American Medical News (10/18/93)
ABLEnews MedNotes
American Medical News (10/18/93)
Coming Out of the Blocks Running (1)
"In unprecedented back-to-back hearings before five congressional
committees, first lady Hillary Rodham Clinton stormed the
Capitol...To those worried that [the administration's health] plan's
expenditure caps might lead to 'sneaky, back-door rationing,' she
repeated former Surgeon General C. Everett Koop's opinion that the
United States spends as much as $200 billion a year on unnecessary
care...Warning that 'the stories, if we are not careful, fade behind
the statistics,' she turned frequently to anecdotes."
Employers Aren't Waiting; Market Clout Forcing Reform (1)
"While Congress dithers over the Clinton plan, health reform is
already sweeping many markets. Driving the change are employers
capitalizing on the 'shared sacrifice' reform rhetoric by pushing
workers into managed care plans--and doctors and hospitals into
integrated delivery networks (IDNs). 'Reform is taking place as we
speak, and it is market-driven rather than legislation-driven,' says
Dan Grauman, a health care consultant based in Philadelphia."
Beginning of the End for Fee for Service? (1)
"Reports of the death of fee-for-service medicine under the Clinton
health reform plan may be slightly exaggerated. But outside of
Medicare and discounted managed care schemes, its survival is
dubious...'The choice will be left to the American citizen, the
worker not the boss, and certainly not some government bureaucrat,'
Clinton said. But by forcing people to make a pocketbook decision
when they chose a plan, Clinton seems to have stacked the deck
against fee-for-service."
Prevention Will Play (2)
Abruptly changing its policy, the Health Care Financing
Administration (HCFA) will allow doctors to bill Medicare
beneficiaries for the noncovered portion of a physical examination
in the context of a covered visit, but Andrea Waxler, of Practice
Diagnostics, discounts the revision's results. "I doubt that the new
rule will have much impact because most physicians are unwilling to
bill Medicare patients for anything--even when they are allowed to
do so," the Andover, MA consultant comments."
Drug Price Controls Nixed (2)
Voluntary restraints violate the Sherman Antitrust Act, says the
Department of Justice.
Ruling on Managed Care Charge Limits (2)
Judge finds Sloan-Kettering Cancer Center illegally billed patients
and advocates report the overcharges may amount to several million
dollars. Sloan-Kettering will appeal.
California Self-Referral Ban (2)
outlaws all referrals to clinical laboratories, diagnostic imaging
centers, home infusion services, radiation oncology centers,
psychometric testing services, or physical therapy centers in which
the referring physician has a financial interest.
Fraud Award for Payment Denial (2)
Los Angeles jury awards $25 million to Burbank, CA man defrauded by
insurer who refused to pay for cancer treatment.
State Board to Review Lab Errors (2)
at Newport Hospital after the death of a patient whose smears
allegedly were mishandled in the Rhode Island hospital's laboratory.
Boosting Generalist Supply (3)
"The Clinton plan would cut residency positions by more than 3,000
in 5 years, shift the specialty mix so half of all slots are in
primary care, and control for regional distribution and minority
representation."
AMA, Clinton Pledge to Negotiate Reform Details (3)
"We can't go into this assuming that we know all of the answers. We
know that we can't get it right the first time, even though we do
give it our best shot. We really are going to be open to ideas and
changes. " --Donna Shalala, PhD, Secretary of Health and Human
Services (HHS).
Physician Group Pay Scales Shift (3)
"Gatekeepers are starting to be compensated correctly. A good
gatekeeper is worth a bonus." --David Gans, senior project director,
Medical Group Management Association, noting "the impact of managed
care, which rewards primary care 'gatekeepers' for limiting
referrals to specialists.
Economists Question Clinton Reform Cost Estimates (5)
"I have seen very few people outside the administration who find the
administration's statements about financing the plan at all
credible." --Gail Wilensky, PhD, former director, Health Care
Finance Administration (HCFA. Commenting on the president's address
to Congress, she continued, "What we heard was that everyone could
have what the best Fortune 500 corporate plans offer, and only the
young would have to pay a little bit more, and the tooth fairy would
be there in the morning to pay the costs. I think that is totally
unrealistic."
Trade Groups Bracing for 1994 Lobbying Law (6)
New federal tax law has deductions for any portion of dues used
for lobbying and broadens the definition of lobbying. As the
American Medical Association (AMA)'s vice president for
legislative activities reflects, "This provision was designed by
the federal government to discourage people from joining trade
associations and from lobbying."
