AMERICAN MEDICAL NEWS (7/19/93)
ABLEnews MedNotes
AMERICAN MEDICAL NEWS (7/19/93)
Los Angeles Health Care Crash Looming (1)
"Drastic budget cuts passed in early July by the state of California threaten to bring the health care system in Los Angeles County crashing down. The looming crisis, exacerbated by federal funding shortages, spotlights the need to address care for illegal aliens now and under health reform."
Court Takes Middle Ground in Expert Witness Debate (1)
"The US Supreme Court's decision in a landmark 'expert witness' case did not contain...clear, specific guidelines for addressing such testimony. But... Daubert et al v. Merrell Dow Pharmaceuticals Inc. struck a blow against 'junk science' in the courtroom."
Data Bank Seeks Doctors' Accounts (1)
"Physicians may soon get to give their account of any report filed with the National Practitioner Data Bank. Data bank officials say the proposed change reflects their willingness to be responsive to practitioners' concerns. Coincidentally, however, the policy shift comes at a time when new efforts to open the bank to the public have made those concerns more serious than ever."
Merging for Managed Care (2)
When Blue Shield of California merges with the hospital-based UniHealth of America the corporate health giant will serve 4.5 million Californians, rivaling mega-HMO Kaiser Permanente's 4.7 million enrollees in the state. The new company's revenues will top $6.5 billion, and its assets will stand at over $2 billion.
Dr. Lee Confirmed (2)
The Senate confirms Philip Lee, MD to oversee the Public Health Service, the Food and Drug Administration, and the National Institutes of Health, as assistant secretary for health in the Department of Health and Human Services.
Suits in Burt Case Can Proceed (2)
Ohio Supreme Court clears way for lawsuits against James Burt, MD, charged with performing vaginal reconstructions on patients without their consent.
Liability Award Cap to Be Tested (2)
$ 3 million malpractice cap challenged in Kansas court.
Growth Hormone Suit (2)
The Foundation on Economic Trends and the Physicians Committee for Responsible Medicine sue the National Institutes of Health "to stop using short but healthy children in a study of synthetic growth hormone therapy."
Thais Making Gains Against AIDS (2)
according to a World Bank health report, which also notes nearly 2 million Third World children die each year from diseases easily prevented by inexpensive vaccines.
A Promise to Listen and Learn (interview) (3)
"You can envisage a health care system without HCFA (the Health Care Financing Administration) or the federal government. You just can't envision a health care system without doctors and nurses." --Bruce Vladeck, administrator, Health Care Finance Administration (HCFA).
Physicians, Insurers Fear Flood of Implant Liability Suits (3)
"The burgeoning number of negligence suits related to silicone breast implants has yet to result in a malpractice award against a plastic surgeon. But some professional liability insurers are running scared, restricting coverage for physicians who implant the devices and considering other steps to limit their liability." "These case generate feeding frenzies. A $25 million award brings out women who had not previously had any health problems and who had never before considered suing their surgeon or the implant maker." --John Fitzpatrick, malpractice defense attorney, before the Physicians Insurers Association of America.
Congress Threatens Long-term Care Plan (3)
While half the states have taken steps to implement a public-private partnership to fund long-term care, the House has passed a budget bill that restricts the program to just six states approved to test the concept under which people who purchase private long-term-care insurance are allowed to retain significant assets yet qualify for Medicaid when their private benefits expire. All others must "spend down" to some $1600 in assets to be eligible for Medicaid coverage.
Support Weak for 'Weighting' to Boost Primary Care (4)
Medicare provides over $5 billion in graduate medical education subsidies. Shifting these subsidies to promote primary care residency programs (aka weighting) is gaining momentum in Congress. Still even partisans of the concept concede it is sinking.
HMOs Eye Easing Doctor Entry into Primary Care (5)
Health maintenance organizations (HMOs) blame medical schools for not turning out enough family practice physicians, pediatricians, ob-gyns, and general internists. They criticize the federal government for wasting education dollars on training subspecialists. Medical schools, however, protest that marketplace forces determine career choices and ant that the primary care shortage arises from managed care companies' failure to compensate physicians in a way conducive to making primary care a preferred career option.
Drug Research Contract Spurs Government Review (5)
Controverted argument between Sandoz Pharmaceutical Corporation and the Scripps Howard Research Institute inspires the National Institutes for Health (NIH)to reexamine contract guidelines.
States Promised Freedom to Craft own Reform Plans (6)
and Health Reform Updates from North Carolina, Kansas, Tennessee, Maine, and Kentucky.
