AMERICAN MEDICAL NEWS (7/5/93)
ABLEnews MedNotes
AMERICAN MEDICAL NEWS (7/5/93)
Senate Panel: More Out of Medicare (1)
"Bowing to pressure from conservative Democrats, the powerful Senate Finance Committee in late June put Medicare back under the knife and voted to slice nearly $70 billion in savings out of the popular program over the next five years...At press time, the Senate was still debating the bill. But it was anticipated that the Medicare cuts would remain intact despite a possible campaign from Senate liberals to restore about half the additional $19 billion [over House-approved cuts]."
Saving Fee for Service Under Reform (1):
RBRVS Could Boost Price Competition
"The biggest problem with current fee-for-service payment is that it's impossible to predict what the ultimate cost of care will be. That's increasingly unacceptable to policymakers [and] payers...Many would prefer to have physicians salaried or on contract with insurance plans to offer...services for a fixed, prepaid sum (called capitation). But to physicians, capitation and other managed care schemes interfere with their autonomy and patients' freedom." CURE Comment: Not just to physicians.
But Old Medicare Garbage Must Go
"AMA executive face a tough sell: convincing doctors that they will benefit from the Association's ne policy supporting non-Medicare use of RBRVS [resource-based relative value scale]... The new policy is designed to bring market forces to bear on physician fees and protect fee-for-service medicine... But broad acceptance of the new policy hinges on a critical issue: whether doctors and payers will differentiate the AMA's RBRVS concept from the Medicare physician- payment system."
What Drugs, When? (2)
Physicians attending the Ninth Annual International Conference on AIDS in Berlin exhibit frustration and uncertainty in the face of reports on the limited efficacy of AZT and ambiguities concerning when and how to prescribe antiviral drugs.
Task Force Can Keep Secrets (2)
Federal appeals court finds White House health reform task force could operate secretly since Hillary Rodham Clinton was a full-time government employee.
Tobacco Companies Sue (2)
to overturn the federal government's designation of secondhand smoke as a carcinogen,
New PRO in Florida (2)
Tampa-based Florida Medical Quality Assurance, Inc. wins three-year, $26 million contract as state's new peer review organization (PRO).
Health Insurance Top Benefit (2)
A survey by the Employee Benefit Research Institute finds that 65% of Americans would opt for better health coverage even at the cost of lower pensions.
Oregon Proposes Provider Tax (2)
A spokesman for the Oregon Medical Association says that while the physician group opposes the 0.5% provider tax, it is pleased that Gov. Barbara Roberts (D-OR) has pushed the issue to the forefront.
White House Reform Goal: Promote Autonomy (interview) (3)
"Ten years from now, nobody's going to remember how we paid for getting everybody covered. What will be important is what happens when a patient goes to the doctor." --Ira Magaziner, Clintons' top health policy adviser. CURE Comment: That is precisely what concerns us, and not just ten years down the road.
Shock-Tactic Ads Target Late-Term Abortion Procedure (3)
"In a series of drawings, the ad illustrates a procedure called 'dilation and extraction,' or D & X, in which forceps are used to remove second- and third-trimester fetuses from the uterus intact with only the head remaining outside the uterus. The surgeon is then shown jamming scissors into the skull...to create an opening large enough to insert a catheter that suctions the brain, while at the same time making the skull small enough to pull through the cervix...Some abortion-rights advocates have questioned the ad's accuracy. A letter to the Star Tribune said the procedure shown "is only performed after fetal death"... But Dr. [Martin} Haskell and another doctor who routinely use the procedure for late-term abortions told AMNews that the majority of fetuses aborted this way were alive until the end of the procedure. Dr. Haskell said the drawings were accurate "from a technical point of view."
Self-Referral No Longer Center Stage (4)*
AMA policy states physicians should avoid self-referral because of potential conflicts of interest. An exception is made for an "extension of practice," which is defined as care personally provided by the referring physician or a member of the physician's group practice at the site where the ancillary service is provided.
Delegates Refuse to Restrict Liability Underwriting (5)*
Despite the American Society of Plastic and Reconstructive Surgeons' pleas to decry "cherry-picking"--an underwriting practice discontinuing coverage to customers posing potentially higher risks of loss, AMA delegates declined to question the insurer's freedom to base underwriting decisions on actuarial data.
Can Nurse Practitioners, PAs do Work Cheaper? (5)*
"Nurse practitioners have received expanded licensing privileges from many state nursing boards. For example, in some states, they cab prescribe from a limited drug formulary. Nut doctors worry that excessive use of nonphysicians, though cheaper, might reduce the quality of care."
Delegates Hit Hospital Use of Economic Credentialing (5)*
While most managed care companies and hospitals stop short of using economic credentialing to deny physicians contracts or hospital privileges, many use measures of economic performance to restrict physicians from practicing. "The result is the same, even though they don't call it 'economic credentialing.'" --William Gibbons, MD, member, AMA House Medical Staff Section.
