Current Shareware 1994 January/SHAR194.ISO/homecook/amn9307.zip/AMN30726.MN

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ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (7/26/93)

Cost-Effective Bundling (1)
  "While some doctors think the demo has in effect made them employees
  of the hospital,...bundling hospital and physician payments has
  worked well for heart bypass surgery and could easily be extended to
  a number of other major procedures."

Will Congress Let White House Ease Lab Rules (1)
  "Physicians are trying to figure out if it's just talk or if the
  Clinton Administration really does plan to relax hated CLIA
  [Clinical Laboratory Improvement Amendments of 1988] regulations...
  There have been a lot of broad hints but few concrete proposals."

Advisory Group Urges HCFA to Plug Gaps in RBRVS (1)
  "Because codes don't exist for these services, physicians often
  aren't reimbursed for managing patients in home-health-care settings
  or for the increased time they spend providing acute care in
  outpatient settings. And to add insult to injury, these 'gratis'
  services generate tremendous savings for Medicare and other payers."

Vaccine Void (2)
  While a dozen therapeutic vaccines are in various stages of trial,
  hopes are fading fast that a vaccine to boost the immune function
  and slow the advance of HIV will be found any time soon. "I think
  people are slowly getting realistic about the state of knowledge
  about therapeutic vaccines." --Martin Delaney, director, Project
  Inform, San Francisco, CA.

Judge Weighing Implant Settlement (2)
  Mentor Corporation of California, the last US manufacturer of
  silicone breast implants, agrees to cease production and pay
  claimants $24 million. Some 1700 of the more than 100,000 women who
  have had Mentor implants sued the company.

Study: Retirement Benefits in Peril (2)
  A General Accounting Office (GAO) study reports that employers are
  terminating the health benefits of current retirees, scrapping them
  for future retirees, and requiring those still receiving benefits to
  pay for them.

Payment Alternative Backed (2)
  A federal appeals court rejects a suit challenging Medicare's
  proposed single payment for cataract surgery and related tasks and
  services. The suit was filed by the American Academy of
  Ophthalmology and two Cleveland physician groups.

Dr. Elder's Nomination Taking Heat (2)
  "Critics...label Dr. Elders a radical supporter of abortion, condoms
  in schools, and elementary-school sex education."

Canadians Sue Over Heart Valve (2)
  Two Canadian provinces sue the maker of the Bjork-Shiley Convexo-
  Concave heart valve for the costs of replacing faulty valves. The
  valve, removed from the market in 1986, has been blamed for more
  than 300 deaths.

Lawyers, Consumers Vow Tort Reform Fight (3)
  With enterprise liability a victim of organized medicine, Pres.
  Clinton is apparently left with such "traditional" tort reforms as
  malpractice damage caps, but Kathleen Hastings, of the Agency for
  Health Care Policy and Research, who co-chaired Clinton's liability
  reform work group affirms, "We never envisaged [traditional tort
  reform] as a stand-alone." And consumers and attorneys oppose them
  outright.

Vermont Leaning Toward Single-Payer, Budget Target Set (3)
  "Will Vermont become the first state to adopt a Canadian-style
  health care system, or will it go with a version of managed
  competition?" CURE Comment: Will Vermont patients become the victims
  of left- or right-wing checkbook euthanasia? According to Harris
  Meyer, of the AMN staff, "Whichever option lawmakers choose, it
  increasingly appears that the new system will feature regulated
  rates, centralized authority, and heavy reliance on managed care."

Tennessee Narrowing in on Reform (3)
  Despite consumer complaints, the state legislature passes Tenn Care
  "with unusual speed." The plan replaces Medicaid with a capitated
  managed care program consisting exclusively of health maintenance
  organizations (HMOs) and preferred provider organizations (PPOs).

Physicians Set Up, Buy Into Iowa Health Plan (4)
  "This is a new generation of product, not a managed care system or
  an HMO, which are driven by insurance companies." --Ronald Hanser,
  senior vice president for community affairs, Iowa Methodist Medical
  Center.

