Practice Beat

Doctor's Unions: Osteopathic physicians won't follow the AMA's lead

The American Osteopathic Association House of Delegates has decided thatunionization isn't a viable solution to the problems physicians face withmanaged care. Instead, the AOA will support legislative efforts to enactan antitrust exemption that would enable self-employed physicians to bargaincollectively with managed care plans.

"We recognize that it has become increasingly difficult for physiciansto negotiate contracts that give them the clinical autonomy to make treatmentdecisions on behalf of their patients," says AOA Executive DirectorJohn B. Crosby. "However, we believe that physicians and managed careorganizations can work together to create an open and constructive dialogueto benefit patients as well as improve the practice environment for osteopathicphysicians."

Private Contracting: A court upholds the two-year bar from Medicare

Physicians who contract privately with Medicare beneficiaries to provideservices that are ordinarily reimbursable under the program can be barredfrom Medicare participation for two years, a federal appellate court hasaffirmed.

The United Seniors Association had sued HHS, claiming that section 4507of the Balanced Budget Act of 1997 is unconstitutional. The group claimedthat the provision makes it virtually impossible for beneficiaries to contractfor medical services outside the Medicare system.

But HHS argued that plaintiffs had simply misunderstood the provision.Its purpose, HHS explained, is to prevent doctors from coercing elderlypatients into paying more for Medicare-covered services than governmentfee schedules would pay. It doesn't impose restrictions on agreements toprovide services beyond those that Medicare covers. So if a doctor and patientagree to a service that wouldn't be reimbursed by Medicare--for any reason--thedoctor wouldn't be subject to the two-year exclusion.

Earlier, a federal district court had upheld the constitutionality ofthe statute and granted summary judgment for the government. The appellatecourt concurred with that decision.

Drug Orders: What primary care physicians are prescribing most

Calcium channel blockers, ACE inhibitors, beta-blockers, antiulcer drugs,and oral antidiabetics comprised the top five therapeutic classes prescribedby primary care physicians last year, according to Scott-Levin, a pharmaceuticalconsulting firm. The average physician wrote 1,900 prescriptions. Primarycare doctors accounted for more than 53 percent of total scripts. Roundingout the top five prescribers: ob/gyns (6.1 percent), pediatricians (5.3percent), cardiologists (3.9 percent), and psychiatrists (3.8 percent).

Fraud and Abuse: Uncle Sam insists his heart is in the right place

The Health Care Financing Administration will expand a program to helpphysicians make sense of Medicare

benefits, coverage, and billing procedures. The $1.3 million campaign,part of the government's antifraud effort, is intended to sharpen doctors'understanding of such topics as Medicare claims filing, coding, and homecare services.

The program includes seminars and interactive computer courses (accessiblethrough the Internet) for physicians and other providers, as well as hands-ontraining for medical residents. During its test phase last year, nearly50,000 physicians and other health care professionals participated.

"Physicians want what we want--for them to get paid fairly for thequality services that they provide," explains HCFA Administrator Nancy-AnnDeParle. "We already have hard evidence that physicians can help usdo our job better. There's still a long way to go, but our success so faris in no small measure due to physicians' doing a better job of documentingcare and filing claims right."

To learn more about HCFA's training program, visit the Learning Resourcessection of the agency's Web site: www.hcfa.gov/learning/default.htm

Alternative Medicine: Five natural remedies draw government scrutiny

A panel representing federal health agencies has recommended four herbalproducts and a substance found in cruciferous vegetables for toxicity testingunder the National Toxicology Program (NTP) at the National Institute ofEnvironmental Health Sciences.

Singled out were aloe vera (used as a dietary supplement and in cosmetics),ginseng (promoted as an energy booster), kava kava (said to be a mood elevator),and milk thistle (considered by some to have anti-cancer and liver-protectiveproperties). Along with the herbs, the National Cancer Institute nominatedindole-3-carbinol, which is thought to have the potential for reducing therisk of cancer.

All five relatively untested substances were initially nominated by theNCI because of their widespread or increasing popularity.

Editorially Speaking

(From the op-ed pages of The Boston Globe, July 25, 1999)

"Why should we be nervous about [prescription benefit managers']role [in treatment decisions]? . . . [Because] patients and their doctors,the people most invested in these decisions, are excluded from the process.At best, considerations of quality or convenience are secondary. . . . Doctorsmust try to satisfy mutually contradictory formularies rather than engagen the care of patients. . . . We need a system in which doctors and patients,not PBMs, make the choices. HMOs should allow doctors and health care systemsto choose drugs based upon quality and cost, without outside formulary restrictions."--KenKukamal and Tom Delbanco

Did you know that . . .

