Media Share 9/MEDIASHARE_09.ISO/mag&info/amn30405.zip/AMN30405.MN

Text File | 1993-04-07 | 14KB | 245 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (4/5/93)

AMA, White House Talk Reform (1)
  The Clinton Administration appeals a March 10 court decision which allows
  its health reform task force to develop its legislative plan in a closed-
  door "war room," but requires "information-gathering and information-
  reporting meetings" to be open to the public. Meanwhile a Republican
  Congressman has published the names of 538 advisers to the 13-member
  interagency task force, names the White House had steadfastly refused to
  release. Hillary Clinton was named by her husband, President Bill Clinton
  to head task force in January. "But this far all the work has been left
  to the 35 advisory work groups directed by Task Force member and White
  House adviser Ira Magaziner, a Rhode Island consultant who sold Clinton
  on managed competition." According to David Vladeck, of Public Citizen,
  Judge Royce Lamberth's ruling "relegates Hillary to a tea-and-cookies
  first lady."

Oregon Waiver Opens Way for State Reform Experiments (1)
  President Clinton signals support for state health care experimentation
  by granting a waiver to Oregon's Medicaid rationing plan. The March 19
  action contrasts with the Bush Administration's rejection of Oregon's
  selective treatment list for violating the Americans with Disabilities
  Act (ADA). "The government said that there was evidence that rankings
  were based on the premise that a disabled person's quality of life is
  less than that of someone without a disability." There were few changes
  in the plan approved by the Clinton Administration from the one rejected
  by the Bush Administration, including changes that led a past supporter,
  the president of the Oregon Medical Society, to complain, "When the
  outcome is know, why should we spend large amounts of our scarce resour-
  ces?" CURE Comment: We didn't know Dr. Kevorkian had moved to Oregon.

"This Is the War Room Here' (1)
  "The American Medical Association deplores the vicious, senseless murder
  of physician David Gunn, MD." --James Todd, MD, executive vice president,
  AMA. The AMA and other medical groups called the incident symptomatic of
  an "increasing escalation of violence against health care workers,"
  citing the February shooting of three physicians in a Los Angeles
  emergency department, an attack on a Chicago nurse with an HIV-tainted
  hypodermic needle, and the killing of a Bellevue, WA plastic surgeon by a
  former patient.

Firing Up Tort Reform Debate (2)
  Physicians lobby hard to ensure that proposals limiting their liability
  for malpractice and providing protection from antitrust actions are
  incorporated into the Clinton health reform package. But trial lawyers
  and consumer groups charge tort reform is diversionary, divisive, and
  unneeded, while antitrust enforcers reject special treatment for doctors.

RBRVS: Expectations Meet Reality in First Year of Payment Reform (3)
  Physicians had high hopes for Medicare payment reform based on the
  resource-based relative value scale (RBRVS) which was expected to boost
  primary care pay. But the experience does not match the expectation. Many
  who were supposed to gain have yet to see the increases they had hoped
  for, while those expecting to lose have seen payment drop far more
  drastically they had anticipated.

How Doctors Are Coping (3)
  If physician payment reform were a boxing match, the Health Care Finan-
  cing Administration (HCFA) would have scored a technical knock out (TKO)
  in 1992. The controversial resource-based relative value scale is cutting
  Medicare reimbursements, even where increases were promised, leaving
  physicians wondering what hit them.

HHS, HCFA Appointees May Open Way to Price Controls (4)
  Advocates of rate-setting and global budgets dominate Clinton appoint-
  ments to high-level posts in the Department of Health and Human Services
  (HHS). "The appointees' strong regulatory bent is one more sign that
  wage-and-price controls may be in the works for health care."

Out-of-State Physicians Object to Paying Minnesota Provider Tax (4)
  "It's taxation without representation. These physicians don't have
  offices in Minnesota, and they don't live in Minnesota. they don't even
  have a vote in Minnesota, yet they're being taxed to pay for health care
  for people in Minnesota." --Jack Bierig, attorney for eight physicians
  suing the Minnesota Department of Revenue for seeking to tax them 2% on
  physician receipts because they treat at least 20 Minnesotans a year.

Family Practice Gains Big Numbers in Resident Match (5)
  16% increase over 1992 is attributed to heightened interest by US medical
  students. The record number of placements in the 1993 Match (16,869) is
  boosted by international medical graduates (IMGs), registering a 25% jump
  in positions filled.

