Current Shareware 1994 January/SHAR194.ISO/textfile/amn30607.zip/AMN30607.MN

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ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (6/7/93)

Reports Hit Unbalanced Medicare Pay Updates (1)
  Reports issued by the Department of Health and Human Services (HHS)
  and Physician Payment Review Commission (PPRC) suggest that
  Medicare's volume performance standard (MVPS) is a flawed tool. They
  recommend allowing physician care expenditures to increase some 8%
  next years and modifications that would lower spending limits
  thereafter. Primary care would receive special protection in the
  process.

Enterprise Liability Model May Not Stand Political Heat (1)
  As proposed by law professors Paul Weiler and Kenneth Abraham in
  1991, enterprise liability would shift malpractice liability from
  individual doctors to the enterprises at which they practice. While
  its authors envisaged these enterprises as hospitals, White House
  reformers are targeting health plans providing insurance coverage
  under managed competition. But physicians are wary of sacrificing
  clinical autonomy and patient advocates want negligent doctors held
  directly accountable for their malfeasance. CURE Comment: We oppose
  enterprise liability and other "no-fault" concepts of malpractice as
  detrimental to the quality of medicine and to the protection of
  patients.

Physicians Clamor to Claim Their Labs Exempt from CLIA Regulation (1)
  "People are either radically changing their practices or are going
  to do other testing and not tell us." --Anthony Tirone, Health Care
  Financing Administration (HCFA)'s Health Standard and Quality
  Bureau. Almost half the physicians with in-office laboratories are
  advising the federal government their tests are so simple that CLIA
  (Clinical Laboratory Improvement Amendments of 1988) regulations do
  not apply."

Mainstreaming of Prevention (2)
  In California, 16 health plans, 17 major employers, and the
  California Department of Health Services adopt guidelines developed
  in 1989 by the US Preventative Services Task Force of the Department
  of Health and Human Services (HHS)to cover 15 million Californians,
  half the state's population. "This may be the wave of the future."
  --Douglas Kamerow, MD, MPH, director of clinical preventative
  services, Office of Disease Prevention and Health Promotion.

NIH Reauthorization Measure (2)
  The House adopts an National Institutes of Health (NIH)
  reauthorization bill with controversial provisions on AIDS and
  abortion. President Clinton is expected to sign the measure.

Abortion Law Challenge Renewed (2)
  Although the Supreme Court upheld the bulk of Pennsylvania's
  abortion law last June, US District Judge Daniel Hyatt III is
  challenging its constitutionality under guidelines issued by the
  Supreme Court in its ruling.

Poll: Mixed Messages on Reform (2)
  Americans are relatively satisfied with their health care and most
  don't believe they will benefit from reform, yet 85% support major
  changes or an overhaul of the system according to a survey conducted
  by Howard University researchers.

Clinic: Killing Trial Delayed (2)
  Denying a "cooling-off period" sought because of pretrial publicity,
  Circuit Judge John Parnum orders the trial of Michael Griffin,
  accused of shooting abortionist David Gunn to go forward in three
  months.

No Confidentiality Violation (2)
  A jury finds Montgomery, AL urologist Alfred Newman, MD did not
  violate confidentiality rules in placing the name of a patient on a
  penile implant referral list.

How Two States Broke Health Reform Impasse:

Purchasing Groups Win Florida Support (3)
  Implementation of the nation's first state-level managed competition
  act is expected next month. The law establishes eleven regional
  Community Health Purchasing Alliances (CHPAs) that will contract
  with state-certified health networks for a basic benefits plan.
  Although Florida Medical Association past president, A. Frederick
  Schild, MD had described the plan last February as "a drastic
  departure from true competition" and has concerns regarding the
  quality of health care to be provided by the CHPAs, the Florida
  Medical Association withdrew their opposition prior to its
  enactment.

Washington Builds Concord, Says Providers (3)
  "For interests as powerful as the insurers to have lost so
  completely is almost unbelievable." --Jeff Mero, Washington State
  Hospital Association lobbyist. "How this happened holds...mind."

AMA to White House: Don't Limit Competition or Payroll (4)
  "At some point 'managed competition' becomes so managed that it
  becomes one step away from a single-payer system. That would be the
  opposite of a competitive market approach where government only
  establishes the ground rules." --AMA's May 18 letter to Ira
  Magaziner, President Clinton's top health policy aide.