Internal Struggle (5)
  Internists debate whether they are generalists or specialists.
  "Internal medicine has to decide if it is producing generalists or
  consultants. If internists want to train generalists, they've got a
  long road ahead." --Marc Rivo, MD, member, the Accreditation Council
  for Graduate Medical Education (ACGME).

Computerized Patient Record Network Not Far Off (6)
  After a research and development investment of $54.4 million, all
  health care participants could be using computerized patient records
  and be linked to a nationwide health care information network within
  the next decade, according to the Work Group on Computerization of
  Patient Records.

Panel Urges Better Emergency Care for Children (7)
  According to a blue-ribbon panel convened by the Institute of
  Medicine, 20,000 children younger than 19 will die in the United
  States this year as a result of injuries, and another 30,000 will be
  permanently disabled by brain injuries.

Missouri to Use Nurses to Expand Access to Care (8)
  Gov. Mel Carnahan (D-MO) signs legislation sanctioning advance
  practice nurses to work independently in areas where a physician is
  not available on a daily basis. Participating in the June 30 bill-
  signing ceremony via satellite, First Lady Hillary Rodham Clinton,
  praises the provision, saying it "makes such good sense."

Oregon Debates How to Pay for Health Plan (8)
  Republicans favor using lottery revenues and monies from the general
  fund to pay for the $84 million price tag for the Oregon Health
  Plan, while Democrats like Gov. Barbara Roberts favor raising taxes.

Leadership Program Brings Residents to Meeting (8)
  Leadership development program sponsored by the American Medical
  Association (AMA) and Burroughs Wellcome Company brings fifty
  residents to last month's AMA Annual Meeting.

No Conclusion on Home Pregnancy Monitoring (9)
  "There is insufficient evidence of clinical effectiveness to
  recommend for or against [home monitoring] as a screening test for
  preterm labor in high-risk pregnancies." --US Preventive Services
  Task Force. Preterm birth is a leading US cause of perinatal
  morbidity and mortality.

Familial Breast Cancer Risk Overrated? (9)
  "The risk associated with a mother or sister history of breast
  cancer is smaller than suggested by earlier retrospective studies."
  --Graham Colditz, Brigham and Women's Hospital, Boston, MA, and
  colleagues.

Was Patient Informed About all the risks? (10)
  An Indiana woman says she would not have undergone cryocauterization
  if the physician had warned her of the risks of cervical adhesion,
  bleeding, infection, death from anesthesia, and bladder perforation.
  As a result of cervical adhesion, she had to undergo a hysterectomy.
  (Culbertson v.Mernitz)

Insurer not Liable for Death from Stress ECG (10)
  The wife of a 51-year-old patient with an eight year history of
  heart disease, who died as a result of a stress test required as a
  precondition to obtain life insurance, has no claim against the
  insurance company, New York's highest court rules. (Rosenberg v.
  Equitable Life Assurance Society of the United States)

Procedure Results in Quadriplegia (10)
  An Ohio appellate court upholds an $8 million judgement against a
  physician and a clinic for performing an unnecessary cerebral
  arteriogram that left a 36-year-old woman quadriplegic, but orders a
  new trial on her husband's claim for loss of consortium, awarded $1
  by the lower court. (Stelma v. Juguilon)

Father Thinks Bill High, But still Must Pay (10)
  A father whose son was treated for severe burns claims the charges
  are excessive and the treatment was ineffective but a South Carolina
  appellate court finds he must pay the $14,885.24 not covered by
  insurance. (Spartansburg Regional Medical Center v. Bulsa)

Glass Left in Patient's Shoulder for 8 Years (10)
  by emergency room physician. Ohio appellate court says suit not
  barred by statute of limitations. (Sparks v. Blanchard Valley
  Hospital)

Defective Bed Not Medical Malpractice (10)
  A claim filed by a patient who was injured when his hospital bed
  collapsed is not a malpractice action, and, accordingly, did not
  have to be submitted to a medical review panel as stipulated in
  Louisiana's Medical Malpractice Act, the state Supreme Court rules.
  (Sewell v. Doctors Hospital)

Teaching Doctors to Communicate (13)
  Officially founded this year, the American Academy of Physicians and
  Patients arose from the 15-year-old Task Force on the Doctor and
  Patient. Still co-founder, Mark Lipkin Jr., traces its history back
  to the 1960s and to the medical training he received--or rather, did
  not receive--then. "My only instruction was 'It's like music. You
  have to have a good sense of rhythm and timing. Keep that in mind
  and you'll be all right.'"

