Current Shareware 1994 January/SHAR194.ISO/homecook/amn31018.zip/AMN31018.MN

Text File | 1993-11-03 | 13KB | 253 lines

ABLEnews MedNotes

                       American Medical News (10/18/93)

Coming Out of the Blocks Running (1)
   "In unprecedented back-to-back hearings before five congressional
   committees, first lady Hillary Rodham Clinton stormed the
   Capitol...To those worried that [the administration's health] plan's
   expenditure caps might lead to 'sneaky, back-door rationing,' she
   repeated former Surgeon General C. Everett Koop's opinion that the
   United States spends as much as $200 billion a year on unnecessary
   care...Warning that 'the stories, if we are not careful, fade behind
   the statistics,' she turned frequently to anecdotes."

Employers Aren't Waiting; Market Clout Forcing Reform (1)
   "While Congress dithers over the Clinton plan, health reform is
   already sweeping many markets. Driving the change are employers
   capitalizing on the 'shared sacrifice' reform rhetoric by pushing
   workers into managed care plans--and doctors and hospitals into
   integrated delivery networks (IDNs). 'Reform is taking place as we
   speak, and it is market-driven rather than legislation-driven,' says
   Dan Grauman, a health care consultant based in Philadelphia."

Beginning of the End for Fee for Service? (1)
   "Reports of the death of fee-for-service medicine under the Clinton
   health reform plan may be slightly exaggerated. But outside of
   Medicare and discounted managed care schemes, its survival is
   dubious...'The choice will be left to the American citizen, the
   worker not the boss, and certainly not some government bureaucrat,'
   Clinton said. But by forcing people to make a pocketbook decision
   when they chose a plan, Clinton seems to have stacked the deck
   against fee-for-service."

Prevention Will Play (2)
   Abruptly changing its policy, the Health Care Financing
   Administration (HCFA) will allow doctors to bill Medicare
   beneficiaries for the noncovered portion of a physical examination
   in the context of a covered visit, but Andrea Waxler, of Practice
   Diagnostics, discounts the revision's results. "I doubt that the new
   rule will have much impact because most physicians are unwilling to
   bill Medicare patients for anything--even when they are allowed to
   do so," the Andover, MA consultant comments."

Drug Price Controls Nixed (2)
   Voluntary restraints violate the Sherman Antitrust Act, says the
   Department of Justice.

Ruling on Managed Care Charge Limits (2)
   Judge finds Sloan-Kettering Cancer Center illegally billed patients
   and advocates report the overcharges may amount to several million
   dollars. Sloan-Kettering will appeal.

California Self-Referral Ban (2)
   outlaws all referrals to clinical laboratories, diagnostic imaging
   centers, home infusion services, radiation  oncology centers,
   psychometric testing services, or physical therapy centers in which
   the referring physician has a financial interest.

Fraud Award for Payment Denial (2)
   Los Angeles jury awards $25 million to Burbank, CA man defrauded by
   insurer who refused to pay for cancer treatment.

State Board to Review Lab Errors (2)
   at Newport Hospital after the death of a patient whose smears
   allegedly were mishandled in the Rhode Island hospital's laboratory.

Boosting Generalist Supply (3)
   "The Clinton plan would cut residency positions by more than 3,000
   in 5 years, shift the specialty mix so half of all slots are in
   primary care, and control for regional distribution and minority
   representation."

AMA, Clinton Pledge to Negotiate Reform Details (3)
   "We can't go into this assuming that we know all of the answers. We
   know that we can't get it right the first time, even though we do
   give it our best shot. We really are going to be open to ideas and
   changes. " --Donna Shalala, PhD, Secretary of Health and Human
   Services (HHS).

Physician Group Pay Scales Shift (3)
   "Gatekeepers are starting to be compensated correctly. A good
   gatekeeper is worth a bonus." --David Gans, senior project director,
   Medical Group Management Association, noting "the impact of managed
   care, which rewards primary care 'gatekeepers' for limiting
   referrals to specialists.