DEA Registration Fee Hike Challenged in Court (6)
by AMA. Joining as plaintiffs in challenging the Drug Enforcement Administration's recent fourfold increase are the American Osteopathic Association, American Dental Association, National Wholesale Druggists Association, and National Association of Retail Druggists.
Community Cooperation Can Ease Access Problem (7)*
"In the past universities--however well meaning--would come in with funded programs, do their thing and leave, and it's been extremely disappointing. You don't go in and open a nice office and say, 'Here I am.' It means you get off your fanny and into the community and work in ways that many of us were never taught in medical school." - -Steven Rothschild, MD, family physician, Chicago, IL.
Financial Incentives for Organ Donation Put on Hold (7)*
"Current AMA opinion bars physicians from participating in a process that allows organ donors to receive payment, other than reimbursement for expenses incurred in connection with the organ's removal...'Presumed consent' laws...allow doctors to presume a...patient has consented to donate organs unless objection has been previously expressed in writing by the patient, or by relatives at the time of [transplantation]... Opponents argued that it would often be impossible to ascertain a patient's objections in the short time in which organs can be harvested. And by presuming consent, physicians would be ignoring religious proscriptions to organ donation that some patients may have." CURE Comment: CURE opposes the legal fiction of "presumed consent." An involuntary "donor" is an oxymoron.
Delegates Urge AMA to Focus on Abusiveness in Medicine (7)*
"Abusive practices are imbedded in our medical culture. We need to know what to do to clean up our own house before we can teach others to address abuse and neglect." --A. Stuart Hanson, MD, AMA delegate, MN.
Using Guidelines in Payment, Liability to Be Considered (8)*
Despite warnings not to ignore the inevitable, AMA delegates decline to support use of 1,500 practice guidelines to govern payment and liability decisions. "We're talking only about the good side of parameters. I'm scared to death about the bad parameters." --Albert Hendler, MD, AMA delegate, TX. CURE Comment: So are we, doctor. So are we.
JAMA Editorial Freedom Kept Intact (8)*
AMA delegates reject resolution directing the Journal of the American Medical Association (JAMA) to "strengthen its peer review process, refrain from entering the public policy debate, devote equal space to proponents from all sides of an issue addressed in its pages, and adopt a policy that letters to the editor from state medical society presidents be printed in JAMA."
Reform Push Puts AMA in Red (8)*
The AMA spends $2.3 million promoting its Health Access America plan in 1992, ending the year $1.9 million in the red.
Medical Education Nervous About Impact of Reform (9)*
While some say medical education has escaped the crippling cuts and intensive oversight to which the rest of medicine has been subjected, academics see dark clouds on the horizon.
Still a Long Way to Go for Women in Medicine (9)*
The AMA's Council on Ethical and Judicial Affairs reports that equal opportunity still evades women in medicine, with discrimination, inadequate accommodation for family needs, and sexual harassment among the barriers to equality.
AMA Tells Role in WMA Election, Ouster of Ex-Nazi (10)*
As the lone physician at a German tuberculosis sanitarium in 1943, the past president of the World Medical Association (WMA), Dr. Hans-Joachim Sewering signed papers sending a 14 year old retarded girl to her death at a euthanasia center. Historians believe the former SS member sent 200 euthanasia victims to such death mills. But while Dr. Sewering has resigned under AMA pressure, a determined ally of his continues to serve as WMA treasurer. Dr. Karsten Vilmar, the president of the German Chamber of Physicians, calls the protest "a cabal by the World Jewish Congress." CURE Comment: CURE resolutely opposes Nazi euthanasia--yesterday, today, and tomorrow.
AMA Suggests Ways to Improve Drug Safety (10)*
Vote on measures to promote pharmaceutical safety, reduce costs.
Concern over Alternative Care (10)*
AMA delegates defer a resolution condemning "recognition and endorsement of nonscientific alternative medical care paltriness." The New England Journal of Medicine reports Americans made 425 million visits to alternative medicine men in 1990, more than they made to primary care physicians in the same year.
Alliance Chief: Children a Priority (10)*
Noting the poverty rate for American children is the highest among the industrial nations, that 10 million latchkey kids are "home alone," that 3,000 teens start smoking every day, and that 17% of boys and 9% of girls are attacked in school, Mary Hanson, the first president of the AMA Alliance (formerly the AMA Auxiliary), appeals: "I am asking each of you to help one child escape the effects of these destructive syndromes. Our children and the children of others must become a priority."
Boundary Crossings (11)
"Sexual temptation can invade patient encounters, and no physician is immune. Experts tell how to stay out of trouble."
AIDS Research Sends Patients from Hope to Despair (14)
"It is a roller coaster propelled in part by the way newsmakers release their findings and the press covers them. Health care providers, like myself, must deal with the fallout." --Michael Gottlieb, MD, assistant clinical professor of medicine, University of California, Los Angeles, School of Medicine.
