HMO quality of care investigations

The Senate Judiciary Committee heard a bill this week that has been the focus on an investigative story in the Star Tribune. When someone enrolled in an HMO plan suffers an injury or death in a health care setting, they or their family members can file a quality of care complaint that triggers an investigation into the circumstances that led to the problem. The results of those investigations are not available to those family members, leaving them without answers for their own peace of mind and not knowing whether they should pursue damages in court.

The bill would require HMOs to submit their results of quality of care investigations to the Department of Health where they would be redacted to remove confidential information. Supporters say they have a right to know results of investigations they request for peace of mind. Opponents say the quality of care investigation process relies on confidentiality to ensure the medical professionals reviewing the adverse outcome can remain candid and honest to continue to improve the quality of care they provide. The balance of the right to know and the need to preserve the integrity of the investigation process remains a sticking point, and the bill was laid on the table for the committee to potentially consider again later this session. (SF 1517)