Economists Question Clinton Reform Cost Estimates (5)
   "I have seen very few people outside the administration who find the
   administration's statements about financing the plan at all
   credible." --Gail Wilensky, PhD, former director, Health Care
   Finance Administration (HCFA. Commenting on the president's address
   to Congress, she continued, "What we heard was that everyone could
   have what the best Fortune 500 corporate plans offer, and only the
   young would have to pay a little bit more, and the tooth fairy would
   be there in the morning to pay the costs. I think that is totally
   unrealistic."

Trade Groups Bracing for 1994 Lobbying Law (6)
   New federal tax law has deductions for any portion of dues used
   for lobbying and broadens the definition of lobbying. As the
   American Medical Association (AMA)'s vice president for
   legislative activities reflects, "This provision was designed by
   the federal government to discourage people from joining trade
   associations and from lobbying."

Empire Blues Profit Despite Enrollment Dip (8)
   of half million in 1993. In January Empire Blue Cross-Blue Shield
   was granted rate increases as high as 27% by New York authorities.

Community Practice (9)
   "What seems to be lost on medical education is that we are turning
   out tons of specialists, but few primary care doctors who really
   care about their communities." --Chris Urbina, MD, MPH, director
   of community education, University of New Mexico. "We're
   developing a new type of physician. In 10 or 20 years after we've
   forced these kind of structural changes. then we'll see the
   differences in health status." --Daniel Ford, MD, MPH, assistant
   professor of medicine, Welch Center for Prevention, Epidemiology,
   and Clinical Research, John Hopkins University.

Physician Looks for Country Home, Finds Room at the Inn (12)
   "All we wanted was to buy some land to put a house on. And we
   wound up with 440 acres, seven farm buildings, and permits for 44
   condominiums." --John Pastore, MD, director, Echocardiography
   Laboratory, St. Elizabeth's Hospital, Brighton, MA; host, Mt. View
   Creamery bread and breakfast, Burke, VT.

Study Shows Female Smokers Are at Higher Risk for Lung Cancer (14)
   about twice that of male smokers says study in American Journal of
   Epidemiology.

When There's Not Enough for All (editorial) (15)
   "It is one of the thorniest issues in medicine: how to allocate
   scarce health resources. The question of what standards should be
   applied in such a decision-making process, and by whom, has been
   addressed by the AMA's Council on Ethical and Judicial
   Affairs...The report runs 69 double-spaced pages and still does
   not address every nuance of the issue--further study is needed."
   CURE Comment: CURE will analyze the report and publish our
   analysis. As the AMNews editorialist notes, "there looms the
   specter of even more widespread rationing...especially in light of
   the talk of global budgets or price controls." CURE rejects the
   "quality-of-life" philosophy promoted by the AMA report and all
   discrimination against persons with disabilities and/or life-
   threatening illnesses or conditions.

Insurers Getting Savings From Electronic Billing (letter-editor)(15)
   "Your editorial, 'Learning to live with electronic billing'
   (August 23/30) is on target with respect to the advantages it
   shall bring to the insurance industry and HCFA [the Health Care
   Finance Administration]. But it should have highlighted that
   it...is actually charging physicians to process their claims...
   Take a look at the fields of information required and compare them
   to the information needed to complete a 1500 C form manually, and
   you'll see who really benefits from this movement." --Victor
   Glorioso, president, Professional Management Inc., Baltimore, MD.

Physicians a 'Hard-Working, Competent Bunch' (letter-editor)(15)
   "I read with interest--and incredulity--Dr. Oppenheim's
   description of physician ineptness encountered as a patient and a
   pathologist (First Person, September 13). Since I function in both
   settings, I feel qualified to make several comments. All of us
   have seen and have made wrong diagnoses...Physicians have an
   obligation to encourage patient autonomy, and this responsibility
   extends to ourselves. Most patients would not be content to
   receive 'a dab of chemotherapy'--and would promptly leave the
   practice of a physician...who inappropriately [indicated] 'his
   batteries had just been recharged during a romantic liaison in
   Hawaii.'" --Kay Woodruff, MD, San Pablo, Ca.