Empire Blues Profit Despite Enrollment Dip (8)
of half million in 1993. In January Empire Blue Cross-Blue Shield
was granted rate increases as high as 27% by New York authorities.
Community Practice (9)
"What seems to be lost on medical education is that we are turning
out tons of specialists, but few primary care doctors who really
care about their communities." --Chris Urbina, MD, MPH, director
of community education, University of New Mexico. "We're
developing a new type of physician. In 10 or 20 years after we've
forced these kind of structural changes. then we'll see the
differences in health status." --Daniel Ford, MD, MPH, assistant
professor of medicine, Welch Center for Prevention, Epidemiology,
and Clinical Research, John Hopkins University.
Physician Looks for Country Home, Finds Room at the Inn (12)
"All we wanted was to buy some land to put a house on. And we
wound up with 440 acres, seven farm buildings, and permits for 44
condominiums." --John Pastore, MD, director, Echocardiography
Laboratory, St. Elizabeth's Hospital, Brighton, MA; host, Mt. View
Creamery bread and breakfast, Burke, VT.
Study Shows Female Smokers Are at Higher Risk for Lung Cancer (14)
about twice that of male smokers says study in American Journal of
Epidemiology.
When There's Not Enough for All (editorial) (15)
"It is one of the thorniest issues in medicine: how to allocate
scarce health resources. The question of what standards should be
applied in such a decision-making process, and by whom, has been
addressed by the AMA's Council on Ethical and Judicial
Affairs...The report runs 69 double-spaced pages and still does
not address every nuance of the issue--further study is needed."
CURE Comment: CURE will analyze the report and publish our
analysis. As the AMNews editorialist notes, "there looms the
specter of even more widespread rationing...especially in light of
the talk of global budgets or price controls." CURE rejects the
"quality-of-life" philosophy promoted by the AMA report and all
discrimination against persons with disabilities and/or life-
threatening illnesses or conditions.
Insurers Getting Savings From Electronic Billing (letter-editor)(15)
"Your editorial, 'Learning to live with electronic billing'
(August 23/30) is on target with respect to the advantages it
shall bring to the insurance industry and HCFA [the Health Care
Finance Administration]. But it should have highlighted that
it...is actually charging physicians to process their claims...
Take a look at the fields of information required and compare them
to the information needed to complete a 1500 C form manually, and
you'll see who really benefits from this movement." --Victor
Glorioso, president, Professional Management Inc., Baltimore, MD.
Physicians a 'Hard-Working, Competent Bunch' (letter-editor)(15)
"I read with interest--and incredulity--Dr. Oppenheim's
description of physician ineptness encountered as a patient and a
pathologist (First Person, September 13). Since I function in both
settings, I feel qualified to make several comments. All of us
have seen and have made wrong diagnoses...Physicians have an
obligation to encourage patient autonomy, and this responsibility
extends to ourselves. Most patients would not be content to
receive 'a dab of chemotherapy'--and would promptly leave the
practice of a physician...who inappropriately [indicated] 'his
batteries had just been recharged during a romantic liaison in
Hawaii.'" --Kay Woodruff, MD, San Pablo, Ca.
Referrals 'Prime Objective of Family Practice Physicians (let-ed) (16)
"I am writing a response to a letter by Dr. James A. Peterson Jr.
(September 6). His statement that the majority of primary
physicians in practice today do not have the training, knowledge,
or sophistication to know when to refer and then not to refer is
absolutely ludicrous." --John Larson, MD, Rushville, IL.
Competent to Treat--and Refer (letter-editor) (16)
"As a board-certified specialist in family practice, I am well
trained not only to appropriately care for 95% of the clinical
problems I face, but to also properly assess and refer the other
5%...We would all benefit by working together to provide high-
quality health care rather than bickering among ourselves while
other parties dictate how medicine will be practices." Eric Prack,
MD, Willard, OH.
Early Practice Same as Residency (letter-editor)(16)
"'Partner or Prey' (AMNews, September 20) simply reflects an
extension of the way in which attending physicians treat the house
staff during the training years...as indentured servants." --Ralph
Braunschweig, MD, Columbia, MD.
Anti-Abortion Letters Reveal Lack of Respect (letter-editor)(16)
"I am constantly reminded daily of the lack of respect for women
that a lot of doctors show towards their patients...The recent
letters against abortion solidified my views...Go back to school
and be a mechanic. Cars may need you. Women do not." --Cynthia
Kleppinger, MD, Martinsburg, WV.
