Practice Beat

Practice Beat

By Joan R. Rose, Senior Editor

Reimbursement
Doctors win a round in their fight to make HMOs pay

If Maryland's insurance commissioner prevails, physicians will be able to recover money owed them when an HMO's intermediary goes under—even if the HMO has already paid the intermediary for those claims.

Commissioner Steven B. Larsen has ordered UnitedHealthcare of the Mid-Atlantic, a Baltimore-based HMO, to pay the outstanding claims of three physician practice management companies that have declared bankruptcy or otherwise ceased operation. As a result, United suddenly owes millions of dollars in unpaid claims to physicians and other providers. The defunct PPMs are Doctors Health, Maryland Personal Physicians, and Dimension Health Network.

Though Larsen has no regulatory authority over PPMs, his department does regulate HMOs. And Maryland law requires HMOs to monitor the solvency of subcontractors and intervene before their financial condition becomes critical. If United fails to comply with the order, a penalty of $1,000 a day will be assessed until all claims are paid. The health plan may be subject to other penalties and sanctions as well, including suspension or revocation of its insurance license.

United has appealed the commissioner's order, contending that its responsibility ends when the money held in reserve is exhausted—even if that's less than the total owed. Hearings were scheduled to begin last week.

Meanwhile, the California Medical Association is suing eight health plans, claiming that they're illegally trying to use the failure of subcontractors in that state as an excuse to avoid paying more than $100 million owed to doctors.

Malpractice Survey
Patients want tighter reins on plaintiffs and lawyers

Though 42 percent of patients believe that the number of malpractice suits filed against physicians is higher than justified, according to a recent nationwide poll, just as many believe the number is about right or even lower than it should be.

Nevertheless, the majority of the 1,029 poll respondents agree that malpractice suits increase health costs and that tort reform should be part of any patients' bill of rights. Seven in 10 patients support capping noneconomic awards, and eight in 10 would limit fees received by plaintiffs' attorneys.

The poll was conducted by Wirthlin Worldwide for the Health Care Liability Alliance, a national coalition that supports federal tort reform. The group is composed primarily of medical organizations and malpractice insurers.

"Questionable" Doctors?
A consumer group rips four health plans' physician panels

A Chicago-based public interest group has released a report suggesting that many HMO physicians are "questionable" doctors.

The report, issued by the Coalition for Consumer Rights, charges that four of Illinois' 10 largest HMOs—Aetna US Healthcare, Humana, Rush Prudential Health Plans of Illinois (now part of WellPoint Health Networks), and United Healthcare—have "hundreds of primary care physicians who have made malpractice payouts or been disciplined by the state Department of Professional Regulation."

Although the coalition's executive director, Nancy Cowles, maintains that a malpractice strike against a physician doesn't necessarily make him a "bad" doctor, the report implies that all doctors who have settled malpractice suits are among the "least desirable providers." Moreover, the group claims that its findings have "particular urgency" in light of the Institute of Medicine's recent report on medical errors.

The coalition is lobbying for passage of a "right to know" bill that would allow patients to review a physician's profile—including information about license status, malpractice payments, disciplinary actions, hospital reprimands, and criminal convictions.

Complementary Medicine
Who else is treating your patients?

Although an increasing number of patients use alternative therapies in conjunction with conventional medicine, they frequently don't tell their doctors. Now a study of women with breast cancer suggests that physicians' attitudes may be the stumbling block.

Nearly 70 percent of the women in the study had used alternative therapies, most commonly traditional Chinese medicine (such as acupuncture or herbs), mind/body healing methods (including prayer and meditation), and nutritional supplements. The women acknowledged that they don't discuss the subject with their physicians, largely because the doctors appear uninterested, ambivalent, biased, or hostile toward alternative medicine. Some patients thought the information wasn't relevant to their medical treatment or that it was none of the doctor's business.

Researchers at the University of California at San Francisco are conducting the study, which is about midway through its five-year course.

LOOKING AHEAD

A handy reference of telephone and fax numbers, as well as e-mail and Web site addresses for sponsoring organizations.

Mark your May calendar

Allergy and Asthma Awareness Month
Allergy and Asthma Network/
Mothers of Asthmatics
2751 Prosperity Ave., Suite 150
Fairfax, VA 22031
Phone: 703-641-9595
Fax: 703-573-7794
E-mail:aanma@aol.com
Web site:www.aanma.org

National High Blood Pressure Education Month
The National Heart, Lung, and Blood Institute Information Center
PO Box 30105
Bethesda, MD 20824-0105
Phone: 301-592-8573
Web site:www.nhlbi.nih.gov/health/prof/
heart/hbp/month/hbp_mo2.htm

American Stroke Association
(a division of the American Heart Association)
7272 Greenville Ave.
Dallas, TX 75231
Phone: 888-4STROKE
Fax: 214-706-5231
E-mail:strokeassociation@heart.org
Web site:www.strokeassociation.org

Breathe Easy Month
American Lung Association
Phone: 800-LUNGUSA
(routes call to local chapter)

National Melanoma/Skin CancerDetection and Prevention Month
American Academy of Dermatology
930 N. Meacham Road
Schaumburg, IL 60173-4965
Phone: 847-240-1737 (Janine Mueller)
E-mail:jmueller@aad.org
Web site:www.aad.org

6 National Nurses Day6-12 National Nurses Week
American Nurses Association
600 Maryland Ave. SW, Suite 100 West
Washington, DC 20024
Phone: 800-274-4ANA
Fax: 800-349-9909 (Document No. 5612)
Web site:www.nursingworld.org/pressrel/nnw.htm

National Arthritis Month
Arthritis Foundation
1330 West Peachtree St.
Atlanta, GA 30309
Phone: 404-872-7100
or contact local chapter
E-mail: info@arthritis.org
Web site:www.arthritis.org

Stroke Awareness Month
National Stroke Association
9707 E. Easter Lane
Englewood, CO 80112-3747
Phone: 800-STROKES
Fax: 303-649-1328
E-mail:info@stroke.org
Web site:www.stroke.org

14-20 Alcohol- and Other Drug-Related Birth Defects Awareness Week
National Council on Alcoholism and
Drug Dependence
12 West 21st St.
New York, NY 10010
Phone: 212-206­6770
E-mail:national@ncadd.orgWeb site:www.ncadd.org

Staff Raises
The purse strings won't be any looser this year

Physicians' office staffers shouldn't expect bigger raises in 2000 than they received in 1999, according to a nationwide survey by The Health Care Group, a consulting firm in Plymouth Meeting, PA. In fact, salary increases this year will shrink a bit: They'll range from 2.64 to 5.07 percent vs the 1999 range of 2.79 to 5.11 percent.

But doctors who want to keep experienced workers may have to be more generous, warns the firm's vice president, Dorothy R. Sweeney. "A productive and motivated staff is a practice's best investment," she notes. And given the tight job market, Sweeney says, employees in difficult frontline jobs may easily be lured away by the promise of a higher salary and the perception of a better position.

More than 1,100 practices in a variety of specialties participated in the survey.

 

Joan Rose. Practice Beat. Medical Economics 2000;7:33.