News in brief - July 10/17, 2000

Includes news in brief from the AMA Annual Meeting.

AMA calls for end to higher co-pay for Medicare psychiatric treatment - Medicare's glucose monitor prescription rules called too strict - Congress urged to investigate burdensome Medicare regulations - AMA calls for creation of Medicaid congressional advisory board - Clinton proposes $21 billion increase in Medicare provider pay - HCFA names two physicians to senior-level posts - Questions arise about whether patient protection compromise is imminent - Human genome "working draft"

AMA calls for end to higher co-pay for Medicare psychiatric treatment

Chicago -- The AMA's House of Delegates directed the Association to register its strong opposition to a "discriminatory" 50% co-pay charged to Medicare beneficiaries who seek psychiatric treatment. The amount should be lowered to match the 20% co-pay charged for the treatment of all other conditions, said delegates to the AMA's Annual Meeting, held last month in Chicago.

James Allen Greene, MD, an alternate delegate from the American Geriatrics Society Inc., pointed out that more than 30 states have already passed legislation to end discrimination by private health insurers against people with mental illnesses and that Medicare's overseeing agency, the Health Care Financing Administration, should follow suit.

"This is a patient advocacy issue," said Mildred Reardon, MD, a Vermont delegate.

Medicare's glucose monitor prescription rules called too strict

Chicago -- Several delegates voiced their displeasure with a Health Care Financing Administration rule that requires physicians to re-write prescriptions for glucose monitors and related supplies for their diabetic patients every six months.

"This is a real aggravation," said Carl Strauss, MD, an alternate delegate from Missouri. "In 38 years of practice, I've never seen anyone overdose on diabetic supplies."

The spirited discussion led the House of Delegates to direct the AMA to request that HCFA change its Medicare requirement to allow physicians to re-write prescriptions every 12 months instead.

The 12-month requirement was adopted in response to concerns raised by several physicians who feared that without some time requirement, patients would not be monitored as closely.

"We know patients can get lost in the system," said Douglas Henley, MD, a delegate from the American Academy of Family Physicians. "It would be in their interest to review their charts every 12 months or so."

The delegates also instructed the AMA to work with other groups in developing a standard form to simplify the renewal process of supplies for diabetic patients.

Congress urged to investigate burdensome Medicare regulations

Chicago -- The House of Delegates urged the AMA to continue to press Congress for oversight hearings on the Health Care Financing Administration -- a reiteration of a request made at the AMA's Interim Meeting in December 1999.

AMA Trustee J. Edward Hill, MD, told the delegates that the AMA had already acted on the earlier request and that oversight hearings focusing on burdensome Medicare regulations had already begun.

However, he added, the Association should continue a "persistent oversight effort."

Marie Kuffner, MD, delegate from the Organized Medical Staff Section, related her experience as the past president of the Practicing Physicians Advisory Committee in stressing the need for ongoing oversight.

Despite her committee's work with HCFA over the regulatory issue, "We were not able to change very much," Dr. Kuffner said.

And if the oversight hearings aren't enough to make the point that the Medicare regulatory burden is overwhelming, the AMA should continue to tell Congress that the provision of health care to Medicare beneficiaries is being compromised by the misapplication of fraud and abuse directives and provider confusion over the laws, the delegates voted.

The body asked that the AMA and state medical societies work together to develop an education program to help physicians come into compliance with the rules.

AMA calls for creation of Medicaid congressional advisory board

Chicago -- The House of Delegates focused attention on the Medicaid program, a timely move in light of the prominent role the program plays in many proposals -- including the AMA's -- to provide coverage to low-income, uninsured people.

The delegates instructed the AMA to support federal legislation that would establish a Medicaid Physician Advisory Commission to advise HCFA and Congress on policies that affect physicians and their low-income patients.

The new commission could be modeled on the Medicare Physician Advisory Commission, which advises Congress on broad changes to that program, said Stuart Cohen, MD, a delegate from the American Academy of Pediatrics.

The delegates also urged the AMA to work toward the restoration of a requirement that states pay the 20% deductible, co-payment and coinsurance amounts for patients who are eligible for both Medicare and Medicaid.

Clinton proposes $21 billion increase in Medicare provider pay

Washington -- President Clinton proposed June 21 to boost Medicare payments to providers by about $21 billion over five years. Physicians are not specifically mentioned in the White House's documentation on the proposal, but some advocacy groups plan to lobby for a portion of the $11 billion earmarked for an "unspecified provider restoration pool."

Some specialty groups recently persuaded the AMA's House of Delegates to support a plan to use the surplus monies to halt an ongoing transition to resource-based practice expense payments under the Medicare fee schedule.

The remaining $9.2 billion in the president's proposal is broken down as follows: hospitals would receive $5 billion; home health agencies, $2 billion; nursing homes, $1 billion; managed care plans, $1 billion; and end-stage renal disease payment update, $2 million.

HCFA names two physicians to senior-level posts

Washington -- The Health Care Financing Administration recently named two physicians to senior-level positions. Hugh F. Hill, MD, was named deputy director of the agency's program integrity group, which works to prevent waste, fraud and abuse in Medicare. Dr. Hill, who is also an attorney, was the acting director of HCFA's coverage and analysis group.

HCFA Administrator Nancy-Ann DeParle said it was important to have a practicing physician's experience and perspective in the leadership ranks of the HCFA's program integrity group.

Sean Tunis, MD, was appointed director of the coverage and analysis group, which manages the Medicare coverage decision-making process. He is a former research scientist with the Lewin Group, a health care policy research and management consulting firm. A third position -- deputy director of HCFA's Center for Health Plans and Providers -- was filed by Mark Miller, PhD, a former official in the federal Office of Management and Budget. One of the center's responsibilities is to oversee the agency's interactions with health care providers.

Questions arise about whether patient protection compromise is imminent

Washington -- Differences of opinion have surfaced on just how close House and Senate negotiators are to reaching agreement on managed care legislation.

Although Republican negotiators claimed an agreement was within reach, a chief sponsor of the House bill, Rep. Charles Norwood, DDS (R, Ga.), said in late June that negotiators are still weeks away from consensus on a patients' rights bill that could pass both chambers and be signed by President Clinton.

Dr. Norwood, who was not invited to be a member of the conference committee that has been debating legislation for the past several months, was asked to attend a special marathon meeting called by Republicans to iron out differences among party members.

After the June 22 meeting, Dr. Norwood contradicted reports made by Republican leaders that consensus was within reach. "What I heard discussed will never pass muster with either the Republicans or Democrats in the House that voted for the original bill," he said. He also said his greatest fear is that Senate staff may have drafted many of the proposals he opposes into a final bill that could be introduced on the Senate floor.

Human genome "working draft"

Washington -- On June 26, two scientific teams announced the mapping of a "rough draft" of the human genome, composed of approximately 3 billion letters of DNA. The effort, which represents the work of the publicly funded Human Genome Project and a private enterprise by Celera Genomics Corp., likely will usher in a new generation of medicines that address the underlying genetic causes of human illnesses from cancer and Alzheimer's disease to diabetes and schizophrenia. President Clinton described the findings as parallel to Galileo's celestial searchings.

The Human Genome Project and Celera have identified 97% and 99% of the genome letters and placed roughly 85% of the genome in order. But sequencing gaps remain, and smaller segments of the genome must be assembled.