Payment Reform--a Work in Progress (7)
  A detailed account of payment reform is available in a book published by
  the AMA entitled "Medicare RBRVS--The Physician's Guide."

Dr. Roper Leaves CDC, But Focus on Prevention Remains (9)
  "There are few leaders who have contributed so substantially in public
  health, health care financing, and the organization and delivery of
  care." --Donna Shalala, Secretary, Health & Humans Services (HHS), on the
  resignation of William Roper, MD, as head of the Centers for Disease
  Control (CDC). "CDC says it has an aggressive America Responds to AIDS
  campaign, but there are a lot of people who have no idea that it exists.
  And those who do are underwhelmed." --Mervyn Silverman, MD, president,
  American Foundation of AIDS Research. CURE Comment: So long, Bill, it
  hasn't been good to know you. Roper was a rationer from the Reagan days.

One Doctor's Story (11)
  "Somewhere along the way changes were made in the RBRVS that emasculated
  it. If there isn't a substantial change in this situation I will have to
  quit practice or go bankrupt. And I am not unique." --Lawrence Witt, MD.
  As a rural family physician, Brookings, OR, Dr. Witt's income was
  supposed to be boosted by as much as 30%, instead a year after reform, he
  makes less than 2% more, not even enough to keep up with inflation.

Interest Rates Say: Time to Look at Refinancing a Home (13)

What Do Medigap Policies Cover? (13)
  And other Practice Pointers.

Surgeon Can't Collect for AIDS Phobia (15)
  A man arrested for burglary is brought to the emergency department of a
  hospital, where a surgeon performs two operations. Afterwards, he is told
  his patient had previously tested positive for HIV. The uninformed
  surgeon who employed no special safeguards--a face shield, double gloves,
  etc. develops a serious emotional problem arising from concerns about
  infection, possible development of AIDS, and death, as does his family.
  He sues the county employing the police officers. Rejecting his suit, a
  New York appellate court rules that "even if there had been a break in
  barrier protection that might have exposed the physician, the police had
  no duty to tell the surgeon about the patient's HIV status." (Ordway v.
  County of Suffolk)

Unhealthy Habits Should Mean Higher Premiums, AMA Says (16)
  "Americans continued to get fatter, and we are surely the fattest nation
  on earth. Fully 66% of adults weigh more than their recommended weights."
  --Humphrey Taylor, Lou Harris and Associates, on 1992 survey of US health
  habits. "Those who choose unhealthy lifestyles should pay higher health
  insurance premiums, said James S. Todd, MD, AMA executive vice president.
  'That's where the greatest savings are going to occur in any health care
  reform.'"

AMA Letter Was a Necessary Step (editorial) (17)
  "Letters rarely make headlines. One that did recently was from the
  American Medical Association to President Clinton's top aide on health
  system reform, Ira Magaziner...The initial response to the letter was
  less than encouraging. The President told reporters the AMA could not
  have a seat on the task force. The press had a field day with that.
  'WHite House keeps docs out of talks' was New York Newsday's take...At
  one time the focus was on a 'seat at the table.' We see now that in a
  process involving about 35 working groups and 500 staffers and consul-
  tants, a literal seat on the table isn't the most important thing."

Doctor Pay Figures 'Grossly Inaccurate' (letter-editor) (17)
  "'Doctors' salaries beat inflation' presents grossly inaccurate figures
  that will undoubtedly be used by the media (AMN, Dec. 28, 1992). The
  article says the average physician earns $170,600...However, for the
  AMA's numbers to specifically exclude rural physicians, residents and
  interns, part-time physicians, academicians, all government-employed and
  other salaried physicians, and then say that the numbers are an accurate
  sampling of physicians is comparable to giving the average salary of an
  NFL quarterback and saying it represents all football players." --Michael
  Ellis, MD, AMA HMSS delegate, Chalmette, LA.

Pay Data Alters Public Perceptions (letter-editor) (18)
  I have a busy practice of internal medicine here in Illinois' second
  largest city, and my actual pre-tax income...was $109,000...It makes me
  uncomfortable that the public perceives me as making so much more money
  than I do." --Keith Wrage, MD, Rockford, IL.