Letter Writers 'Narrow-Minded' (letter-editor) (18)
"I am appalled at the number of physicians, dedicated to providing
medical care to their patients, who are so narrow-minded and
obviously unable to discern the practice of good medical care from
the political/religious bias held by a minority of Americans." --
George Miks, MD, Duluth, MN.
Are We in Danger of Losing the Mature Physicians? (op-ed) (18)
"It seems that every time I walk into a medical staff lounge or
give a speech about health care reform to a physician group, I
inevitably hear an older doctor state, 'That's it--one more
government intrusion and I'm out of here.' Of course, there are
variations...but the bottom line is always the same. Older doctors
are looking to get out. If we listen to economists, it doesn't
seem like such a bad thing...If you look past the hype and think
what the profession is really all about, however, the loss of
mature physicians is hardly a benefit." --Gary Krieger, MD,
pediatrician, San Pedro, CA, member, AMA House of Delegates.
Beneath the Surface (19)
"Hiring a new employee can be like walking through a minefield for
any business. This is especially true for medical offices...The
ADA [Americans with Disabilities Act], which took effect last
year, must also be considered." "You can't ask if they have a
disability. You can ask if they can perform the essential job
functions required of the job. You tell them the duties and then
you ask, 'Are you able to perform these functions?'" --Margaret
Kostopolous, labor counsel to Chief Judge, Cook County (IL)
Circuit Court.
Integrity Testing Can Help You Avoid Hiring a Thief (20)
"All of us have heard stories about the trusted employee who
embezzles practice funds. Theft is an important business problem
with estimates of annual financial losses running between $40
billion and $50 billion...Integrity tests are paper-and-pencil
exams easily administered and scored, which can be used to screen
job applicants for 'organizationally delinquent' behaviors,
including a tendency towards stealing, sabotage, substance abuse,
absenteeism, lying, unreliability, immaturity, or
insubordination."
August Physician Price Hikes Match Inflation Rate (21)
0.3% versus 0.4% respectively.
Wisconsin Small Businesses Set Up Buying Cooperative (27)
for employee health insurance program.
[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).
American Medical News (10/18/93)
Coming Out of the Blocks Running (1)
"In unprecedented back-to-back hearings before five congressional
committees, first lady Hillary Rodham Clinton stormed the
Capitol...To those worried that [the administration's health] plan's
expenditure caps might lead to 'sneaky, back-door rationing,' she
repeated former Surgeon General C. Everett Koop's opinion that the
United States spends as much as $200 billion a year on unnecessary
care...Warning that 'the stories, if we are not careful, fade behind
the statistics,' she turned frequently to anecdotes."
Employers Aren't Waiting; Market Clout Forcing Reform (1)
"While Congress dithers over the Clinton plan, health reform is
already sweeping many markets. Driving the change are employers
capitalizing on the 'shared sacrifice' reform rhetoric by pushing
workers into managed care plans--and doctors and hospitals into
integrated delivery networks (IDNs). 'Reform is taking place as we
speak, and it is market-driven rather than legislation-driven,' says
Dan Grauman, a health care consultant based in Philadelphia."
Beginning of the End for Fee for Service? (1)
"Reports of the death of fee-for-service medicine under the Clinton
health reform plan may be slightly exaggerated. But outside of
Medicare and discounted managed care schemes, its survival is
dubious...'The choice will be left to the American citizen, the
worker not the boss, and certainly not some government bureaucrat,'
Clinton said. But by forcing people to make a pocketbook decision
when they chose a plan, Clinton seems to have stacked the deck
against fee-for-service."
Prevention Will Play (2)
Abruptly changing its policy, the Health Care Financing
Administration (HCFA) will allow doctors to bill Medicare
beneficiaries for the noncovered portion of a physical examination
in the context of a covered visit, but Andrea Waxler, of Practice
Diagnostics, discounts the revision's results. "I doubt that the new
rule will have much impact because most physicians are unwilling to
bill Medicare patients for anything--even when they are allowed to
do so," the Andover, MA consultant comments."
Drug Price Controls Nixed (2)
Voluntary restraints violate the Sherman Antitrust Act, says the
Department of Justice.
Ruling on Managed Care Charge Limits (2)
Judge finds Sloan-Kettering Cancer Center illegally billed patients
and advocates report the overcharges may amount to several million
dollars. Sloan-Kettering will appeal.
