AMERICAN MEDICAL NEWS (7/26/93)
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).
