Current Shareware 1994 January/SHAR194.ISO/homecook/amn9307.zip/AMN30705.MN

Text File | 1993-07-26 | 18KB | 337 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (7/5/93)

Senate Panel: More Out of Medicare (1)
  "Bowing to pressure from conservative Democrats, the powerful Senate
  Finance Committee in late June put Medicare back under the knife and
  voted to slice nearly $70 billion in savings out of the popular
  program over the next five years...At press time, the Senate was
  still debating the bill. But it was anticipated that the Medicare
  cuts would remain intact despite a possible campaign from Senate
  liberals to restore about half the additional $19 billion [over
  House-approved cuts]."

Saving Fee for Service Under Reform (1):

RBRVS Could Boost Price Competition
  "The biggest problem with current fee-for-service payment is that
  it's impossible to predict what the ultimate cost of care will be.
  That's increasingly unacceptable to policymakers [and] payers...Many
  would prefer to have physicians salaried or on contract with
  insurance plans to offer...services for a fixed, prepaid sum (called
  capitation). But to physicians, capitation and other managed care
  schemes interfere with their autonomy and patients' freedom." CURE
  Comment: Not just to physicians.

But Old Medicare Garbage Must Go
  "AMA executive face a tough sell: convincing doctors that they will
  benefit from the Association's ne policy supporting non-Medicare use
  of RBRVS [resource-based relative value scale]...The new policy is
  designed to bring market forces to bear on physician fees and
  protect fee-for-service medicine...But broad acceptance of the new
  policy hinges on a critical issue: whether doctors and payers will
  differentiate the AMA's RBRVS concept from the Medicare physician-
  payment system."

What Drugs, When? (2)
  Physicians attending the Ninth Annual International Conference on
  AIDS in Berlin exhibit frustration and uncertainty in the face of
  reports on the limited efficacy of AZT and ambiguities concerning
  when and how to prescribe antiviral drugs.

Task Force Can Keep Secrets (2)
  Federal appeals court finds White House health reform task force
  could operate secretly since Hillary Rodham Clinton was a full-time
  government employee.

Tobacco Companies Sue (2)
  to overturn the federal government's designation of secondhand smoke
  as a carcinogen,

New PRO in Florida (2)
  Tampa-based Florida Medical Quality Assurance, Inc. wins three-year,
  $26 million contract as state's new peer review organization (PRO).

Health Insurance Top Benefit (2)
  A survey by the Employee Benefit Research Institute finds that 65%
  of Americans would opt for better health coverage even at the cost
  of lower pensions.

Oregon Proposes Provider Tax (2)
  A spokesman for the Oregon Medical Association says that while the
  physician group opposes the 0.5% provider tax, it is pleased that
  Gov. Barbara Roberts (D-OR) has pushed the issue to the forefront.

White House Reform Goal: Promote Autonomy (interview) (3)
  "Ten years from now, nobody's going to remember how we paid for
  getting everybody covered. What will be important is what happens
  when a patient goes to the doctor." --Ira Magaziner, Clintons' top
  health policy adviser. CURE Comment: That is precisely what concerns
  us, and not just ten years down the road.

Shock-Tactic Ads Target Late-Term Abortion Procedure (3)
  "In a series of drawings, the ad illustrates a procedure called
  'dilation and extraction,' or D & X, in which forceps are used to
  remove second- and third-trimester fetuses from the uterus intact
  with only the head remaining outside the uterus. The surgeon is then
  shown jamming scissors into the skull...to create an opening large
  enough to insert a catheter that suctions the brain, while at the
  same time making the skull small enough to pull through the
  cervix...Some abortion-rights advocates have questioned the ad's
  accuracy. A letter to the Star Tribune said the procedure shown "is
  only performed after fetal death"...But Dr. [Martin} Haskell and
  another doctor who routinely use the procedure for late-term
  abortions told AMNews that the majority of fetuses aborted this way
  were alive until the end of the procedure. Dr. Haskell said the
  drawings were accurate "from a technical point of view."