Uninsured Are Denied Care (letter-editor) (18)
  "I was dismayed by the naivete expressed by J.N. Brouillette, MD ('My
  Opinion,' Jan. 11). Dr. Brouillette's assertion that "the 37 million
  people who don't have insurance are seldom denied health care" is a
  myth...As a medical student I see the effects of people being denied care
  until their situation is serious enough to be admitted to a hospital.
  These uninsured persons are presented to the ED [emergency department]
  because they have been repeatedly denied care...When they do receive
  care, they often receive a standard below those persons who are insured."
  --John Whyte, Philadelphia, PA. CURE Comment: That isn't naivete, John,
  it's callousness.

Primary Care Pay Hasn't Increased (letter-editor) (18)
  "Physicians in this area who are primary care givers have found that our
  income has dropped 30% to 35% with the many changes that have occurred! I
  am still expected to provide good patient care despite the fact that I
  can no longer be reimbursed for interpretation of ECGs, for consultations
  on my patients who are hospitalized by other physicians..., or for
  emergency room visits!" --Thomas Smith, MD, Pueblo, Co.


Continue Ban on HIV-Positive Immigrants (letter-editor) (18)
  "An immigrant should be selected on the basis of his or her good health
  with the prospect of said immigrant being capable of self-support and
  able to contribute to the welfare of this country." --Edwin Madden, MD,
  Warwick, RI. CURE Comment: Leaving aside the more complex question of the
  headline, isn't the good doc saying, "TABs only need apply"? Hardly your
  Emma Lazarus: "Give me your poor, your huddled masses..." etc.

Managed Competition and the Physician Surplus (op ed) (19)
  "One of the sleeper issues in the nation's seemingly inexorable march
  toward managed competition is the impact of reform on the market for
  physician supply. Physicians naturally worry that managed competition
  ...will limit both the patient's freedom of choice at time of illness and
  the physician's traditional freedom to...practice medicine as he or she
  sees fit. That is bound to happen...But it is the physician supply facet
  ...that should lead young physicians particularly to rethink...If managed
  competition swiftly swept the nation, and if it worked as advertised, it
  could trigger a sizeable surplus of physicians, especially among medical
  specialists." --Uwe Reinhardt, PhD, professor of political economy,
  Woodrow Wilson School of Public and International Affairs, Princeton
  University.

The Greening of Medicine (21)
  "It seems to me that every environmental problem and every pollution
  problem is or will be a medical or public health problem, and this,
  pollution prevention can become disease prevention." --John Grupenhoff,
  PhD, executive vice president, National Association of Physicians for the
  Environment (NAPE).

Doctor-Photographer Sees the Holy Land as It Was, and Is (23)
  "In some of the photos, the sites are so different now [than in the
  1800s] that you can't believe it is the same scene, while others have
  changed so little that it even takes me a few seconds sometimes to
  realize which is the old one and which is the new one I took." --Daniel
  Tassi, MD.

Do You Listen to Your Patients--Or Their Parents? (23)
  "Doctor, if a parent tells you that something is wrong with the child on
  the exam table and you ask why we think so, please don't close your mind
  when we say, 'I'm not sure, but something is just not right.' This kind
  of parental thinking while irrational, illogical, unjustifiable, and
  unscientific is nearly never wrong. Furthermore, Doctor, don't treat me
  as an adversary. If you take the time to talk to me, you'll discover how
  important I am to the care of your patient. Treat me as a member of the
  team; if you treat me as an outsider; I will give you nothing but agony
  since you are dealing with the dearest thing in my life, a member of my
  family." --James Fancher, computer consultant, Omaha, NE.

Larger-than-Life-Size Look at Pesky Pollens, Maddening Molds (23)
  "I thought it would be a fun and interesting way to show our patients
  what is giving them the allergies. Because I deal with chronic disease,
  my patients are with me a long time. I wanted to create an atmosphere
  that is conducive to waiting and to not minding shots." --James Crisp,
  MD, Lubbock, TX. Dr. Crisp's allergy clinic displays giant pollen grains
  and oversize mold spores sculpted in clay.

[The above listing, prepared for ABLEnews by CURE, includes all major
articles in the cited issue and a representative selection of the rest.]

...For further information, contact CURE, 812 Stephen Street, Berkeley
Springs, West Virginia 25411 (304-258-LIFE/258-5433).