Current Shareware 1994 January/SHAR194.ISO/homecook/amn9307.zip/AMN30719.MN

Text File | 1993-08-01 | 17KB | 303 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (7/19/93)

Los Angeles Health Care Crash Looming (1)
  "Drastic budget cuts passed in early July by the state of California
  threaten to bring the health care system in Los Angeles County
  crashing down. The looming crisis, exacerbated by federal funding
  shortages, spotlights the need to address care for illegal aliens
  now and under health reform."

Court Takes Middle Ground in Expert Witness Debate (1)
  "The US Supreme Court's decision in a landmark 'expert witness' case
  did not contain...clear, specific guidelines for addressing such
  testimony. But...Daubert et al v. Merrell Dow Pharmaceuticals Inc.
  struck a blow against 'junk science' in the courtroom."

Data Bank Seeks Doctors' Accounts (1)
  "Physicians may soon get to give their account of any report filed
  with the National Practitioner Data Bank. Data bank officials say
  the proposed change reflects their willingness to be responsive to
  practitioners' concerns. Coincidentally, however, the policy shift
  comes at a time when new efforts to open the bank to the public have
  made those concerns more serious than ever."

Merging for Managed Care (2)
  When Blue Shield of California  merges with the hospital-based
  UniHealth of America the corporate health giant will serve 4.5
  million Californians, rivaling mega-HMO Kaiser Permanente's 4.7
  million enrollees in the state. The new company's revenues will top
  $6.5 billion, and its assets will stand at over $2 billion.

Dr. Lee Confirmed (2)
  The Senate confirms Philip Lee, MD to oversee the Public Health
  Service, the Food and Drug Administration, and the National
  Institutes of Health, as assistant secretary for health in the
  Department of Health and Human Services.

Suits in Burt Case Can Proceed (2)
  Ohio Supreme Court clears way for lawsuits against James Burt, MD,
  charged with performing vaginal reconstructions on patients without
  their consent.

Liability Award Cap to Be Tested (2)
  $ 3 million malpractice cap challenged in Kansas court.

Growth Hormone Suit (2)
  The Foundation on Economic Trends and the Physicians Committee for
  Responsible Medicine sue the National Institutes of Health "to stop
  using short but healthy children in a study of synthetic growth
  hormone therapy."

Thais Making Gains Against AIDS (2)
  according to a World Bank health report, which also notes nearly 2
  million Third World children die each year from diseases easily
  prevented by inexpensive vaccines.

A Promise to Listen and Learn (interview) (3)
  "You can envisage a health care system without HCFA (the Health Care
  Financing Administration) or the federal government. You just can't
  envision a health care system without doctors and nurses." --Bruce
  Vladeck, administrator, Health Care Finance Administration (HCFA).

Physicians, Insurers Fear Flood of Implant Liability Suits (3)
  "The burgeoning number of negligence suits related to silicone
  breast implants has yet to result in a malpractice award against a
  plastic surgeon. But some professional liability insurers are
  running scared, restricting coverage for physicians who implant the
  devices and considering other steps to limit their liability."
  "These case generate feeding frenzies. A $25 million award brings
  out women who had not previously had any health problems and who had
  never before considered suing their surgeon or the implant maker."
  --John Fitzpatrick, malpractice defense attorney, before the
  Physicians Insurers Association of America.

Congress Threatens Long-term Care Plan (3)
  While half the states have taken steps to implement a public-private
  partnership to fund long-term care, the House has passed a budget
  bill that restricts the program to just six states approved to test
  the concept under which people who purchase private long-term-care
  insurance are allowed to retain significant assets yet qualify for
  Medicaid when their private benefits expire. All others must "spend
  down" to some $1600 in assets to be eligible for Medicaid coverage.

Support Weak for 'Weighting' to Boost Primary Care (4)
  Medicare provides over $5 billion in graduate medical education
  subsidies. Shifting these subsidies to promote primary care
  residency programs (aka weighting) is gaining momentum in Congress.
  Still even partisans of the concept concede it is sinking.

HMOs Eye Easing Doctor Entry into Primary Care (5)
  Health maintenance organizations (HMOs) blame medical schools for
  not turning out enough family practice physicians, pediatricians,
  ob-gyns, and general internists. They criticize the federal
  government for wasting education dollars on training subspecialists.
  Medical schools, however, protest that marketplace forces determine
  career choices and ant that the primary care shortage arises from
  managed care companies' failure to compensate physicians in a way
  conducive to making primary care a preferred career option.

Drug Research Contract Spurs Government Review (5)
  Controverted argument between Sandoz Pharmaceutical Corporation and
  the Scripps Howard Research Institute inspires the National
  Institutes for Health (NIH)to reexamine contract guidelines.

States Promised Freedom to Craft own Reform Plans (6)
  and Health Reform Updates from North Carolina, Kansas, Tennessee,
  Maine, and Kentucky.

