Current Shareware 1994 January/SHAR194.ISO/textfile/amn30614.zip/AMN30614.MN

Text File | 1993-07-11 | 17KB | 340 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (6/14/93)

Physicians, Hospitals Unite to Meet Reform Head-On (1)
  In Orlando, FL, a local business coalition has pushed physicians,
  hospitals, and other health care providers to form an integrated,
  tightly controlled delivery network that is a "well-positioned"
  player in the nation's first statewide managed competition system, a
  model favored by the Clinton Administration.

Price Caps Threatened to 'Cure' Cost-Shifting (1)
  "Greater Southeast Healthcare System uses Robin Hood pricing tactics
  to support its massive outreach to poor people in the nation's
  capital. Like many hospitals Greater Southeast uses hefty price
  mark-ups to some private payers to help pay for programs from blood
  pressure screening in neighborhood barber shops to adult medical day
  care." "Cost shifting is how we survive. It's probably how the vast
  majority of hospitals in this country survive." --Tom Chapman,
  president, Greater Southeast Healthcare System. CURE Comment: When
  First Lady Hillary Clinton blasts hospitals for cost shifting is her
  patron Prince John? Let's hear it for the high sheriff of
  Nottingham, er, Washington?

Health System Reform or Not, Physician Salary Caps Are Coming (1)
  "Physicians are likely to face reimbursement caps as well as more
  managed care whether Washington mandates it or not. Big businesses
  and investors--the people who pay for and sup[ply capital for health
  care--are starting to dictate terms under which they'll contract
  with physicians. Increasingly these terms include: tying physician
  compensation to a percentage of the revenues, or capping it
  outright; emphasis on primary care; group practice; (and) ability to
  contract directly with businesses, skipping insurers or other
  entities."

Dishing the Data (2)
  The Joint Commission on Accreditation of Healthcare Organizations
  (JCAHO) plans to begin releasing detailed, organization-specific
  information on 5,200 accredited hospitals and 3,000 other accredited
  organizations by mid-1994. "If we weren't willing to provide our
  data to be accountable, we wouldn't be playing." --Dennis O'Leary,
  MD, president, JCAHO.

Medicare Measures Pass House (2)
  calling for 1994 physician pay hikes based on Medicare volume
  performance standards, reinstating separate payments for
  electrocardiogram (ECG) interpretations, and repealing pay cuts for
  new doctors.

Outbreak Puzzles Investigators (2)
  Mysterious adult respiratory-distress syndrome kills 13 near Navaho
  Indian Reservation.

Vladeck Takes Over at HCFA (2)
  Bruce Vladeck, former head of the United Hospital Fund, is sworn in
  as administrator of the Health Care Financing Administration (HCFA).

APA Classifies PMS (2)
  The American Psychiatric Association (APA) plans to classify a
  severe form of pre-menstrual syndrome (PMS) as a "depressive
  disorder."


New Cigarette Tax Imposed (2)
  A 17-cent hike in New York's state excise tax on cigarettes makes
  the total state tax of 56 cents a pack the nation's highest.

Should Optometrists Prescribe? (2)
  The California state assembly has passed a measure allowing
  optometrists to prescribe some drugs. The California Medical
  Association (CMA) and many ophthalmologists oppose the measure,
  charging optometrists are inadequately trained to treat eye
  disorders with drugs. CURE Comment: We oppose the lowering of
  standards of patient care implicit in such legislation.

AMA Backs Broader Use of RBRVS (3)
  In a major policy shift, the AMA Board of Trustees endorses
  implementing the resource-based relative value scale (RBRVS) outside
  Medicare as a way to preserve fee-for-service medicine in a world of
  managed competition. Critics cite the Medicare scale's flaws.

AMA Gets Accreditation Contract (3)
  Will assume operation of the American Council for Continuing Medical
  Education (ACCME) in January. "It's a new era in which we pay more
  attention to quality control than in the past." ----Roy Schwartz,
  MD, senior vice president for medical education and science, AMA.