. . . 39 million elderly and disabled people (13.8 percent of the USpopulation) are covered by Medicare today.

. . . By 2025, the number of Medicare-eligible beneficiaries is expectedto reach 69 million, or 20.6 percent of the population.

. . . Medicare spending for the noninstitutionalized elderly will reach$4,855 per person by 2025--nearly double the $2,508 spent in 1998.

. . . Beneficiaries' share of Medicare-related expenses will probablyincrease from 21.4 percent in 1998 to 25.8 percent in 2025.

. . . On average, 29 percent of beneficiaries' incomes will go towardhealth care in 2025.

Source: The Commonwealth Fund, "Growth in Medicare Spending: WhatWill Beneficiaries Pay?" by Marilyn Moon, The Urban Institute, May1999

LOOKING AHEAD: October

A handy reference of telephone numbers, as well as e-mail and Web siteaddresses for some sponsoring organizations.

1-31 Breast Cancer Awareness Month(Mammography Day Oct. 15)Zeneca Health Care Foundation

Web site: www.nbcam.org

1-31 Child Health Month American Academy of Pediatrics

CHM Project Manager

Phone: 800-433-9016, ext. 7134

E-mail: chm@aap.org

Web site: www.aap.org/advocacy/chm99fact.htm

1-31 Domestic Violence Awareness Month National Coalition AgainstDomestic Violence

Phone: 303-839-1852

Fax: 303-831-9251

Web site: www.ncadv.org

1-31 SIDS Awareness Month Sudden Infant Death Syndrome Alliance

Phone: 410-653-8226

Fax: 410-653-8709

E-mail: sidshq@charm.net

Web site: www.sidsalliance.org

10-16 Adult Immunization Awareness Month National Coalition for AdultImmunization

Phone: 301-656-0003

E-mail: adultimm@aol.com

Web site: www.nfid.org/ncai

7 Depression Screening DNational Mental Illness Screening ProjectPhone: 781-239-0071

Fax: 781-431-7447

E-mail: jreizes@nmisp.org

Web site: www.nmisp.org

Quick Takes

Third-party name game.Oregon Medical Association President RichardG. Kinkade sent a letter to hospitals and insurers in the state asking thatthey stop referring to physicians as "providers." So far, at leasttwo insurers--Regence BlueCross BlueShield and LifeWise--have acceded tothe request.

Nonphysician prescribing. Last spring, the US Department of VeteransAffairs published--and then withdrew--a proposal suggesting that nonphysiciansbe granted prescribing privileges. The retreat came after the AMA and otherprofessional organizations objected to the proposal's lack of specificityand detail. The VA, agreeing that the proposal was open to misinterpretation,will rewrite it to clarify which professionals will be allowed to prescribeand under what circumstances.

Medicare and Y2K. If HCFA's Y2K readiness efforts continue ontrack, Medicare payment updates for doctors will be made on or close toschedule--in October and mid-January. HCFA had predicted earlier that Y2Kpriorities might delay the updates.

National Practitioner Data Bank. Since the launch of the NPDBin 1990, physicians have been allowed to review information about themselvesfree of charge. Now there's a $10 fee for each self-query.

Organ transplants. Preliminary data from the Department of Healthand Human Services and the United Network for Organ Sharing show that theoverall number of donors whose organs were authorized for use after deathwas nearly 6 percent higher in 1998 than in 1997--the first substantialgain since 1995. Donors aged 60 and above accounted for the largest increase,followed closely by those 40 to 59.

Managed Care: John Q. Public is unhappier--and more worried

While state and federal policymakers debate patients' health care rights,their constituents know what they'd do in the lawmakers' place. And althoughpatients give consistently high ratings to their own health plans, theycontinue to hold a generally negative view of managed care overall.

Respondents express strong support for many of the patient protectionmeasures under legislative consideration. In most cases, patients stillfavor legislation "even if insurance premiums go up." That's nosurprise, since they're more worried now about health plans' emphasis onthe bottom line. Nearly three-fifths of patients polled in April fear theywon't get needed care. In September '97, fewer than half felt that way.

By Joan R. Rose, Senior Editor

Joan Rose. Practice Beat.

Medical Economics

1999;17:32.