News in brief - May 1, 2000

Senate forges compromise on organ transplant bill

Washington -- The Senate Health, Education, Labor and Pensions Committee unanimously approved a bill April 12 to rewrite policies governing the nation's organ transplant system.

The bill, introduced by heart transplant surgeon Sen. William Frist (R, Tenn.), MD, is supported by Sen. Edward Kennedy (D, Mass.) and the Dept. of Health and Human Services. It represents a possible compromise in the two-year power struggle over who should control the allocation of organs for transplant.

Under the legislation, an organ procurement and transplantation network would be run by an oversight board of transplant community representatives and health experts. This board would establish the network's policies, which would be carried out by a private contractor who administered the system. The board would consider geographic variations in the availability of organs, race, ethnicity, socioeconomic status and whether an area is medically underserved. If HHS disagreed with the board's approach, a 21-member expert panel could review and arbitrate the differences.

Chicago -- The U.S. District Court for the Northern District of Illinois has dismissed a lawsuit brought by 11, primarily surgical, specialty societies challenging the method the government used to shift to resource-based Medicare practice expense payments.

The shift toward resource-based payment generally lowered reimbursement to hospital-based physicians and increased payments to office-based doctors. The suit, against the Dept. of Health and Human Services, argued that the agency chose the wrong year as the base for the transition to resource-based payment -- a move the plaintiffs said would lead to the misallocation of about $495 million. Medical societies representing primary care physicians opposed the suit.

The court ruled that, under Medicare law, it did not have jurisdiction over the matter. In addition, the ruling stated that even if the Medicare Act allowed judicial review, the court would have found for HHS because the practice expense regulation was "a reasonable interpretation of an unclear statute and, accordingly, [was] not inconsistent with the act."

Washington -- Congressional negotiators working on the patient protection legislation reached tentative agreement on an appeals process for patients who are denied coverage by their managed care plans.

Last month's agreement, which is being hailed as something of a breakthrough in the lengthy debate over the patients' rights legislation, would establish an independent external review process to settle disputes between patients and health plans over a treatment's medical necessity, experimental nature or coverage status.

The agreement also says that in the event of a medical dispute between a plan and a physician about treatment, an independent medical expert -- a physician of the same specialty -- would make the final determination.

Noting that the appeals process is only part of a still-to-be-developed package of patients' rights, AMA Chair D. Ted Lewers, MD, was cautiously optimistic about the agreement. "Our goal for the appeals process is that it must be external, it must be timely and it must be binding. It is my understanding that what the conference committee has done is in that direction, and for that we are pleased and encouraged," he said.

The agreement was reached just before Congress adjourned April 14 for a two-week recess. Congressional staffers are now filling in the details of the agreement.