California Board to Police Doctors with 'Tickets' (5)
  "Basically, we will be able to cite and fine a violator without the
  cost and time of the full hearing process." --John Lacara,
  enforcement chief, Medical Board of California. "Right now, they are
  focusing on the jaywalkers and not the hit-and-run drivers."
  --Timothy Shannon, Jr., associate vice president for government
  relations, California Medical Association.

AMA Backs Broader Nonbias Policy (5)
  Despite years of resistance by the House of Delegates, the Board of
  Trustees is recommending expanding that the AMA explicitly cover
  homosexuals in its anti-discrimination policy. "The report has been
  lauded by backers of a bylaws amendment [overwhelming rejected at
  four annual meetings since 1989], including a national gay
  physicians group, which says it might demonstrate at the [1993
  annual meeting] in support of the measure. But some delegates...say
  they will continue to oppose the measure, which they consider
  unnecessary and part of a larger gay-rights agenda."

DC Rally Tries to Get Physicians to Cheer Reform (5)
  The May 20 conference of the National Health Planning Council was
  "the first of many pep rallies in which the administration will try
  to sell its reform package...Judith Feder, deputy assistant
  secretary of the Department of Health and Human Services...joined a
  wonk-studded gathering of speakers, which included Steve Gleason,
  DO; Irvin Redlener, MD; Walter Zelman; Robert Berenson, MD; Sens.
  John D. Rockefeller IV (D-WV) and Edward Kennedy (D-MA); and Rep.
  Richard Gephardt (D-MO). Gephardt said reform could be passed
  because 'We're good enough, we're smart enough.' He did not mention
  whether people like them."

Prescriptions the Norm--Study (6)
  The National Center for Health Statistics reports that 60% of visits
  to physician offices result in the patient receiving one or more
  drugs.

House, Board Prepare to Elect New Officers, Fill Seats (7)
  Fourteen physicians will vie for AMA offices at June annual meeting.

Minnesota Looking to Save Money with Managed Care Networks (10)
  And Health Reform Updates from Kentucky, Missouri, New Jersey,
  California, Kansas, and Indiana.

Time and a Bottle (11)
  "'I became an alcoholic when I was about 68,' says Violet, a slight
  tremor in her voice. She says retirement from nursing left an
  unbearable chasm of time in its wake. At a loss, she substituted
  alcohol and began drinking wine alone in her apartment...Three phone
  calls to the same AA [Alcoholics Anonymous] branch office find three
  different elderly recovering alcoholics...waiting to offer support
  to callers. One man says that, like Violet, he became an alcoholic
  when he retired. 'I sat down and put my feet up in front of the TV,
  with a keg at my elbow.' Another woman began drinking after her
  husband died. Together, they humanize what the numbers have been
  saying for a while: There is a significant drinking problem among
  the elderly in this country," 2.5 million, according to the House
  Select Committee on Aging.

Coalition Backs Bill to Let FDA Regulate Tobacco (13)
  "Tobacco is America's Number 1 preventable cause of death." --Rep.
  Mike Synar (D-OK), sponsor of the Fairness in Tobacco and Nicotine
  Regulation Act of 1993. "Tobacco is a drug as addictive as cocaine
  or heroin. It is appalling that, in spite of the many well-known
  dangers of cigarette smoking, there has not been one central federal
  agency with the authority to regulate the manufacture, sale,
  distribution, labeling, and advertising of such products." --James
  Todd, MD, executive vice president, AMA.

Pharmaceutical Group Stresses Commitment to Helping Elderly (13)
  More than 300 drugs being developed to treat diseases affecting the
  elderly are "the best hope for saving lives and reducing health care
  expenditures. These new medicines will keep older Americans out of
  hospitals, emergency rooms, and nursing homes, thus reducing
  treatment costs." --Gerald Mossinghoff, president, Pharmaceutical
  Manufacturers Association. According to Dan Durhan, legislative
  representative of the American Association of Retired Persons, 10%
  of the respondents to a recent AARP survey said they had to cut back
  on necessities like food, health care, and fuel to pay for
  prescription drugs.