Self-Referral No Longer Center Stage (4)*
  AMA policy states physicians should avoid self-referral because of
  potential conflicts of interest. An exception is made for an
  "extension of practice," which is defined as care personally
  provided by the referring physician or a member of the physician's
  group practice at the site where the ancillary service is provided.

Delegates Refuse to Restrict Liability Underwriting (5)*
  Despite the American Society of Plastic and Reconstructive Surgeons'
  pleas to decry "cherry-picking"--an underwriting practice
  discontinuing coverage to customers posing potentially higher risks
  of loss, AMA delegates declined to question the insurer's freedom to
  base underwriting decisions on actuarial data.

Can Nurse Practitioners, PAs do Work Cheaper? (5)*
  "Nurse practitioners have received expanded licensing privileges
  from many state nursing boards. For example, in some states, they
  cab prescribe from a limited drug formulary. Nut doctors worry that
  excessive use of nonphysicians, though cheaper, might reduce the
  quality of care."

Delegates Hit Hospital Use of Economic Credentialing (5)*
  While most managed care companies and hospitals stop short of using
  economic credentialing to deny physicians contracts or hospital
  privileges, many use measures of economic performance to restrict
  physicians from practicing. "The result is the same, even though
  they don't call it 'economic credentialing.'" --William Gibbons, MD,
  member, AMA House Medical Staff Section.

DEA Registration Fee Hike Challenged in Court (6)
  by AMA. Joining as plaintiffs in challenging the Drug Enforcement
  Administration's recent fourfold increase are the American
  Osteopathic Association, American Dental Association, National
  Wholesale Druggists Association, and National Association of Retail
  Druggists.

Community Cooperation Can Ease Access Problem (7)*
  "In the past universities--however well meaning--would come in with
  funded programs, do their thing and leave, and it's been extremely
  disappointing. You don't go in and open a nice office and say, 'Here
  I am.' It means you get off your fanny and into the community and
  work in ways that many of us were never taught in medical school." -
  -Steven Rothschild, MD, family physician, Chicago, IL.

Financial Incentives for Organ Donation Put on Hold (7)*
  "Current AMA opinion bars physicians from participating in a process
  that allows organ donors to receive payment, other than
  reimbursement for expenses incurred in connection with the organ's
  removal...'Presumed consent' laws...allow doctors to presume
  a...patient has consented to donate organs unless objection has been
  previously expressed in writing by the patient, or by relatives at
  the time of [transplantation]... Opponents argued that it would
  often be impossible to ascertain a patient's objections in the short
  time in which organs can be harvested. And by presuming consent,
  physicians would be ignoring religious proscriptions to organ
  donation that some patients may have." CURE Comment: CURE opposes
  the legal fiction of "presumed consent." An involuntary "donor" is
  an oxymoron.

Delegates Urge AMA to Focus on Abusiveness in Medicine (7)*
  "Abusive practices are imbedded in our medical culture. We need to
  know what to do to clean up our own house before we can teach others
  to address abuse and neglect." --A. Stuart Hanson, MD, AMA delegate,
  MN.

Using Guidelines in Payment, Liability to Be Considered (8)*
  Despite warnings not to ignore the inevitable, AMA delegates decline
  to support use of 1,500 practice guidelines to govern payment and
  liability decisions. "We're talking only about the good side of
  parameters. I'm scared to death about the bad parameters." --Albert
  Hendler, MD, AMA delegate, TX. CURE Comment: So are we, doctor. So
  are we.

JAMA Editorial Freedom Kept Intact (8)*
  AMA delegates reject resolution directing the Journal of the
  American Medical Association (JAMA) to "strengthen its peer review
  process, refrain from entering the public policy debate, devote
  equal space to proponents from all sides of an issue addressed in
  its pages, and adopt a policy that letters to the editor from state
  medical society presidents be printed in JAMA."