Lure of Money Can Be Stronger than Friendship (16)
  "Whenever the subject of malpractice comes up, doctors are advised
  that the best way to protect themselves against a legal suit is to
  establish a cordial relationship with the patient. Patients, it is
  so often repeated by malpractice mavens, find it more difficult
  psychologically to litigate against a person who is liked than
  someone who is held in lower esteem...There are exceptions."--Joseph
  Wasserug, MD.

Confronting Medicine's Glass Ceiling (editorial) (17)
  "Addressing individuals by their titles is rare in this rather
  egalitarian society. Yet 'doctor' endures. It underscores the
  special status physicians hold in our culture. It also suggests--at
  least to the outside world--a widespread sense of equality within
  the profession."

Care Has Always Been Rationed (letter-editor) (17)
  "Medical care has always been rationed, but unfairly. Before the
  days of medical insurance, rationing depended on the thickness of
  the wallet and the willingness of the poor to humble themselves to
  obtain free clinic care. Since the advent of medical insurance, and
  then with Medicare and Medicaid, rationing has prevailed by
  exclusions and limitations of benefits, as well as by requirement of
  financial or health-related criteria." --Marion Friedman, MD,
  Baltimore, MD.

Don't Criticize Mechanic's Pay (letter-editor) (17)
  "When one takes the time to consider all the overhead expenses in
  running an auto service facility, $45 an hour is a bargain. The
  average garage owner works at least 60 hours per week and is lucky
  to earn an annual income of around $25,000. A more appropriate
  target...might be the millions of dollars made by professional
  athletes or actors. Misplaced cheap shots by physicians upon hard-
  working citizens who are well below them on the economic ladder is
  counterproductive and only serves to reinforce the public's
  perception of [members of] the medical profession as being ivory
  tower elitists." --Bill Sniger, medical student, Auburn, MA.

Skin Cancer Screening Important (letter-editor) (18)
  "I am heartened to learn that there is a sincere effort to create
  guidelines for preventive care. What troubles me, however, is the
  complete lack of skin cancer screening as an appropriate medical
  activity...Melanoma is the fastest growing cancer in the United
  States...even growing more rapidly than breast cancer." --Michael
  Franzblau, MD, Greenbrae, CA.

AMA Should Pursue Different Strategy (letter-editor) (18)
  "Over the past decade, the AMA's policy toward the government has
  been one of conciliation and acceptance. They have treated the
  government's progressive direction of the provision of medical care
  in this country not unlike Neville Chamberlain treated the Nazis in
  the 1930s...The myth that our current methods are overly expensive
  and in need of a major overhaul must be clearly exposed. Aggressive
  perpetuation of the truth and contradiction of untoward government
  activity is the policy AMA must pursue." --Michael Sukoff, MD, Santa
  Ana, CA.

Tort Reform Shouldn't Shield Bad Care (letter-editor) (18)
  "Tort reform in this era of managed health scares me. Tort reform to
  stop needless law suits is one thing, but to use tort reform to
  allow gatekeepers to deny appropriate care is another. When patients
  do not receive x-rays for so-called sprains that turn out to be
  fractures, or have to wait five to six months for mammograms with
  known masses in their breasts, or are denied lumpectomies and
  radiation and are only given the choice of radical mastectomy by
  their capitated physicians, tort reform will take way the last right
  of the patient for appropriate medical care." --Peter Holmes, MD,
  San Antonio, TX. CURE Comment: Dr. Holmes' last sentence summarizes
  the reason CURE opposes such "tort reform."