How to Practice under a Global Budget (7)
"With a 1,000 ER [emergency room] visits a day, you have to become more efficient. To that end, they've started moving emergency patients, who averaged nine hours wait for treatment, through the system more rapidly. We've instituted a triage process where nurse practitioners spend time on the intake process to make sure the queue gets bumped by those in need." Jonathan Wisbach, MD, medical director, LA County Department of Health Services. AMA policy opposes global budgeting, expenditure targets, and price controls as arbitrary devices that promote rationing and paperwork. CURE Comment: We oppose bureaucratic dictates that arbitrarily restrict patients' access to health care regardless of need.
HMO Industry Stabilized, Diversified; Enrollment Up (7)
In 1992 enrollment in the 546 US health maintenance organizations (HMOs) exceeded 40 million for the first time, but the mix of types has remained relatively constant over the past few years. The top five HMO markets by percentage of population enrolled are: Rochester, NY (54%), Worcester, MA (51%), San Francisco-Bay Area, CA (49%), Minneapolis-St. Paul, MN (46%), and Albuquerque, NM (40%). The largest HMO corporation is Kaiser Foundation Health Plans with more than six and a half million enrollees, or 16% of the US total.
Smoking Gun (9)
Second-hand smoke contributes to 3,000 deaths from lung cancer a year in the United States, 36,000 from heart disease, 300,000 cases of infant respiratory infection, and 26,000 new cases and a million exacerbated cases of asthma in children.
Humor Magazine Eases AIDS Pain (12)
"Michael Botkin's humor magazine for people with AIDS encourages readers to develop a 'petulant bad attitude.' 'It's my party and I'll die if I want to,' said Botkin, editor of Diseased Pariah News...Staying true to character, the magazine [which calls itself a 'cranky, irreverent, insightful forum of, by, and for people with HIV'] doesn't print stories on AIDS research or possible cures."
Smoking Increase Blots a Decade of Health Gains (14)
and other Public Health Updates.
When Screening Is the Wrong Thing to Do (editorial) (15)
"You and your patients call it illness. Insurers think of it another way: risk. The more people a health insurer covers who become sick, the more the insurer has to pay out. So from its perspective, the more the risk is controlled the better. That's why requiring testing to screen out those who might have a genetic predisposition to certain conditions, such as heart disease or cancer, has a natural appeal to insurers."
Gatekeepers Provide Quality, Cost Containment (letter-editor) (15)
"It's important to take issue with Dr. Joseph D. Wasserug's comments agains the deification of the gatekeeper (My Opinion, May 24/31). Is he aware that in countries with health plans more cost effective than our own, it's readily apparent that the generalist/specialist ratio is 8:1, opposite of that in this country?" --MArc Schneiderman, MD, immediate past president, Pennsylvania Academy of Family Physicians, Harrisburg, PA. CURE Comment: We suspect it's even higher in Cuba and the former Soviet Union and its other erstwhile satellites, but the quality of medical care is also far lower.
Views 'Predictable' and Inaccurate' (letter-editor) (15)
"As a sub-specialist, Dr. Wasserug's negative views of family physicians as gatekeepers are predictable and inaccurate." --Peter Rives, MD, Phillipsburg, NJ. CURE Comment: By his own standards, Dr. Rives' views as a family physician are no less "predictable." The real test, of course, is not whether one's opinions are predictable, but whether they are right. CURE's opposition to the gatekeeper does not derive so much from the fact it is performed by family physicians, as that it is performed at all to restrict patients access to medical care recommended by their physicians, specialists or otherwise.
Some Refusing to Pay Cost Shift (letter-editor) (15)
"One of the major contributors of the increase in private health care costs in previous years has been 'cost shifting' to private payers to make up for spectacular Medicaid shortfalls. Recently, however, through a variety of contractual care arrangements, private payers have begun to refuse to pay the cost shift... This has forced Medicaid to increase the rates to somewhere near actual medical costs for large Medicaid providers. While this has resulted in a huge increase in Medicaid spending..., it has not changed the level of net health care spending in the country." --Mike Koetting, PhD, vice president, University of Chicago Hospitals, Chicago, IL.
Homosexuality a Behavior to Be Opposed (letter-editor) (16)
"I believe we should love and accept all people for who they are, but this does not mean indifference toward their behavior... Behavior has personal and social consequences. How can the AMA accept and endorse behavior that spreads sexually transmitted diseases such as hepatitis and AIDS? Is it not the AMA's purpose to promote health?" --Michael Biavati, MD, Iowa City, IA.