How to Practice under a Global Budget (7)
  "With a 1,000 ER [emergency room] visits a day, you have to become
  more efficient. To that end, they've started moving emergency
  patients, who averaged nine hours wait for treatment, through the
  system more rapidly. We've instituted a triage process where nurse
  practitioners spend time on the intake process to make sure the
  queue gets bumped by those in need." Jonathan Wisbach, MD, medical
  director, LA County Department of Health Services. AMA policy
  opposes global budgeting, expenditure targets, and price controls as
  arbitrary devices that promote rationing and paperwork. CURE
  Comment: We oppose bureaucratic dictates that arbitrarily restrict
  patients' access to health care regardless of need.

HMO Industry Stabilized, Diversified; Enrollment Up (7)
  In 1992 enrollment in the 546 US health maintenance organizations
  (HMOs) exceeded 40 million for the first time, but the mix of types
  has remained relatively constant over the past few years. The top
  five HMO markets by percentage of population enrolled are:
  Rochester, NY (54%), Worcester, MA (51%), San Francisco-Bay Area, CA
  (49%), Minneapolis-St. Paul, MN (46%), and Albuquerque, NM (40%).
  The largest HMO corporation is Kaiser Foundation Health Plans with
  more than six and a half million enrollees, or 16% of the US total.

Smoking Gun (9)
  Second-hand smoke contributes to 3,000 deaths from lung cancer a
  year in the United States, 36,000 from heart disease, 300,000 cases
  of infant respiratory infection, and 26,000 new cases and a million
  exacerbated cases of asthma in children.

Humor Magazine Eases AIDS Pain (12)
  "Michael Botkin's humor magazine for people with AIDS encourages
  readers to develop a 'petulant bad attitude.' 'It's my party and
  I'll die if I want to,' said Botkin, editor of Diseased Pariah
  News...Staying true to character, the magazine [which calls itself a
  'cranky, irreverent, insightful forum of, by, and for people with
  HIV'] doesn't print stories on AIDS research or possible cures."

Smoking Increase Blots a Decade of Health Gains (14)
  and other Public Health Updates.

When Screening Is the Wrong Thing to Do (editorial) (15)
  "You and your patients call it illness. Insurers think of it another
  way: risk. The more people a health insurer covers who become sick,
  the more the insurer has to pay out. So from its perspective, the
  more the risk is controlled the better. That's why requiring testing
  to screen out those who might have a genetic predisposition to
  certain conditions, such as heart disease or cancer, has a natural
  appeal to insurers."

Gatekeepers Provide Quality, Cost Containment (letter-editor) (15)
  "It's important to take issue with Dr. Joseph D. Wasserug's comments
  agains the deification of the gatekeeper (My Opinion, May 24/31). Is
  he aware that in countries with health plans more cost effective
  than our own, it's readily apparent that the generalist/specialist
  ratio is 8:1, opposite of that in this country?" --MArc
  Schneiderman, MD, immediate past president, Pennsylvania Academy of
  Family Physicians, Harrisburg, PA. CURE Comment: We suspect it's
  even higher in Cuba and the former Soviet Union and its other
  erstwhile satellites, but the quality of medical care is also far
  lower.

Views 'Predictable' and Inaccurate' (letter-editor) (15)
  "As a sub-specialist, Dr. Wasserug's negative views of family
  physicians as gatekeepers are predictable and inaccurate." --Peter
  Rives, MD, Phillipsburg, NJ. CURE Comment: By his own standards, Dr.
  Rives' views as a family physician are  no less "predictable."  The
  real test, of course, is not whether one's opinions are predictable,
  but whether they are right. CURE's opposition to the gatekeeper does
  not derive so much from the fact it is performed by family
  physicians, as that it is performed at all to restrict patients
  access to medical care recommended by their physicians, specialists
  or otherwise.

Some Refusing to Pay Cost Shift (letter-editor) (15)
  "One of the major contributors of the increase in private health
  care costs in previous years has been 'cost shifting' to private
  payers to make up for spectacular Medicaid shortfalls. Recently,
  however, through a variety of contractual care arrangements, private
  payers have begun to refuse to pay the cost shift...This has forced
  Medicaid to increase the rates to somewhere near actual medical
  costs for large Medicaid providers. While this has resulted in a
  huge increase in Medicaid spending..., it has not changed the level
  of net health care spending in the country." --Mike Koetting, PhD,
  vice president, University of Chicago Hospitals, Chicago, IL.

Homosexuality a Behavior to Be Opposed (letter-editor) (16)
  "I believe we should love and accept all people for who they are,
  but this does not mean indifference toward their behavior...Behavior
  has personal and social consequences. How can the AMA accept and
  endorse behavior that spreads sexually transmitted diseases such as
  hepatitis and AIDS? Is it not the AMA's purpose to promote health?"
  --Michael Biavati, MD, Iowa City, IA.