Don't Deny Patients Specialized Care (letter-editor) (18)
  "The implication is that family physicians are perfectly able to
  handle anything and everything. I vehemently disagree. Board
  certified specialists, whether they be in allergy, gastroenterology,
  or infectious diseases are far more qualified to deal with problems
  that require time, attention, patience, and expertise than are
  family doctors. To deny a patient specialized care and careful
  analysis for their problems belittles the advances made in medicine
  in the various specialties in recent years." --Bruce Prenner, MD,
  San Diego, CA. CURE Comment: We utterly concur with Dr. Prenner's
  closing comment.

Reform Will Bring Less Access, More Expense (letter-editor) (18)
  "Costs will skyrocket if it costs the patient nothing to visit the
  doctor. Then, like a vicious circle, increasing access and expense
  at the primary care level in a cost-contained system will limit
  access to secondary and tertiary life-saving care. The net result:
  less access and more expense, exactly the opposite of what we want."
  --George Robinson, MD, Gadsden, AL.

Government Regulations Improve our Lot--Not! (op ed) (19)
  "The AMA House of Delegates made a loud statement of frustration,
  anger, and impatience over three of the most misguided of
  government's attempts at regulating medicine. The house voted to
  seek the abolition of the National Practitioner Data Bank, the
  Clinical Laboratory Improvement Amendments of 1988, and the National
  Childhood Vaccine Injury Act. In doing so, it defied its own
  leadership...There comes a time when enough is enough; and American
  physicians through the AMA House are saying that time is now."

Bridging the Gap (21)
  When doctors in a 26-bed hospital in rural New York found a heart
  murmur in a newborn infant there were no specialists available to
  examine the baby. But through an innovative videoconferencing
  network, a pediatric cardiologist in Buffalo viewed the child's
  echocardiogram and assisted in the diagnosis. While setting up such
  a network is not inexpensive, it may prove money well spent. A study
  by Arthur D. Little Inc. estimates videoconferencing could save $132
  million a year in remote consultations nationally.

Kentucky Doctors Sue to Stop Provider Tax (23)
  "Doctors have no greater responsibility to fund Medicaid than the
  general public." --William Monnig, MD, president, Kentucky Medical
  Association.

Defining 'Employee' vs. 'Independent Contractor' (24)
  and other Business and Taxes.

Ohio Insurer Cuts Pay for C-Sections as Disincentive (24)
  Community Mutual Insurance, one of the region's largest health
  insurers, is now paying the same for cesarean and vaginal
  deliveries. They had paid about $3,300 more or an average of $7,900
  in physician and hospital fees for a C-section. "How many of these
  are medically necessary? Is that a way to get additional payment for
  a service?" --John O'Neil, director, Employer Health Care Alliance,
  representing 90 Cincinnati corporations. "Basically, most
  obstetricians can make a pretty good living doing just normal
  deliveries. To say that a physician is doing this for reason of
  monetary gain is foolish." --Frank Cianciolo, president, Cincinnati
  Academy of Medicine. CURE Comment: Last May Blue Cross of California
  announced the same disincentive payment policy. Dr. Cianciolo notes
  cesarean births are performed to avoid medical emergencies that
  could occur in vaginal births. Since one C-section can take two to
  three times as long as a normal delivery will the welfare of mothers
  and their babies suffer as a result of equal pay for unequal work?

Is a Vaccine for Lyme Disease on the Way? (25)
  John Mays of Connaught Laboratories Inc. says initial safety tests
  on a vaccine for Lyme disease, a purified protein, were successful
  and that the Pennsylvania companies hopes to market the product
  within 3 1/2 years.

New Hampshire to Allow DNR Bracelet (31)
  New Hampshire is about to join Connecticut, Virginia, Colorado, and
  New York to "become the fifth state to extend do-not-resuscitate
  [DNR] orders outside the hospital. A new program will allow
  terminally ill patients to wear orange plastic bracelets that alert
  emergency medical people to let them die. CURE Comment: After
  they've risked their lives to get there in time to save their lives?
  For further information regarding no-codes, request our brochure
  "DaNgeR--DNR."

[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).