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News summaries for Jan. 18, 1999
Top Stories
New speaker knows health care
Health groups are praising the new House Speaker Rep. J. Dennis Hastert (R, Ill.) for his consensus-building skills, but doubts remain about how that will translate into patient protection legislation this year. Hastert, elected to Congress in 1986, is no stranger to health care. He chaired the GOP task force that developed the Republicans' version of managed care patient protection legislation, served on Hillary Rodham Clinton's health reform task force in 1993, and has worked on health issues in the House Commerce Committee. However, some groups predict that Hastert will have little control over the fate of patient protection legislation, as the prognosis is uncertain for bipartisan cooperation in a postimpeachment House. ... Go to full text.
Government & Medicine |AMA wants insurers to pay Sunbeam settlement
AMA leaders are suing two insurers, contending the policies they wrote compelled them to defend the AMA in its lawsuit with the Sunbeam Corp. According to AMA leaders, both the AMA insurance policies themselves and Illinois law obligate the insurance companies to pick up the $10 million settlement tab plus legal fees. Until now, the North Carolina-based insurers, American and Foreign Insurance Co. and its sister corporation, Royal Insurance Co., have refused to pay, arguing that the AMA is not covered for the breach of contract Sunbeam officials alleged in their September 1997 lawsuit. But AMA officials said the policy requires the companies to defend the organization from the defamation charges Sunbeam brought as part of the same lawsuit. Under Illinois law, AMA officials say, if an insurer has a duty to defend against part of a claim, it's responsible for defending the entire claim. The insurers have refused settlement talks with AMA and requests for comment.
Professional Issues |Oregon task force calls for better pain care
Even in Oregon, a leader in improving end-of-life care, a task force finds more needs to be done to treat patients with chronic, intractable pain. The 30-member Task Force on Pain and Symptom Management, created by the Oregon Legislature in 1997, has recommended the creation of an office to improve pain management and serve as a resource to doctors who treat patients with both terminal and chronic pain. It also advised hiring an ombudsman to coordinate chronic pain initiatives in the state and to serve as an advocate for both patients and the health professionals who treat them. The panel is made up of physicians, alternative medicine providers, nurses, home health care workers, social workers, pharmacists, consumers, people with chronic pain, insurers, legislators and experts in education, law and medicine. Although the task force has no power to legislate, it hopes its recommendations will be embraced by the state Legislature and enacted into law.
Specialists' suit hits UCLA network plan
In a lawsuit that illustrates the dilemma teaching hospitals face competing for patients in a heavily saturated managed care market, a group of Santa Monica anesthesiologists and the California Medical Assn. are suing to stop UCLA Medical Center from hiring primary care physicians to staff a network of clinics in the Los Angeles area. Among several allegations in the lawsuit, the CMA and the 14-member Santa Monica Anesthesia Medical Group contend that UCLA has violated the state's "corporate practice of medicine" law, which forbids ownership of physician practices by corporations. The lawsuit also charges UCLA with improper referral inducements, unfair competition, false advertising and conspiracy to restrain trade. It seeks more than $20 million in damages. An attorney representing UCLA contends the university is exempt from the state law because it is a public entity. He also disputes the lawsuit's other allegations.
Medical Markets |Regence amends contracts to meet doctors' concerns
Washington state's largest health insurer, Regence BlueShield, has completely rewritten its new provider contract, following a challenge by the Washington State Medical Assn. and the state insurance commissioner. The revised contract, which will be sent to physicians this month, clarifies that doctors are responsible for making medical decisions. It also softens provisions for on-site audits of doctors' offices, streamlines physicians' appeals of company policy and removes an "exit gag clause," which barred physicians who drop Regence contracts from explaining their actions to patients. While medical association officials applauded the new document approved last month, both the commissioner and the doctors' group have some misgivings about the contract. The commissioner vows to write new regulations to deal with those concerns in the next few months. Defending the contract, a spokesman for Regence said the company wanted to establish a "business relationship" with physicians and had no intention of interfering in the doctor-patient relationship.
Business & Technology |Customized network boosts flexibility
Physician Linkage, a new service Bell Atlantic launched last month, aims at creating a virtual medical practice by changing the way hospitals, health systems and doctors communicate and do business. The new service lets doctors admit patients, prescribe medicine, access the Internet, update clinical information and medical records, instantly access hospital records and laboratory test results, and participate in video-based medical applications via computer. The computers, linked by local area networks, enable doctors to get access from any computer on- or off-site via the Internet or a direct dial-up connection. In addition, the system provides end-to-end communications, including data storage and retrieval, that can be customized for each customer. Currently at use at a number of hospital systems, Physician Linkage is getting rave reviews.
