Practice Beat

By Joan R. Rose

Drug Plans for Seniors: Yankee ingenuity may still do the trick

Last October, Vermont—with HHS' blessing—was poised to become the first state in the nation to offer a pharmaceutical prescription program to Medicare beneficiaries and others who lack drug coverage. Now a US appellate court has banned the program, finding that the Feds exceeded their authority in granting the program a waiver. But backers of the plan still have hope.

Vermont has joined with Maine and New Hampshire to form the nation's first multistate prescription drug purchasing pool. Managed by a Virginia-based pharmaceutical benefit management company, the cooperative is expected to be up and running by Nov. 1. The states believe they can cut their own prescription drug outlays by an estimated 10 to 15 percent annually.

Initially, just the 330,000 Medicaid recipients in the three states will be covered, but after the first year, the pool will be opened to employees of small businesses and other entities, such as local governments. In the future, the states hope to use the pool to make prescription drug coverage more affordable for their uninsured residents, as well.

Medicare: Uncle Sam will beef up his senior snoop patrol

HHS is spending $9.3 million this year to recruit and train retired professionals to identify waste, fraud, and abuse in the Medicare program. The four-year-old Senior Medicare Patrol Project teaches retired doctors, nurses, attorneys, accountants, investigators, and other professionals how to work with Medicare and Medicaid beneficiaries. Volunteers work in senior citizen centers in their own communities teaching seniors how to spot problems—such as overbilling, overcharging, and unnecessary or inappropriate services—in EOB statements.

Our Web Poll

We asked visitors to our Web site (www.memag.com ): "Some doctors hire firms that send 'mystery shoppers' into their offices. These pseudo-patients rate the practice in a wide range of areas. Would you make a bold practice decision—firing a rude employee, say—based on these shoppers' observations?"

47%   YES That's the whole purpose of the whole exercise
53%   NO Impressions of a few individuals are of no use

Bureaucracy: Farewell HCFA, hello CMS

The agency formerly known as HCFA has been renamed the Centers for Medicare & Medicaid Services (CMS). The name change is meant to symbolize the Bush administration's goal of greater efficiency and responsiveness to doctors and patients.

In addition, the agency will be restructured around three centers— the Center for Medicare Management, the Center for Beneficiary Choices, and the Center for Medicaid and State Operations—to focus more clearly on its three primary lines of service.

Managed Care: Insurer consortium moves to create a single online portal

MedUnite, a consortium of seven of the nation's largest health insurers, recently purchased NDCHealth's physician network services business.

The consortium plans to combine NDCHealth's electronic claims submission capability with MedUnite's other Internet-based services to enable physicians to perform "real time" eligibility, benefit, and formulary checks and to obtain referral authorizations from every insurer.

NDCHealth connects providers with 300 payers—from the Blues to the Mediplans—and the company also owns rights to the Lytec, MediSoft, and Concept practice management systems.

While only about 10 to 15 percent of the more than 100,000 physicians who use those software programs are currently submitting claims through NDCHealth, the consortium wants every physician user to adopt its full program. That will give

MedUnite a leg up in its competition with WebMD, which also offers online transactions with payers.

The insurers who founded MedUnite are Aetna US Healthcare, Anthem, Cigna, Health Net, Oxford Health Plans, PacifiCare Health Systems, and WellPoint Health Networks.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2001;14:15.