Referrals 'Prime Objective of Family Practice Physicians (let-ed) (16)
   "I am writing a response to a letter by Dr. James A. Peterson Jr.
   (September 6). His statement that the majority of primary
   physicians in practice today do not have the training, knowledge,
   or sophistication to know when to refer and then not to refer is
   absolutely ludicrous." --John Larson, MD, Rushville, IL.

Competent to Treat--and Refer (letter-editor) (16)
   "As a board-certified specialist in family practice, I am well
   trained not only to appropriately care for 95% of the clinical
   problems I face, but to also properly assess and refer the other
   5%...We would all benefit by working together to provide high-
   quality health care rather than bickering among ourselves while
   other parties dictate how medicine will be practices." Eric Prack,
   MD, Willard, OH.

Early Practice Same as Residency (letter-editor)(16)
   "'Partner or Prey' (AMNews, September 20) simply reflects an
   extension of the way in which attending physicians treat the house
   staff during the training years...as indentured servants." --Ralph
   Braunschweig, MD, Columbia, MD.

Anti-Abortion Letters Reveal Lack of Respect (letter-editor)(16)
   "I am constantly reminded daily of the lack of respect for women
   that a lot of doctors show towards their patients...The recent
   letters against abortion solidified my views...Go back to school
   and be a mechanic. Cars may need you. Women do not." --Cynthia
   Kleppinger, MD, Martinsburg, WV.

Letter Writers 'Narrow-Minded' (letter-editor) (18)
   "I am appalled at the number of physicians, dedicated to providing
   medical care to their patients, who are so narrow-minded and
   obviously unable to discern the practice of good medical care from
   the political/religious bias held by a minority of Americans." --
   George Miks, MD, Duluth, MN.

Are We in Danger of Losing the Mature Physicians? (op-ed) (18)
   "It seems that every time I walk into a medical staff lounge or
   give a speech about health care reform to a physician group, I
   inevitably hear an older doctor state, 'That's it--one more
   government intrusion and I'm out of here.' Of course, there are
   variations...but the bottom line is always the same. Older doctors
   are looking to get out. If we listen to economists, it doesn't
   seem like such a bad thing...If you look past the hype and think
   what the profession is really all about, however, the loss of
   mature physicians is hardly a benefit." --Gary Krieger, MD,
   pediatrician, San Pedro, CA, member, AMA House of Delegates.

Beneath the Surface (19)
   "Hiring a new employee can be like walking through a minefield for
   any business. This is especially true for medical offices...The
   ADA [Americans with Disabilities Act], which took effect last
   year, must also be considered." "You can't ask if they have a
   disability. You can ask if they can perform the essential job
   functions required of the job. You tell them the duties and then
   you ask, 'Are you able to perform these functions?'" --Margaret
   Kostopolous, labor counsel to Chief Judge, Cook County (IL)
   Circuit Court.

Integrity Testing Can Help You Avoid Hiring a Thief (20)
   "All of us have heard stories about the trusted employee who
   embezzles practice funds. Theft is an important business problem
   with estimates of annual financial losses running between $40
   billion and $50 billion...Integrity tests are paper-and-pencil
   exams easily administered and scored, which can be used to screen
   job applicants for 'organizationally delinquent' behaviors,
   including a tendency towards stealing, sabotage, substance abuse,
   absenteeism, lying, unreliability, immaturity, or
   insubordination."

August Physician Price Hikes Match Inflation Rate (21)
   0.3% versus 0.4% respectively.

Wisconsin Small Businesses Set Up Buying Cooperative (27)
   for employee health insurance program.

[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).