Health & Science |Ethical questions in father-daughter transplant
A medical ethics committee at the University of California, San Francisco, Medical Center is considering the unusual request by 37-year-old prisoner David Patterson, who in December 1998 offered to donate a second kidney to his 16-year-old daughter. He first donated a kidney in 1996, but the girl's body started showing signs of rejection the year after she stopped taking immunosuppressive drugs. The case has sparked a national debate about whether an individual should be allowed to sacrifice his health -- and possibly his life --through organ donation. The removal of a sole healthy kidney from a living donor would be unprecedented. The ethics committee could issue an opinion on the case as early as late January, according to a spokesperson for the UCSF Medical Center. Other factors weighing in the decision are the father's prisoner status, the teen's physical ability to accept her father's organ, and the wait time for a cadaveric kidney. Pending a decision on whether to remove her father's last kidney, the teen has again been placed on a transplant waiting list.
News Briefs
Jury examines role of anti-abortion Web site
Portland, Ore. -- Do posters and Web sites that identify abortion providers and claim they are "guilty of crimes against humanity" incite violence? A U.S. District Court jury was scheduled to begin hearing a case here this month that seeks to answer this.
The case pits several Oregon physicians and abortion providers against militant anti-abortion groups and activists. The providers maintain that the federal "Freedom of Access to Clinic Entrances Act" protects them from what they refer to as a "campaign of terror and intimidation." The 1994 law prohibits "force or threat of force" to intentionally injure, intimidate or interfere with anyone seeking or providing reproductive health services.
The anti-abortion activists contend that their activity is protected free speech.
AMA faces antitrust challenge to CPT
San Jose, Calif. -- A company that produces coding software for physicians has accused the AMA of violating antitrust laws by demanding royalties for using Current Procedural Technology codes.
The suit, filed in the Northern District of California last month by subsidiaries of QuadraMed, seeks repayment of $500,000 the firm paid to use CPT in software. It also seeks an injunction preventing the AMA from demanding licenses from others who use CPT in their products.
QuadraMed contends the AMA has an illegal monopoly because it controls 100% of the market for doctors' outpatient procedure codes.
The AMA sued QuadraMed in Illinois for copyright infringement two months before QuadraMed's counterclaim. The Association derives about $15 million in revenues from CPT products.
Feds say Columbia overbilled, inflated fees
Washington -- The U.S. Dept. of Justice announced Dec. 30, 1998, that it had joined a second whistle-blower lawsuit against Columbia/HCA Healthcare.
The recently unsealed suit alleges Columbia routinely submitted false claims in its Medicare, Medicaid and CHAMPUS cost reports to increase reimbursements. It also alleges that Columbia purchased several home health agencies at artificially low prices and then paid the agencies inflated management fees -- charged to Medicare as legitimate costs.
More than 100 Columbia hospitals are named.
A separate suit, unsealed last October, makes similar allegations against Health Corp. of America and HealthTrust, both now part of Columbia, and Quorum Health Group. Both cases were filed in U.S. District Court for the Middle District of Florida.
National Patient Safety Foundation grants
Chicago -- Attempting to stimulate innovative projects to prevent medical errors and patient injuries, the National Patient Safety Foundation at AMA awarded its first grants.
Totaling $350,000, the grants will fund researchers at: University of California, San Diego, to study how physicians acquire clinical expertise; University of Maryland, to study audio alarms in clinical settings; University of Illinois at Chicago, to examine "look-alike-sound-alike" drug names and create a computer program to help prevent potentially error-causing similarities before new drug names are assigned; and Kaiser Permanente Medical Care Program in Oakland, Calif., to develop a computer program for identifying obstetrical cases that should be carefully examined for errors and system problems.
Clinton seeks funds for long-term care needs
Washington -- President Clinton recently announced a $6.2 billion package to help pay for long-term care for people with chronic illnesses or disabilities.
The proposal, part of Clinton's budget plan, includes $1,000 tax credits for people requiring long-term care or their families; a national network to assist families; and a campaign to educate Medicare beneficiaries about long-term-care options.