Long wait at the doctor’s office

Six years after a California law was signed requiring speedier health care visits, the problems remain: a half-hour on hold, a 45-minute stint in the waiting room to see a physician, a long delay to see a specialist and weeks to get an appointment.

It looks like patients are going to have to wait longer still: After years of discussion and several versions, the regulation aimed at cutting the delays was finally put together – only to be rejected recently by the powerful but obscure Office of Administrative Law, which has to sign off on all proposed regulations. The proposed rule hadn't been made sufficiently available for public comment, the OAL said: It was available for 15 days, and the comment period should have been double that.

No new timely access regulation has been drafted. State regulators will have up to a year to put one together.

Since at least since 2004, the Department of Managed Health Care, the state office that regulates HMOs, has been working on rules governing the delays that patients experience when receiving health care. The regulation itself has been delayed: The law that authorized the regulation was approved in 2002 and went into effect in January 2003, and participants in the discussions say they didn't really gather steam until late 2004 or early 2005.

Although seemingly simple, expediting patient visits – the issue is known as "timely access" to regulators and health professionals alike – can be complex. That's because cutting waiting times can entail the hiring of additional medical and office staff, capping the times of visits, altering schedules and hours, adding equipment, increasing specialization and other factors. By one estimate, rules governing timely access focused on more than three dozen individual issues ranging from how long people wait on the telephone to the wait to sign in.

Complexity is common to the discussions over health care reform. But there appears to have been, at least marginally, more of a level of agreement on timely access than on other aspects. On four separate occasions since December 2004, an array of health care interests jointly offered language for the proposed regulation to the DMHC. The signatories included representatives of the lobby and trade groups representing California's doctors, hospitals, HMOs, dental plans and health group physicians.

"Nobody likes to sit in a waiting room for a long time. The doctor-patient relationship is a very important one. We are concerned that regulations inject government into that relationship by micromanaging the time that doctors in medical groups spend with their patients," said Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, which regulates HMOs.

The issue is as much economic as it has been medical.

"Broadly speaking, the issue of timely access is a supply and demand issue," said Ned Wigglesworth, a spokesman for the California Medical Association. Forcing shorter elapsed times means that health plans will be required to hire more doctors, because if they don't, "it results in squeezing the amount of time that everybody has with their doctors."

"Insurers overstate their networks by saying, ‘In our network, we've got a thousand doctors,' but the reality is that not all are accepting patients," he added. "They are essentially overstating the availability of doctors." In the doctors' view, that is the fundamental problem with timely access proposals floated thus far, that they don't force health networks to have a sufficient level of doctors.

The responsibility for putting together a new regulation rests with the DMHC. There also are bills in the Legislature dealing with timely access and related issues, including one by Sen. Sheila Kuehl, D-Santa Monica, the head of the Senate Health Committee.