Union Airs Charges Against Kaiser Before House Panel (3)
  "A labor union that represents more than 30,000 employees of Kaiser
  Permanente told Congress that the nation's biggest HMO is charging
  its enrollees increasingly bigger premiums and turns away non-
  members seeking emergency services...Kaiser Permanente provides
  health care services to more than 6.6 million members enrolled in 16
  states, owns and operates 30 hospitals in 4 states, contracts with
  many community hospitals, operates 238 outpatient medical clinics
  and 12 dental facilities, employs more than 90,000 persons, and
  contracts for services from about 9,000 full-time physicians."

Proposed Stark Lab Rule Threatens Group Practices (4)
  "It's really easy to get around the self-referral law by forming a
  fictitious corporation and setting up one billing office." --
  staffer, House Ways and Means health subcommittee. "It creates a
  policy that will force thousands of legitimate group practices to
  discontinue ancillary services or close sites." --Randy Teach,
  Washington representative, Medical Group Management Association, on
  changes to self-referral ban proposed by Rep. Pete Stark (D-CA).

Providers Debate System Fix; Patients Just Confused (5)
  Doctors, hospitals, and HMO representatives meeting in Washington,
  DC, agree on the diagnosis: the US health care system could do a
  better job of getting care to those who need it. The prescriptions
  they offer vary widely. "The fact of the matter is that fee-for-
  service medicine in this country is dead." --James Doherty,
  executive director, Group Health Association of America (GHAA), the
  HMO industry trade association. "The patients' right to choose their
  physician is one of the hallmarks of the American system." --Percy
  Wooton, MD, trustee, American Medical Association (AMA).

AMA Guidelines Outline Early Treatment for HIV Patients (5)
  "The guidelines' message for physicians and patients is that all
  primary care doctors can provide appropriate medical care to
  patients in the early stages of HIV infection." --Paul Volberding,
  MD, chairman, AMA Advisory Group on HIV Early Care Guidelines.


CMA President-Elect to Appeal Malpractice Judgment (5)
  "The president-elect of the California Medical Association (CMA)
  plans to appeal a malpractice judgment issued for his failing to
  diagnose a patient's breast cancer for two years. A Superior Court
  jury found last month that Ralph R. Ocampo, MD, was negligent
  because he didn't perform a biopsy on the patient until 1987,
  although she first complained of a lump in her breast in 1985."

School Still In for Developers of Report Cards on Health Plans (6)
  A panel of insurers and employers release the Health Plan Employer
  Data and Information Set, which includes more than 60 performance
  measures to help employers pick and evaluate plans, but the
  standards' developers grade their own effort "incomplete." "Everyone
  in the industry measures quality and utilization differently.
  Consequently, we don't know how we're doing in comparison to the
  plan down the street, or if we're making headway internally on
  improving." --W. Allen Schaffer, MD, assistant vice president for
  quality management, Aetna Health Plans, panel member.

Doctor-Assisted Suicide Law Overturned in Michigan (6)
  "paving the way for Jack Kevorkian, MD, to continue aiding those
  seeking to kill themselves."

Antitrust Advice (7)
  "In the brave new world of vertically integrated health delivery
  systems, physicians will face at least one old nemesis--the risk of
  new collaborations becoming antitrust violations." "Integration is
  not a free pass, or a get-out-of-jail-free card." --Arthur Lerner,
  antitrust attorney, Washington, DC.

Reform Dominates Discussion at State (Medical Society) Meetings (9)
  in Arkansas, Connecticut, Florida, Massachusetts, New Jersey, New
  Mexico, Nevada, North Dakota, Rhode Island, and Texas.