Reform Push Puts AMA in Red (8)*
  The AMA spends $2.3 million promoting its Health Access America plan
  in 1992, ending the year $1.9 million in the red.

Medical Education Nervous About Impact of Reform (9)*
  While some say medical education has escaped the crippling cuts and
  intensive oversight to which the rest of medicine has been
  subjected, academics see dark clouds on the horizon.

Still a Long Way to Go for Women in Medicine (9)*
  The AMA's Council on Ethical and Judicial Affairs reports that equal
  opportunity still evades women in medicine, with discrimination,
  inadequate accommodation for family needs, and sexual harassment
  among the barriers to equality.

AMA Tells Role in WMA Election, Ouster of Ex-Nazi (10)*
  As the lone physician at a German tuberculosis sanitarium in 1943,
  the past president of the World Medical Association (WMA), Dr. Hans-
  Joachim Sewering signed papers sending a 14 year old retarded girl
  to her death at a euthanasia center. Historians believe the former
  SS member sent 200 euthanasia victims to such death mills. But while
  Dr. Sewering has resigned under AMA pressure, a determined ally of
  his continues to serve as WMA treasurer. Dr. Karsten Vilmar, the
  president of the German Chamber of Physicians, calls the protest "a
  cabal by the World Jewish Congress." CURE Comment: CURE resolutely
  opposes Nazi euthanasia--yesterday, today, and tomorrow.

AMA Suggests Ways to Improve Drug Safety (10)*
  Vote on measures to promote pharmaceutical safety, reduce costs.

Concern over Alternative Care (10)*
  AMA delegates defer a resolution condemning "recognition and
  endorsement of nonscientific alternative medical care paltriness."
  The New England Journal of Medicine reports Americans made 425
  million visits to alternative medicine men in 1990, more than they
  made to primary care physicians in the same year.

Alliance Chief: Children a Priority (10)*
  Noting the poverty rate for American children is the highest among
  the industrial nations, that 10 million latchkey kids are "home
  alone," that 3,000 teens start smoking every day, and that 17% of
  boys and 9% of girls are attacked in school, Mary Hanson, the first
  president of the AMA Alliance (formerly the AMA Auxiliary), appeals:
  "I am asking each of you to help one child escape the effects of
  these destructive syndromes. Our children and the children of others
  must become a priority."

Boundary Crossings (11)
  "Sexual temptation can invade patient encounters, and no physician
  is immune. Experts tell how to stay out of trouble."

AIDS Research Sends Patients from Hope to Despair (14)
  "It is a roller coaster propelled in part by the way newsmakers
  release their findings and the press covers them. Health care
  providers, like myself, must deal with the fallout." --Michael
  Gottlieb, MD, assistant clinical professor of medicine, University
  of California, Los Angeles, School of Medicine.

Long US Wait Seen for RU-486 (16)
  Edouard Sakiz, president of Roussel-Uclaf, a French subsidiary of
  the German pharmaceutical giant Hoechst, says the French abortion
  pill they manufacture will not be available for US use for "four or
  five years."

The Sinking of Enterprise Liability (editorial) (17)
  "Enterprise liability once seemed an unstoppable dreadnought in the
  Clinton health system reform flotilla. Now comes reports that it may
  be sunk...Still, we're withholding final pronouncements. The
  administration has a track record of flip-flops. And its repeatedly
  delayed announcing the specifics of its reform plan. The White House
  may yet decide to refloat enterprise liability...It was the carrot
  that was to lead doctors into the era of accountable health plans
  and managed competition."

Objects to News Analysis on Reform (letter-editor) (17)
  "The AMA, based largely on Council of Medical Service reports, has
  developed extremely sound, thoughtful, comprehensive, and detailed
  policy for health system reform. It is regrettable that a front page
  editorial masquerading as News Analysis in AMNews [May 3] should
  have ignored the policies so laboriously produced by the AMA
  itself." --Perry Lambird, MD, chairman (1991-1993), AMA Council on
  Medical Service.

