News in brief - July 14, 2003

Guidelines set on gifts from patients - Genetic counseling guidelines amended - Consent required for filming - AMA opposes plan for Mexican doctors - Visa waiver program reopens - Internal medicine board selects new president - Lawsuit against insurer settled - Safety foundation calls for more action, fewer mandates - Florida cracks down on unlicensed health care - New Florida State University medical school moves forward

Guidelines set on gifts from patients

There are no rules on whether a physician should accept a gift from a patient, but there are a few questions that can help you decide, the AMA says. For example, would you feel comfortable if colleagues or the public knew that you accepted the gift?

The AMA's Council on Ethical and Judicial Affairs, in a report accepted at the Association's Annual Meeting in June, said that some gifts are given as part of a patient's cultural tradition and can enhance the patient-physician relationship. But some gifts signal the patient has psychological needs the physician must address.

The AMA cautions physicians about patients discussing gifts in the context of a will, saying that it shouldn't influence medical care. Also, if a doctor finds out about a willed gift after a patient dies, he or she should consider declining if accepting it would pose a financial or emotional hardship to the family.

Genetic counseling guidelines amended

Physicians have a duty to protect patients' genetic information, and pre- and posttest counseling must include implications of genetic information for patients' biological relatives, according to amendments made to AMA policy in June.

The policy says that when patients are considering genetic testing, physicians should discuss with the patients whether to invite family members to also be tested. The doctor also should identify instances in which the patient would be expected to notify biological relatives about information related to disease risk. The physician should also be available to help a patient in talking with relatives about counseling and testing opportunities.

Consent required for filming

Physicians filming a patient for educational purposes should get the patient's informed consent. If it's impossible to get prior consent, physicians must get the patient's consent before the film is used. The AMA adopted filming recommendations from the Council on Ethical and Judicial Affairs in June.

Physicians also must store the recorded material securely or properly destroy it and the footage can only be shown to health professionals, professionals-in-training and health profession students, unless the patient is told a non-health professional will see it and has given his or her consent.

AMA opposes plan for Mexican doctors

AMA members took a stand against a pilot program that would bring in 30 physicians and 30 dentists from Mexico to practice at California clinics. Members passed two resolutions at the Annual Meeting opposing this project and supporting alternatives for providing health care for California's underserved.

Such alternatives included expanding use of the National Health Service Corps or J-1 visa waivers and assisting newly retired Spanish-speaking physicians to obtain California medical licenses and liability coverage.

In addition to these new policies, existing AMA policy holds that international medical graduates must meet the same or equivalent licensing and credentialing requirements as U.S. medical graduates.

Visa waiver program reopens

The U.S. Dept. of Health and Human Services is now accepting applications from physicians holding J-1 visas who want waivers of their two-year home residency requirement. In June HHS finalized the program's guidelines and application form, completing its transition to being the national sponsor for such waivers.

Individual states and a few regional rural health care groups also sponsor applicants for J-1 visa waivers.

The J-1 visa waiver allows international medical graduates who have finished U.S. residencies to bypass a requirement to return to their home countries for two years before applying for a U.S. work visa. The physicians can be involved in research or be willing to provide primary care for three years in federally designated health profession shortage areas.

In the final version of its guidelines, HHS dropped a requirement that physicians have a state license before applying, since several states do not issue licenses until a physician has a visa. However, a requirement that the physician must complete his or her residency before applying remains. Critics say this means physicians will be delayed in starting new jobs and could even fall out of legal status during the wait for a waiver.

Another controversial requirement is that the employer and staff may not be acquainted with the J-1 physician prior to his or her application. Employers might argue that they prefer to recruit people they know in order to find a candidate with ties to the community and who is more likely to stay once the three-year commitment is finished.

HHS also announced that it will create a database to determine the J-1 physician population in a particular community, regardless of the program's sponsor.

Internal medicine board selects new president

Christine Cassel, MD, is the new leader of the American Board of Internal Medicine and the ABIM Foundation.

Dr. Cassel was dean of the medical school and vice president for medical affairs at Oregon Health and Science University in Portland. Before joining OHSU, she was a professor and chair of the Henry L. Schwartz Dept. of Geriatrics and Adult Development at Mount Sinai School of Medicine and director of the Geriatric Research, Education and Clinical Center at the Bronx Veterans Affairs Medical Center in New York.

Dr. Cassel chairs the ABIM Foundation and the board of the Greenwall Foundation, which supports work in bioethics, and this year is president of the American Federation for Aging Research. She is a member of the Institute of Medicine of the National Academy of Sciences and the Assn. of American Physicians and serves on the advisory committee to the director of the National Institutes of Health. She is past president of the American College of Physicians and former chair of the ABIM board.

Lawsuit against insurer settled

The Pennsylvania Orthopaedic Society and three physicians in June reached a settlement in a class-action lawsuit against Independence Blue Cross that is expected to mean an extra $40 million in claims payments to physicians over the next two years.

The proposed settlement applies to about 20,000 doctors in Pennsylvania and New Jersey who submitted claims to Independence Blue Cross and might have been denied payment or reimbursement or might have received reduced reimbursement.

"The real victory is that physicians now will know what and how they are going to be paid," said Kathy DeWittie, executive director of the Pennsylvania society.

Under the settlement agreement, which still needs to be approved by the court, the insurer will:

Disclose standard fee schedules.
Disclose policies and procedures that could impact reimbursement.
Process claims according to established standards.
Replace the independent procedure designation with the separate procedure designation of the Current Procedural Terminology.
Establish a process for resolving payment disputes.

Safety foundation calls for more action, fewer mandates

In order to solve systemic problems in health care quality, National Patient Safety Foundation Executive Director Robert Krawisz urged members of the U.S. Senate not to look at more regulation and mandates but instead to focus on moving toward a culture of constructive action and evidence-based planning.

Krawisz, U.S. Agency for Healthcare Research and Quality Executive Director Carolyn Clancy, MD, Joint Commission on Accreditation of Healthcare Organizations President Dennis O'Leary, MD, and several other speakers testified at a hearing on patient safety held June 11 before the Senate Governmental Affairs Subcommittee on Investigations.

"There are several evidence-based strategies that are starting to produce dramatic quality and patient safety improvements," Krawisz said. "The challenge is to close the gap between what is known and what is being practiced in most hospitals."

Florida cracks down on unlicensed health care

The Florida Dept. of Health's Division of Medical Quality Assurance has expanded its unlicensed activity program by opening a second specialized office in the Tampa Bay area. The move was prompted by a growing number of complaints involving unlicensed health care practitioners.

The department's first unlicensed activity office opened in Hollywood, Fla., in 1998.

"Unlicensed activity is a crime that puts the health of our citizens at risk," state DOH Secretary John O. Agwunobi, MD, said in a statement. "The opening of this new office reflects our commitment to stopping the perpetrators performing unlicensed, unregulated health care services."

The statewide unlicensed-activity program protects Florida residents and visitors from the potentially serious and dangerous consequences of receiving health care services from an unlicensed person, state officials said. The quality assurance division investigates and refers for prosecution all complaints and allegations of unlicensed health care activity. The unit then works with local law enforcement and states attorney offices to prosecute individuals practicing without a license, a felony-level criminal offense.

New Florida State University medical school moves forward

Florida State University's new medical school continues to march toward full accreditation. The Laison Committee on Medical Education recently upheld provisional accreditation of the school following a review of its third- and fourth-year curriculum.

The Florida Legislature launched the school in 2000. It started its first class of 30 students in spring 2001, followed by a second class of 40 in 2002.

Its first class will graduate in 2005.