'Sharing' Criteria Actually Means Selling It (letter-editor) (16)
  "Recently, AMNews featured a letter from Charles M. Jacobs,
  chairman/CEO of InterQual (March 8) under the headline 'UR
  [utilization review] firm favors sharing criteria'...A call to
  InterQual's phone order line was met with polite laughter when I
  inquired how a physician might go about 'sharing' an InterQual
  criteria set. One quickly learns that in the lexicon of InterQual
  'sharing,' 'knowing,' and 'available' all mean the same thing:
  selling." --Stephen Lamb, director of state health policy, American
  Managed Care and Review Association, Washington, DC. AMNews Editor's
  Note: "InterQual does sell its data, but does so now under a newly
  established licensing arrangement. Chairman/CEO Charles M. Jacobs
  says that physicians are not barred from getting the criteria free
  from licensees--such as hospitals and managed care and review
  organizations--that the doctors work with."

AMA Self-Referral Policy is Wrong (letter-editor) (16)
  "The AMA policy on self-referral is poorly thought out, unfair, and
  not in the spirit of keeping costs down. A ban on self-referral by
  private practitioners, without similarly banning the practice in
  health maintenance organizations, is completely ludicrous. The ban
  will make it even more difficult for primary care doctors to compete
  with the K-mart-type HMOs next door." --Anton Dahlman, MD, Long
  Beach, CA.

Flawed Reform (letter-editor) (17)
  "Any tort reform that allows physicians to hide behind the
  accountability of the enterprise at which they practice is flawed...
  because it essentially encourages and stimulates doctors to be
  employees rather than health professionals. This further erodes the
  concept of the physician/patient relationship and further stimulates
  the physician to give his primary allegiance to his employer or to
  his managed health care system or to his managers. This is not only
  a real but an ethical violation of the oath that we have taken to
  cause no harm to our patients." --Gerhard Mundinger, Jr., MD,
  Jackson, MS. CURE Comment: Here, here, doctor! Well said.

Support Ecological Packaging of Drug Samples (letter-editor) (17)
  "Medicine is certainly in good hands with students like John J.
  Whyte and Roya E. Dardashti, with their very sensible plan for
  reducing packaging for drug samples (My Opinion June 7)." --Sheldon
  Cohen, MD, Atlanta, GA.

Packaging Criticism 'Out of Focus' (letter-editor) (17)
  "The samples are designed to catch the attention of the physicians
  dispensing them...When in medical practice, if these two students do
  not want in their offices these bulky samples full of garbage for
  the planet, all they have to do is tell the representative not to
  drop them off. However, they will be wasting thousands of health
  care dollars by depriving themselves of starter packages to initiate
  patient therapy." --Wanda Velez-Ruiz, MD, Detroit, MI.

Patients Need a Physician's Soothing Touch (op ed) (18)
  "Do you remember the image of the physician sitting at bedside with
  his hand on the patient? In the past, this was the classical picture
  that patients had of their doctor...Today, touching patients, except
  for the purpose of examining them, is a rare occurrence. More and
  more, due to fear of contracting a contagious disease--either from
  the patient to the doctor or from the doctor to the patient--
  physicians wear gloves when they examine and touch their patients.
  New sophisticated diagnostic tests enable us to determine our
  patients' problems and to monitor their progress without touching
  them or, occasionally, without even seeing them. Sometimes
  physicians are afraid to touch their patients for fear of what the
  patient or others might think, or say, about their behavior...To
  abandon the physician's touch because of advanced technology, the
  fear of contracting a communicable disease or what others might say,
  is giving up one of the most valuable tools our profession has. How
  else could one demonstrate kindness and compassion in such a simple
  and meaningful way?" --Robert M. Tenery, Jr., MD, president, Texas
  Medical Association.

Primary Care Power (19)
  "After years of watching their highly-paid subspecialist colleagues
  tooling around in Cadillacs and Mercedes, primary care physicians
  are being handed the keys...And it appears the trip to economic
  improvement will be pleasurable for primary care physicians if they
  follow the right itinerary...The key to managed care centers on
  using primary care physicians to treat the majority of patients and
  have them to serve as 'gatekeepers,' referring patients to
  subspecialists only when medically necessary." CURE Comment: Or
  rather, to be more exact, when their employers deem it "necessary."

You Can't Win by Doing Employees' Work for Them (21)
  "I'm constantly evaluating events on a professional basis--even when
  I'm on vacation. This summer's excursion was no exception. While I
  was travelling out West my wife and I happened on to an outlet of a
  popular fast food restaurant (PFFR) in Moab, Utah. The place had as
  much case material for a management professor as it did chopped
  cow." -- Robert Solomon, PhD, author, Clinical Practice Management.

S Corporation Health Insurance May Be Tax-Exempt (22)
  Doctor's Business Calendar.

[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).