Prescription for Happiness--A Little Pickin' and Grinnin' (16)
  Pathologist Richard Dieterle, MD and Paul Shapiro, MD, a specialist
  in physical medicine and rehabilitation have charted their medical
  careers to cause minimal disruption to their stage careers as member
  of the RFD Boys, the bluegrass band they founded in Ann Arbor, MI in
  1967.

TB Spreading Faster Than Doctors' Knowledge about Cure (17)
  A survey of AMA members indicates that as many as two of three
  physicians cannot correctly interpret results of the Mantoux skin
  test for tuberculosis. The Centers for Disease Control and
  Prevention, and the National Society of Practitioners in Preventing
  and Treating Tuberculosis find barely 50% of doctors surveyed could
  describe a recommended treatment regimen for active TB, and 16%
  would use an incorrect regiment for preventive therapy. Meanwhile,
  the nation's TB rate has climbed 20% since 1985, with children's
  cases up 35%.

After Reform's Premier--Then What? (editorial) (19)
  "The summer blockbusters that we're all accustomed to...pale in
  comparison to a certain White House production about to be unveiled.
  We still don't know exactly when the President or Mrs. Clinton will
  finally pull the wraps of their health care reform package. And a
  rumored 1,000 pages--about two per White House reform task force
  member--the plan may be captivating beach ready for only the most
  dedicated policy wonks. But the plot outline does have quite a hook.
  It will literally change your life."

Breast Cancer Chemo Trials Not Floundering (letter-editor) (19)
  "Currently, the NCI is sponsoring four large trials [on the use of
  high dose chemotherapy in women with breast cancer]; two of these
  are enrolling patients at the expected rate...The other two are
  accruing more slowly...The larger issue is why the studies are
  accruing more slowly than anyone would like." --Bruce Cheson, MD;
  Jeffrey Abrams, MD; Michael Friedman, MD; Cancer Therapy Evaluation
  Program, Division of Cancer Treatment, National Cancer Institute
  (NCI), Bethesda, MD.

Two Understand Physicians Not 'Villains' (letter-editor) (19)
  "Hats off to those two great journalists, Mike Royko and Carl Rowan,
  for their blunt, real-life commentaries (Other Opinion, May 3)...It
  is truly a shame how the politicians have turned the many honest,
  hard-working physicians in this country into the villains of our
  health care crisis. We are tired of being the whipping boy on the
  one hand, and asked to 'cure the world' on the other. It sure is
  nice to be appreciated for a change." --Pasquale Baratta, MD,
  Damascus, PA.

Letter Supported Bad Ideas (letter-editor) (20)
  "Dr. Todd's letter to the White House, regarding the AMA position on
  health care reform, expresses support for some very bad ideas
  [Insert, March 15]. Managed competition will not, as he claims,
  restrain costs!...Although attractive at first glance, 'community
  rating' is a bad policy...Perhaps, the worst idea is the call for a
  federally mandated minimum benefits package." --Edwin Charnock, MD,
  DeSoto, TX.

Residency Cuts Hardest on IMGs? (letter-editor) (20)
  "It looks like the Council on Graduate Medical Education and the
  Physician Payment Review Commission are very much concerned
  regarding the recent sharp gains of IMG [international medical
  graduates] in the resident match. Matter of fact, US students always
  get the first preference for the available slots and only leftover
  slots are filled by IMGs. Is it a good reason to cut down the
  existing slots, because there are not enough American medical
  graduates?" --Mahendra Khera, MD, Randallstown, MD.


HIV Immigration Ban Discriminatory (letter-editor) (20)
  "I agree with Dr. Edwin Madden that HIV-infected immigrants would be
  a burden on an already burdened health system. But so would
  immigrants with diabetes, cancer, mental illness, and other chronic
  diseases." --Elena Geovanes, MD, Hemet, CA.

Does the Government Need the Control It Is Seeking? (op ed) (22)
  "As you read this, the cost of being treated by a physician appears
  to be moderating, without global budgets but purely because of
  competition--managed or not...Why then are we undertaking a total
  health system reform? We hear that global budgets are necessary to
  control costs. For a sweetener, the Clinton Administration promises
  that these could be enforced with less central regulation and less
  micromanagement of physicians' practices--an obvious impossibility."
  --Susan Hershberg Adelman, MD, past president, Michigan State
  Medical Society.