California Self-Referral Ban (2)
outlaws all referrals to clinical laboratories, diagnostic imaging
centers, home infusion services, radiation oncology centers,
psychometric testing services, or physical therapy centers in which
the referring physician has a financial interest.
Fraud Award for Payment Denial (2)
Los Angeles jury awards $25 million to Burbank, CA man defrauded by
insurer who refused to pay for cancer treatment.
State Board to Review Lab Errors (2)
at Newport Hospital after the death of a patient whose smears
allegedly were mishandled in the Rhode Island hospital's laboratory.
Boosting Generalist Supply (3)
"The Clinton plan would cut residency positions by more than 3,000
in 5 years, shift the specialty mix so half of all slots are in
primary care, and control for regional distribution and minority
representation."
AMA, Clinton Pledge to Negotiate Reform Details (3)
"We can't go into this assuming that we know all of the answers. We
know that we can't get it right the first time, even though we do
give it our best shot. We really are going to be open to ideas and
changes. " --Donna Shalala, PhD, Secretary of Health and Human
Services (HHS).
Physician Group Pay Scales Shift (3)
"Gatekeepers are starting to be compensated correctly. A good
gatekeeper is worth a bonus." --David Gans, senior project director,
Medical Group Management Association, noting "the impact of managed
care, which rewards primary care 'gatekeepers' for limiting
referrals to specialists.
Economists Question Clinton Reform Cost Estimates (5)
"I have seen very few people outside the administration who find the
administration's statements about financing the plan at all
credible." --Gail Wilensky, PhD, former director, Health Care
Finance Administration (HCFA. Commenting on the president's address
to Congress, she continued, "What we heard was that everyone could
have what the best Fortune 500 corporate plans offer, and only the
young would have to pay a little bit more, and the tooth fairy would
be there in the morning to pay the costs. I think that is totally
unrealistic."
Trade Groups Bracing for 1994 Lobbying Law (6)
New federal tax law has deductions for any portion of dues used
for lobbying and broadens the definition of lobbying. As the
American Medical Association (AMA)'s vice president for
legislative activities reflects, "This provision was designed by
the federal government to discourage people from joining trade
associations and from lobbying."
Empire Blues Profit Despite Enrollment Dip (8)
of half million in 1993. In January Empire Blue Cross-Blue Shield
was granted rate increases as high as 27% by New York authorities.
Community Practice (9)
"What seems to be lost on medical education is that we are turning
out tons of specialists, but few primary care doctors who really
care about their communities." --Chris Urbina, MD, MPH, director
of community education, University of New Mexico. "We're
developing a new type of physician. In 10 or 20 years after we've
forced these kind of structural changes. then we'll see the
differences in health status." --Daniel Ford, MD, MPH, assistant
professor of medicine, Welch Center for Prevention, Epidemiology,
and Clinical Research, John Hopkins University.
Physician Looks for Country Home, Finds Room at the Inn (12)
"All we wanted was to buy some land to put a house on. And we
wound up with 440 acres, seven farm buildings, and permits for 44
condominiums." --John Pastore, MD, director, Echocardiography
Laboratory, St. Elizabeth's Hospital, Brighton, MA; host, Mt. View
Creamery bread and breakfast, Burke, VT.
Study Shows Female Smokers Are at Higher Risk for Lung Cancer (14)
about twice that of male smokers says study in American Journal of
Epidemiology.
When There's Not Enough for All (editorial) (15)
"It is one of the thorniest issues in medicine: how to allocate
scarce health resources. The question of what standards should be
applied in such a decision-making process, and by whom, has been
addressed by the AMA's Council on Ethical and Judicial
Affairs...The report runs 69 double-spaced pages and still does
not address every nuance of the issue--further study is needed."
CURE Comment: CURE will analyze the report and publish our
analysis. As the AMNews editorialist notes, "there looms the
specter of even more widespread rationing...especially in light of
the talk of global budgets or price controls." CURE rejects the
"quality-of-life" philosophy promoted by the AMA report and all
discrimination against persons with disabilities and/or life-
threatening illnesses or conditions.
Insurers Getting Savings From Electronic Billing (letter-editor)(15)
"Your editorial, 'Learning to live with electronic billing'
(August 23/30) is on target with respect to the advantages it
shall bring to the insurance industry and HCFA [the Health Care
Finance Administration]. But it should have highlighted that
it...is actually charging physicians to process their claims...
