning, is also introducing a new way for consumers to rate their providers.

Oxford, one of the nation's leading HMOs, will allow members who have an operation to rate the hospital, surgeons and nurses in a report card that will be given to other patients facing the same surgery.

The program is designed to improve the performance of surgical teams and let new patients choose teams that have the most experience, highest success rates and best bedside manner.

Oxford will unveil the program today in a news conference in Tampa, as well as at several Oxford sites in the Northeast. Oxford has not had a presence in Tampa Bay, although it owns 20 percent of St. Augustine Healthcare, a Medicaid HMO in Pinellas, Hillsborough, Pasco and Hernando counties. Oxford plans to offer a commercial HMO in the Tampa area immediately and have a Medicare HMO available by the end of the year.

Oxford, based in Norwalk, Conn., serves about 1.7-million members mostly in the Northeast. Its new consumer report card is part of an overhaul designed to address the most frequent gripes about managed care and save the company money.

Another sore spot the company will target: the process of getting claims or medical information from anonymous clerks on the phone.

Each Oxford member will get a "personal service agent" _ a single person to call whenever he has a question _ who will be responsible for getting an answer within 24 hours.

Enrico Madonna, an Oxford member from the New York City borough of Queens, got such service as part of a pilot program last year and said the agent was invaluable answering questions about his wife's pregnancy.

"When you're dealing with one person they know your situation without you having to re-explain it every time you call up," he said.

Health economists, often skeptical of HMO motives, applauded Oxford's moves.

"This obviously will take some effort to get it right, but to move that way is really quite impressive," said Uwe Reinhardt, a health care economist at Princeton University.

Oxford is one of the most profitable health maintenance organizations in the country at a time when many of its competitors are struggling with rising medical costs.

The company has done a better job of controlling costs and has grown rapidly by catering to consumer demand for more freedom in making health care choices.

For instance, it has moved aggressively into "point of service" plans, which let members choose doctors and hospitals outside the closed HMO network if they agree to pay part of the cost.

Last year, it began covering alternative medicine such as acupuncture, massage, yoga and herbal remedies.

While other HMOs are now trying to boost their profit margins by restricting drug choices and imposing tighter controls on doctors, Oxford says it hopes to save money and improve care, too.

Oxford's new surgery program abandons the current, sometimes haphazard, system of arranging an operation. The company is asking surgeons to set up teams of medical professionals to provide a specific service at a preset fee.

Examples include delivering a baby, performing a heart bypass or a hip replacement. Typical team members would include a hospital, other surgeons, anesthesiologists, physical therapists and visiting nurses. Oxford has set up more than 200 teams and hopes to establish an additional 500 this year.

Patients will pick their team after reading the report cards on several.

"We're giving people more power to make their own decisions in health care and we're giving them the tools to make those decisions," Oxford chairman and chief executive Stephen Wiggins said Monday.

Those considering a balloon angioplasty to clear their heart arteries of cholesterol will be able to find out how many of these procedures each team has performed, and how many were successful.

A man considering whether to have a cancerous prostate gland removed will find out what percentage of a surgeon's patients suffered incontinence or impotence afterward.

The program will be optional, but Wiggins hopes patients will prefer it.

"Most people have no idea about the training, background and success rate of providers before they undergo surgery," he said. "Our game plan is to clear the clouds, because sunshine is the best disinfectant."

While these surgical teams will get paid less than their usual fees, teams that get good report cards will likely be rewarded with more patients.

"If it works right, it will set Oxford apart," said Bob Eicher of Foster Higgins, a consulting firm that advises employers on their health benefits. "The only place I think could be damaging is you may see providers turn down some of the tougher cases."

_ Times staff writer Kris Hundley contributed to this report.