Optometrists Are Proficient Lobbyists (letter-editor) (17)
  "The optometrist quoted [in your April 19 article about
  nonphysicians seeking a bigger role in a reformed health delivery
  system] says the reason that many state legislatures are passing
  optometric therapeutic bills stems from optometrists' proficiency.
  What should be added is their proficiency at
  lobbying...Unfortunately, privileges obtained by legislation rather
  than education do not confer knowledge or judgment to its holders."
  --Gary Rubin, MD, president, Illinois Association of Ophthalmology.

An Insider's View of the Clinton Plan (op ed) (18)
  "The concept is that as many of the public as possible are to buy
  care from accountable health plans (AHPs) through public entities
  now called alliances. When this finally rolls in all public and
  private programs, it will amount to a regionalized single-payer
  system...The AHP would cover all its doctors, even in the fee-for-
  service plan, making it hard to characterize anyone as a private
  practitioner any more. The word employee comes to mind, also
  control." --Susan Adelman, MD, past president, Michigan State
  Medical Society. ABLEnews Editor's Note: Dr. Adelman served on the
  White House Health Professionals Review Group, a 47-member group
  asked to critique the work of the Clinton/Magaziner health reform
  task force.

Pay Proposal Misses Mark (letter-editor) (18)
  "'Paying Doctors for time, not procedures' is a gross simplification
  of the problem (Letters, April 26). Every physician knows, and most
  patients know, that the time spent by each physician for a specific
  problem varies greatly...When an anesthesiologist provides 30
  minutes of anesthesia time to an 80-year-old cardiac patient for a
  carpal tunnel syndrome, it is not comparable to the time spent by an
  orthopedist who takes 30 minutes to debride and clean toe nails."
  --Andrew Kant, MD, Houston, TX.

Fee Control for Barbers Too? (letter-editor) (18)
  "Bill Clinton's barber makes what is essentially a one-hour 'house
  call' to Air Force One and charges $200 plus tip. I spend two hours
  making a house call, and Medicare reimburses me all of $25.19--and
  no tip. Maybe we should consider fee controls and schedules on
  barbers and hairdressers. Anyone can always receive basic emergency
  care at the emergency room, but try getting a government-subsidized
  perm." --Charles Davant, III, MD, Blowing Rock, NC.

Reach Out and Diagnose Someone (23)
  "By making the latest medical information easily available, the
  computer has become a medical tool 'as important as the
  stethoscope,' says Michael Zaroukian, MD, PhD, an associate
  professor in the Department of Medicine at Michigan State
  University...'I can't imagine practicing medicine without it,' says
  Michael Durfee, MD, a pediatrician in Raleigh, NC, and chairman of
  his state's Governor's Council on Alcoholism and Substance Abuse.
  On-line data bases cover topics including AIDS, cancer, nursing,
  bioethics, pharmaceuticals, and toxicology, among many other topics.
  Many are abstracts of journal articles, but full text data bases are
  increasingly available."

How the Family and Medical Leave Act May Affect You (25)
  and other Business and Taxes matters.

How to Market Your Medical Practice to Women (25)
  "Until a few years ago, virtually all health care--including
  research and development--was directed toward men. But the reality
  is that in many instances men's health has no significance to
  women's health problems. Research has consistently shown that women
  are responsible for 80% of health care decisions in the United
  States. Women select the provider for their families, usually making
  doctor appointments not only for themselves, but for their families
  as well...They're often better informed about their health needs and
  the needs of their families. And, finally, women are more likely
  than men to follow directions." ----Neil Baum, MD, urologist,
  author, "Marketing Your Clinical Practice."

Psychiatrist, AMA Journal Editor Dies (31)
  Dr. Daniel Freeman, "the premier academic and research psychiatrist
  of his time," and the veteran editor of the Archives of General
  Psychiatry, died June 2 at the age of 71. Dr. Freeman was a pioneer
  in the use of drugs to treat mental illness.

[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).