It Can't Happen in This Country--But then Again... (op ed) (23)
  "This country faces a fundamental restructuring of the health care
  system, which some say is the biggest domestic change since Social
  Security...But what will happen in this brave new world to the
  development of new technologies? What about the breakthroughs in
  gene and molecular biology, and the advances in drugs and other
  treatment modalities that have changed the face of medicine? Of
  course, this is the United States of America...It just can't happen
  here as it has happened in Britain, Canada, and other countries
  where resources for development of new technology dried up. We won't
  let that happen. Right?" --Gray Krieger, MD, member, AMA House of
  Delegates, San Pedro, CA.

Stop the Wasteful Packaging of Drug Samples (op ed) (24)
  "The other day during our ambulatory care rotation, a patient
  complained about not having enough room in her handbag to fit all
  the sample medications given her for treatment of an upper
  respiratory infection. We found this, at first, to be comical; later
  on, we realized the underlying significance to what took place. With
  all the recent debate about rising health care costs and
  environmental waste, why hasn't anyone addressed the packaging of
  drug samples." --John Whyte and Roya Dradashti, fourth-year medical
  students, Hahnemann University School of Medicine.

Residents in Residence (25)
  Fewer than 5% of US internal medicine residencies include hands-on
  training in a private practice setting, according to Rudolph
  Napodano, MD, director, of the University of Rochester primary care
  program in internal medicine, one of the first to incorporate
  private practice experience in 1974. Dr. Napodano reports 65% to 70%
  of his graduates stay in general internal medicine, compared to 30%
  in traditional programs, where training is hospital-based.

Physician Service Price Hikes Slow (27)
  0.4% April increase corresponds with services in general and overall
  inflation, according to the Consumer Price Index.

Protect Yourself Against Problem Workers, Patients (28)
  "Have you ever wondered where the sociopathic, borderline, passive-
  aggressive, narcissistic, character-disorder types are when they are
  not swindling little old ladies, talking judges into reduced
  sentences, running for political office, or napping through a
  therapy session? Well they may be your patients or employees, and
  you need to know how to manage them. If you don't they can cause
  serious problems." --Robert Solomon, PhD, author, Clinical Practice
  Management. CURE Comment: Are we alone in decrying Dr. Solomon's
  bandying of psychiatric diagnoses in a stereotypical smear of
  persons with mental disabilities?

Use Care Leaving Sensitive Info on Patient's Answering Machines (28)
  and other Practice Pointers.

NY Medicaid Must List Clozaril in Formulary (29)
  A New York trial court finds three Medicaid recipients entitled to
  have clozapine (Clozaril), a drug used in treating schizophrenia,
  added to the Medicaid Formulary. (Alexander L. V. Cuomo)

Paralyzed Patient Didn't Know Cause (29)
  Reversing a trial court decision dismissing a charge of negligence,
  the Alaska Supreme Court holds that reasonable minds might differ as
  to whether the patient should have discovered the cause of his
  paralysis earlier. (Pedersen v. Zielski)

No Negligence in Pre-Employment Exam (29)
  A Pennsylvania appellate court rules a physician may not be sued for
  negligence by a patient he saw for a third-party sponsored medical
  examination. (Tomko v. Marks)

Certificate-of-Need Denial Not Arbitrary (29)
  A Florida appellate court finds a hospital field to demonstrate the
  immediate and long-term financial feasibility of a 36-bed acute
  osteopathic facility. (Suburban Medical Hospital v. Department of
  Health and Rehabilitative Services)

Failure to Diagnose Not Cause of Death (29)
  of patient who died of breast cancer, a Pennsylvania Superior Court
  determines. (Soda v. Baird)

Hospital Misread Genetic Test (29)
  of father of unborn child subsequently born with sickle cell anemia.
  "The mother claimed she would have terminated her pregnancy if she
  had known the father also carried the trait...When both parents have
  the trait there is a 25% chance the child will have it." (Jorge v.
  New York City Health and Hospitals Corporation)

AMA Delegates Face Resolutions at Annual Meeting (30)
  in Chicago this month.

[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).