Take a look at the fields of information required and compare them
to the information needed to complete a 1500 C form manually, and
you'll see who really benefits from this movement." --Victor
Glorioso, president, Professional Management Inc., Baltimore, MD.
Physicians a 'Hard-Working, Competent Bunch' (letter-editor)(15)
"I read with interest--and incredulity--Dr. Oppenheim's
description of physician ineptness encountered as a patient and a
pathologist (First Person, September 13). Since I function in both
settings, I feel qualified to make several comments. All of us
have seen and have made wrong diagnoses...Physicians have an
obligation to encourage patient autonomy, and this responsibility
extends to ourselves. Most patients would not be content to
receive 'a dab of chemotherapy'--and would promptly leave the
practice of a physician...who inappropriately [indicated] 'his
batteries had just been recharged during a romantic liaison in
Hawaii.'" --Kay Woodruff, MD, San Pablo, Ca.
Referrals 'Prime Objective of Family Practice Physicians (let-ed) (16)
"I am writing a response to a letter by Dr. James A. Peterson Jr.
(September 6). His statement that the majority of primary
physicians in practice today do not have the training, knowledge,
or sophistication to know when to refer and then not to refer is
absolutely ludicrous." --John Larson, MD, Rushville, IL.
Competent to Treat--and Refer (letter-editor) (16)
"As a board-certified specialist in family practice, I am well
trained not only to appropriately care for 95% of the clinical
problems I face, but to also properly assess and refer the other
5%...We would all benefit by working together to provide high-
quality health care rather than bickering among ourselves while
other parties dictate how medicine will be practices." Eric Prack,
MD, Willard, OH.
Early Practice Same as Residency (letter-editor)(16)
"'Partner or Prey' (AMNews, September 20) simply reflects an
extension of the way in which attending physicians treat the house
staff during the training years...as indentured servants." --Ralph
Braunschweig, MD, Columbia, MD.
Anti-Abortion Letters Reveal Lack of Respect (letter-editor)(16)
"I am constantly reminded daily of the lack of respect for women
that a lot of doctors show towards their patients...The recent
letters against abortion solidified my views...Go back to school
and be a mechanic. Cars may need you. Women do not." --Cynthia
Kleppinger, MD, Martinsburg, WV.
Letter Writers 'Narrow-Minded' (letter-editor) (18)
"I am appalled at the number of physicians, dedicated to providing
medical care to their patients, who are so narrow-minded and
obviously unable to discern the practice of good medical care from
the political/religious bias held by a minority of Americans." --
George Miks, MD, Duluth, MN.
Are We in Danger of Losing the Mature Physicians? (op-ed) (18)
"It seems that every time I walk into a medical staff lounge or
give a speech about health care reform to a physician group, I
inevitably hear an older doctor state, 'That's it--one more
government intrusion and I'm out of here.' Of course, there are
variations...but the bottom line is always the same. Older doctors
are looking to get out. If we listen to economists, it doesn't
seem like such a bad thing...If you look past the hype and think
what the profession is really all about, however, the loss of
mature physicians is hardly a benefit." --Gary Krieger, MD,
pediatrician, San Pedro, CA, member, AMA House of Delegates.
Beneath the Surface (19)
"Hiring a new employee can be like walking through a minefield for
any business. This is especially true for medical offices...The
ADA [Americans with Disabilities Act], which took effect last
year, must also be considered." "You can't ask if they have a
disability. You can ask if they can perform the essential job
functions required of the job. You tell them the duties and then
you ask, 'Are you able to perform these functions?'" --Margaret
Kostopolous, labor counsel to Chief Judge, Cook County (IL)
Circuit Court.
Integrity Testing Can Help You Avoid Hiring a Thief (20)
"All of us have heard stories about the trusted employee who
embezzles practice funds. Theft is an important business problem
with estimates of annual financial losses running between $40
billion and $50 billion...Integrity tests are paper-and-pencil
exams easily administered and scored, which can be used to screen
job applicants for 'organizationally delinquent' behaviors,
including a tendency towards stealing, sabotage, substance abuse,
absenteeism, lying, unreliability, immaturity, or
insubordination."
August Physician Price Hikes Match Inflation Rate (21)
0.3% versus 0.4% respectively.
Wisconsin Small Businesses Set Up Buying Cooperative (27)
for employee health insurance program.
[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).
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