News in brief - July 7, 2003

Physicians worry about legal consequences of medical privacy law - Doctors call for HIPAA extension - AMA asked to study HMO act's impact - AMA to help in efforts to rebuild Iraqi health infrastructure - Doctors seek change to allow free care for Medicare, Medicaid patients - House passes association health plan bill - Medicare widens ICD coverage - Bill would bar boutique practices from billing Medicare

Physicians worry about legal consequences of medical privacy law

The AMA will work to address physician concerns that the Health Insurance Portability and Accountability Act might have unintended legal consequences for doctors who wouldn't be covered by traditional liability insurance. Physicians fear plaintiffs and trial attorneys might use alleged HIPAA privacy violations to try to force settlements.

At its Annual Meeting last month, the AMA House of Delegates directed the Association to take appropriate legislative, regulatory and legal action to make sure lawyers don't attach HIPAA violations that aren't malicious in intent to lawsuits that claim a doctor was medically negligent.

Doctors call for HIPAA extension

Physicians at the AMA Annual Meeting in June expressed concern that health plans' computers won't be able to send and receive standardized electronic claims by an Oct. 16 Health Insurance Portability and Accountability Act deadline. They asked the AMA to support legislative or regulatory changes to extend the deadline.

Physicians want a delay so health plans can legally still accept -- and pay -- nonstandard electronic claims or paper claims from physicians while they make the final adjustment to a standardized form.

AMA asked to study HMO act's impact

Thirty years after Congress enacted the Health Maintenance Organization Act of 1973, the AMA will study the legislation's impact on the nation's health care system, under a measure passed last month at the Annual Meeting. Physicians are concerned that the law has not helped reduce health care costs and that it has only created frustration and anguish for physicians and patients.

"The government must have had goals when the legislation passed," said ob-gyn Domenic R. Federico, MD, an AMA delegate from Michigan. "The question is if it achieved the goals. If it has not, it's time to change it."

AMA to help in efforts to rebuild Iraqi health infrastructure

The AMA House of Delegates has asked the Association to serve as a liaison between state and specialty societies and the federal government in efforts to get U.S. aid to help rebuild Iraq's health infrastructure. The AMA also will encourage medical societies to reach out to counterpart societies in Iraq that in many ways were isolated from the rest of the world during Saddam Hussein's reign.

Doctors seek change to allow free care for Medicare, Medicaid patients

The American Medical Association will work to change laws or regulatory policies so that physicians are able to provide free medical services or waive deductibles and co-payments for Medicare and Medicaid patients, as well as patients with other health insurance. Physicians at the AMA's Annual Meeting in Chicago in June said they worry that if they were to make that choice under current law, they could be accused of engaging in fraud and abuse.

House passes association health plan bill

Sympathy for small businesses and the difficulties they face in offering their employees health insurance has fueled House of Representatives passage of a bill to bring association health plans under the umbrella of federal regulation. Proponents of exempting the plans from state mandates say that AHPs will allow small businesses to purchase health coverage as if they were large companies.

Opponents, which include most of the private insurance industry and consumer advocates, say the federal government does not have the resources to oversee AHPs. They say the plans are too reminiscent of the multiple-employer welfare arrangements that popped up in the 1970s and just as quickly disappeared with members' premiums before Congress banned them.

The American Medical Association recently adopted a policy that supports AHPs in theory but maintains that they should continue to be bound by state regulations. The current bill does not meet that criterion.

Medicare widens ICD coverage

Medicare will expand coverage for implantable cardiac defibrillators but not as much as many physicians and health groups had wanted. A study completed in 2002 found a broad range of patients could benefit from the devices but the Centers for Medicare & Medicaid Services opted to limit coverage to a subgroup the agency maintains will benefit most.

CMS said it will review its coverage decision early next year when results of another clinical trial are released. The agency must now issue instructions to the contractors that process and pay Medicare claims before the new coverage becomes effective, a process that usually takes about six months. More information is available on the CMS Web site (www.cms.gov/media/press/release.asp?counter=807).

Bill would bar boutique practices from billing Medicare

Physicians would be prohibited from charging Medicare beneficiaries membership or access fees to receive their services under a bill introduced by Rep. Benjamin Cardin (D, Md.). The measure seeks to stem the growth of boutique practices that offer patients greater access to physicians in exchange for an up-front fee. The legislation would bar any physician charging such fees from billing Medicare for two years.

"The law is clear in protecting Medicare patients against excessive charges. But premium practices undermine those protections and threaten access to and continuity of care," Cardin said. "My legislation will ensure that physicians cannot increase their incomes arbitrarily at the expense of seniors who have fixed incomes."