Doctor Should Have Ordered Monitor, Not Cola (10)
  a Texas appellate court rules in case of woman who miscarried after
  automobile accident. "The woman (who) was eight months pregnant at
  the time of the accident...told the nurse her baby was not moving.
  Fetal heartbeat was heard...The nurse called the (emergency room)
  physician at home, and he directed the mother to drink a cola and
  determine movement. Movement was detected." (Crites v. Pietila)

Settlement Amount Reduces Award (10)
  in Texas malpractice case. (Sisters of Charity of the Incarnate Word
  v. Dunsmoor)

MD Not Liable; Estate Didn't Prove Case (10)
  A finding against a physician in favor of the estate of a patient
  who died of myocarditis should be reversed, a Louisiana appellate
  court rules. (Martin v. East Jefferson General Hospital)

Bailiff's Remarks Were Coercive (10)
  "The patient had coronary bypass surgery in 1987. She allegedly was
  administered an excessive amount of potassium. She had a cardiac
  arrest in the operating room and was resuscitated. She filed suit
  against the hospital and others claiming she sustained brain
  damage...A (South Carolina) jury returned a verdict in favor of the
  hospital and others...(after) a bailiff had told the foreman of the
  jury that the trial judge did not like a hung jury and that a hung
  jury placed an extra burden on taxpayers."  (Blake v. Spartansburg
  General Hospital)

Settlement Doesn't Reduce Award (10)
  in Arizona negligence case. (Roland v. Bernstein)

Colon Cancer May Not Be from Asbestos (10)
  A New York federal trial court finds asbestos manufacturers entitled
  to summary judgment in an action filed by the estate of a sheet-
  metal worker who died of colon cancer. (In Re: Joint Eastern and
  Southern District Asbestos Litigation)

Cryogenics Firm to Get Death Certificates (10)
  previously withheld by the state Department of Health Services, a
  California appellate court rules. (Mitchell v. Roe)

Pacemaker Wires Left in Patient's Chest (10)
  does not constitute negligence on part of cardiologist, finds New
  Jersey Supreme Court. (Graham v. Gielchinsky)

Breast-Cancer Warrior (11)
  "Susan Love, MD, a breast-cancer surgeon and former nun, has never
  been content to help patients one at a time. In 1991, hoping to save
  the lives of millions of women, she launched the National Breast
  Cancer Coalition--and helped change, perhaps forever, the politics
  of medical research. 'I guess it's my Irish Catholic upbringing,'
  she says, as if apologizing. 'It's the idea that you just don't do
  your thing and go home. You try to change the world. Make it a
  better place.'"

Physicians Can Improve Care of Children with Asthma (15)
  "When there's an asthma emergency, people often try to blame
  patients in some way--they didn't take their medications or they
  waited too long to come in. We need to take a look at how physicians
  can work on their own skills to impact this disease." --Ellen Crain,
  MD, director, pediatric emergency department, Bronx Municipal
  Hospital Center.

Ruling that Cigarettes Are 'Defective' May Spur More Suits (16)
  and other Tobacco Updates.

Weighing an Answer on Reform (editorial) (17)
  "Decision making is at the heart of what you do as a physician. Your
  patients look to you to weigh the options and make the right call in
  every exam and procedure, every working day of your career. You and
  they must live with your decisions. The Clinton administration's
  health system reform plan will require another important decision
  from you. Your support or opposition to its provisions will greatly
  affect the outcome of the reform process. This, too, is something
  that you and your patients will have to live with for a long time."

Enterprise Liability 'Seriously Faulted' (letter-editor) (17)
  "A new liability system that shifts the risk to the 'enterprise'
  such as a hospital, managed health care plan, or the like puts the
  practitioner at the mercy of the entrenched powers who control the
  enterprise." --Daniel Shapiro, MD, attorney, Mineola, NY.

Ready for Pay Based on the 'CMHWI'? (letter-editor) (17)
  "Last week I had my car worked on and was billed the standard hourly
  labor charge of $45. Certainly there can be no argument that doctors
  are worth at least as much as car mechanics charge. I would call
  this the Car Mechanic Hourly Wage Index--or CMHWI, knowing how much
  our government likes abbreviations." --J. Charles Spivak, MD,
  Birmingham, AL.