Long US Wait Seen for RU-486 (16)
Edouard Sakiz, president of Roussel-Uclaf, a French subsidiary of the German pharmaceutical giant Hoechst, says the French abortion pill they manufacture will not be available for US use for "four or five years."
The Sinking of Enterprise Liability (editorial) (17)
"Enterprise liability once seemed an unstoppable dreadnought in the Clinton health system reform flotilla. Now comes reports that it may be sunk...Still, we're withholding final pronouncements. The administration has a track record of flip-flops. And its repeatedly delayed announcing the specifics of its reform plan. The White House may yet decide to refloat enterprise liability...It was the carrot that was to lead doctors into the era of accountable health plans and managed competition."
Objects to News Analysis on Reform (letter-editor) (17)
"The AMA, based largely on Council of Medical Service reports, has developed extremely sound, thoughtful, comprehensive, and detailed policy for health system reform. It is regrettable that a front page editorial masquerading as News Analysis in AMNews [May 3] should have ignored the policies so laboriously produced by the AMA itself." --Perry Lambird, MD, chairman (1991-1993), AMA Council on Medical Service.
Optometrists Are Proficient Lobbyists (letter-editor) (17)
"The optometrist quoted [in your April 19 article about nonphysicians seeking a bigger role in a reformed health delivery system] says the reason that many state legislatures are passing optometric therapeutic bills stems from optometrists' proficiency. What should be added is their proficiency at lobbying...Unfortunately, privileges obtained by legislation rather than education do not confer knowledge or judgment to its holders." --Gary Rubin, MD, president, Illinois Association of Ophthalmology.
An Insider's View of the Clinton Plan (op ed) (18)
"The concept is that as many of the public as possible are to buy care from accountable health plans (AHPs) through public entities now called alliances. When this finally rolls in all public and private programs, it will amount to a regionalized single-payer system...The AHP would cover all its doctors, even in the fee-for- service plan, making it hard to characterize anyone as a private practitioner any more. The word employee comes to mind, also control." --Susan Adelman, MD, past president, Michigan State Medical Society. ABLEnews Editor's Note: Dr. Adelman served on the White House Health Professionals Review Group, a 47-member group asked to critique the work of the Clinton/Magaziner health reform task force.
Pay Proposal Misses Mark (letter-editor) (18)
"'Paying Doctors for time, not procedures' is a gross simplification of the problem (Letters, April 26). Every physician knows, and most patients know, that the time spent by each physician for a specific problem varies greatly...When an anesthesiologist provides 30 minutes of anesthesia time to an 80-year-old cardiac patient for a carpal tunnel syndrome, it is not comparable to the time spent by an orthopedist who takes 30 minutes to debride and clean toe nails." --Andrew Kant, MD, Houston, TX.
Fee Control for Barbers Too? (letter-editor) (18)
"Bill Clinton's barber makes what is essentially a one-hour 'house call' to Air Force One and charges $200 plus tip. I spend two hours making a house call, and Medicare reimburses me all of $25.19--and no tip. Maybe we should consider fee controls and schedules on barbers and hairdressers. Anyone can always receive basic emergency care at the emergency room, but try getting a government-subsidized perm." --Charles Davant, III, MD, Blowing Rock, NC.
Reach Out and Diagnose Someone (23)
"By making the latest medical information easily available, the computer has become a medical tool 'as important as the stethoscope,' says Michael Zaroukian, MD, PhD, an associate professor in the Department of Medicine at Michigan State University...'I can't imagine practicing medicine without it,' says Michael Durfee, MD, a pediatrician in Raleigh, NC, and chairman of his state's Governor's Council on Alcoholism and Substance Abuse. On-line data bases cover topics including AIDS, cancer, nursing, bioethics, pharmaceuticals, and toxicology, among many other topics. Many are abstracts of journal articles, but full text data bases are increasingly available."
How the Family and Medical Leave Act May Affect You (25) and other Business and Taxes matters.
How to Market Your Medical Practice to Women (25)
"Until a few years ago, virtually all health care--including research and development--was directed toward men. But the reality is that in many instances men's health has no significance to women's health problems. Research has consistently shown that women are responsible for 80% of health care decisions in the United States. Women select the provider for their families, usually making doctor appointments not only for themselves, but for their families as well...They're often better informed about their health needs and the needs of their families. And, finally, women are more likely than men to follow directions." ----Neil Baum, MD, urologist, author, "Marketing Your Clinical Practice."
Psychiatrist, AMA Journal Editor Dies (31)
Dr. Daniel Freeman, "the premier academic and research psychiatrist of his time," and the veteran editor of the Archives of General Psychiatry, died June 2 at the age of 71. Dr. Freeman was a pioneer in the use of drugs to treat mental illness.
[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).