'Sharing' Criteria Actually Means Selling It (letter-editor) (16)
"Recently, AMNews featured a letter from Charles M. Jacobs, chairman/CEO of InterQual (March 8) under the headline 'UR utilization review] firm favors sharing criteria'... A call to erQual's phone order line was met with polite laughter when I uired how a physician might go about 'sharing' an InterQual criteria set. One quickly learns that in the lexicon of InterQual 'sharing,' 'knowing,' and 'available' all mean the same thing: selling." --Stephen Lamb, director of state health policy, American Managed Care and Review Association, Washington, DC. AMNews Editor's Note: "InterQual does sell its data, but does so now under a newly established licensing arrangement. Chairman/CEO Charles M. Jacobs says that physicians are not barred from getting the criteria free from licensees--such as hospitals and managed care and review organizations--that the doctors work with."
AMA Self-Referral Policy is Wrong (letter-editor) (16)
"The AMA policy on self-referral is poorly thought out, unfair, and not in the spirit of keeping costs down. A ban on self-referral by private practitioners, without similarly banning the practice in health maintenance organizations, is completely ludicrous. The ban will make it even more difficult for primary care doctors to compete with the K-mart-type HMOs next door." --Anton Dahlman, MD, Long Beach, CA.
Flawed Reform (letter-editor) (17)
"Any tort reform that allows physicians to hide behind the accountability of the enterprise at which they practice is flawed... because it essentially encourages and stimulates doctors to be employees rather than health professionals. This further erodes the concept of the physician/patient relationship and further stimulates the physician to give his primary allegiance to his employer or to his managed health care system or to his managers. This is not only a real but an ethical violation of the oath that we have taken to cause no harm to our patients." --Gerhard Mundinger, Jr., MD, Jackson, MS. CURE Comment: Here, here, doctor! Well said.
Support Ecological Packaging of Drug Samples (letter-editor) (17)
"Medicine is certainly in good hands with students like John J. Whyte and Roya E. Dardashti, with their very sensible plan for reducing packaging for drug samples (My Opinion June 7)." --Sheldon Cohen, MD, Atlanta, GA.
Packaging Criticism 'Out of Focus' (letter-editor) (17)
"The samples are designed to catch the attention of the physicians dispensing them...When in medical practice, if these two students do not want in their offices these bulky samples full of garbage for he planet, all they have to do is tell the representative not to rop them off. However, they will be wasting thousands of health care dollars by depriving themselves of starter packages to initiate patient therapy." --Wanda Velez-Ruiz, MD, Detroit, MI.
Patients Need a Physician's Soothing Touch (op ed) (18)
"Do you remember the image of the physician sitting at bedside with his hand on the patient? In the past, this was the classical picture that patients had of their doctor... Today, touching patients, except for the purpose of examining them, is a rare occurrence. More and ore, due to fear of contracting a contagious disease--either from he patient to the doctor or from the doctor to the patient-- physicians wear gloves when they examine and touch their patients. New sophisticated diagnostic tests enable us to determine our patients' problems and to monitor their progress without touching them or, occasionally, without even seeing them. Sometimes physicians are afraid to touch their patients for fear of what the patient or others might think, or say, about their behavior... To abandon the physician's touch because of advanced technology, the fear of contracting a communicable disease or what others might say, is giving up one of the most valuable tools our profession has. How else could one demonstrate kindness and compassion in such a simple and meaningful way?" --Robert M. Tenery, Jr., MD, president, Texas Medical Association.
Primary Care Power (19)
"After years of watching their highly-paid subspecialist colleagues tooling around in Cadillacs and Mercedes, primary care physicians are being handed the keys...And it appears the trip to economic improvement will be pleasurable for primary care physicians if they follow the right itinerary...The key to managed care centers on using primary care physicians to treat the majority of patients and have them to serve as 'gatekeepers,' referring patients to subspecialists only when medically necessary." CURE Comment: Or rather, to be more exact, when their employers deem it "necessary."
You Can't Win by Doing Employees' Work for Them (21)
"I'm constantly evaluating events on a professional basis--even when I'm on vacation. This summer's excursion was no exception. While I was travelling out West my wife and I happened on to an outlet of a popular fast food restaurant (PFFR) in Moab, Utah. The place had as much case material for a management professor as it did chopped cow." -- Robert Solomon, PhD, author, Clinical Practice Management.
S Corporation Health Insurance May Be Tax-Exempt (22)
Doctor's Business Calendar.
[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).