Pay Difference Not Unreasonable (letter-editor) (18)
  "Today a plumber unstopped my kitchen sink for $45. Medicare pays me
  six times that much (considering the dollar amount and the time to
  do the job) to bypass stopped-up arteries in somebody's heart. With
  the sink unstopped, I can conveniently prepare meals. With the heart
  arteries bypassed, a patient can live and work, pay taxes and play
  for years to come. I don't think six times more than a plumber is
  unreasonable." --George Robinson, MD, Gadsden, AL.

Physician Rejects Florida Plan (letter-editor) (18)
  "Regarding managed competition in New York  and Florida (AMNews,
  April 19), I found it very interesting to note that in the body of
  this article it was stated that Florida's physicians had struck a
  deal with politicians...After discussing this with my colleagues, I
  have found not a single physician that has struck an agreement. The
  Florida Medical Association may have made an agreement, however,
  there is not a consensus of the rank-and-file physician." --Ralph
  Rosato, MD, Fort Pierce, FL>

Physicians Should Learn: Quitters Can't Win (op ed) (20)
  "If everyone were to adopt the attitude that we will lose no matter
  what we do, then we will...Silence or lack of action always admits
  and accepts defeat...Let us assume for a moment, though, that the
  system many have worked so vigorously to preserve is not doomed. It
  is based on the fee-for-service arrangement , with freedom of choice
  for both the patient and the doctor...It allows the patients to
  select their doctor based on reputation and rapport." --Robert M.
  Tenery, Jr., MD, president, Texas Medical Association.

Making the Numbers Work for You (21)
  "Once the government released the RBRVS genie from its bottle,
  physicians had a hunch they'd be seeing it used by the insurance
  industry. They were right. Today, many insurers are converting
  physician reimbursement from the typical 80% of usual and customary
  to the resource-based relative value scale. So far, insurers are
  primarily converting to RBRVS in managed care plans, mostly in
  HMOs."

Tax Advantages of Funding Retirement Plans Now, or Each Month (23)
  Doctor's Business Calendar.

Elder Resources (23)
  For a free copy of "Resource Directory for Older People" call the
  National Institute on Aging (NIA) Information Center toll-free at 1-
  800-222-2225.

Medicare to Pay for Pre- and Post-Surgical Consults (24)
  and other RBRVS Answers.

Support for Uniform Electronic Claims (24)
  from National Electronic Information Corporation (NEIC).

Computerized Patient Records Taking Hold, But Slowly (25)
  "Computer-based patient records is a term that encompasses a broad
  array of designs and visions. For Selma C. Kunitz, PhD, president of
  Kunitz and Associates in Rockville, MD, it brings to mind 'a
  regional repository of data on the health of people--from birth to
  death--that could be used by any appropriate entity to track or
  improve a community's health status.'" CURE Comment: "Appropriate"
  in whose eyes?  "Track" to what end? "Improve" in which way?

Most Americans Breath Dirty Air (27)
  The American Lung Association reports that two of three Americans
  live in a county or city that violated federal clean air standards
  for ozone, carbon monoxide, lead, and three other pollutants in
  1991.

New Washington Group Offers Suicide 'Assistance' (31)
  Most board members of Compassion in Dying are affiliated with the
  Hemlock Society and were involved with the campaign in support of
  Initiative 119, an effort to legalize physician-assisted suicide
  rejected by Washington state voters two years ago.

Cigna Ordered to Pay Fired MD (31)
   "I hope some good comes out of this. I had to stand up for the
  patients and the physicians that endured the circumstances I did."
  --Robert French, MD, awarded $7.7 million by an Orange County, CA
  jury after the 18-year employee was demoted, ordered back to work,
  suspended, and fired by the Cigna Corporation health care system.

Formula Maker Settles Antitrust Charges (31)
  Abbott Laboratories agrees to $140 million settlement of federal
  antitrust litigation over sale of baby formula.

[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).