News in brief - June 12, 2006

Kansas appeals ruling on teen sex reporting - House rejects Medicare cuts - CMS tightens drug plan marketing rules - Canadians healthier than U.S. counterparts, study finds

Kansas appeals ruling on teen sex reporting

Kansas Attorney General Phill Kline in May appealed a federal ruling that found physicians and other health care professionals are not required by state law to report all underage sexual activity as child abuse.

The challenge comes after the U.S. District Court for the District of Kansas in April blocked Kline's opinion that a 1982 law requires doctors, teachers and others to report to the state any sex, both consensual and nonconsensual, involving adolescents who are younger than 16.

The American Medical Association, along with more than a dozen other organizations, filed a friend-of-the-court brief in the case expressing concern that Kline's interpretation was overbroad, would force doctors to breach patient confidentiality and would deter minors from seeking necessary medical care if they knew they could be reported.

Failing to report could result in a misdemeanor criminal charge.

U.S. District Judge J. Thomas Marten ruled that the law allows doctors to use their professional judgment to determine whether to make a report of injury resulting from sexual abuse.

House rejects Medicare cuts

The House of Representatives last month passed a $2.7 trillion budget resolution for fiscal year 2007, paving the way for a conference committee to try to iron out differences with the Senate measure that was passed in March.

Although both resolutions are far apart on many issues, neither one includes the nearly $36 billion in five-year cuts to Medicare that the White House called for at the beginning of this year. Such a level of budget austerity could have complicated physician efforts to procure the tens of billions of dollars needed to reverse upcoming Medicare reimbursement cuts.

Congress still can set funding levels for programs through the apprpriations process even if there is no budget resolution for the year.

CMS tightens drug plan marketing rules

The Centers for Medicare & Medicaid Services recently instructed Part D drug plans that they must include in any promotional materials a disclaimer informing beneficiaries that medication formularies might change mid-year.

CMS clarified the policy to insurers in draft marketing guidelines for the 2007 plan year, for which beneficiaries can begin signing up on Nov. 15.

"An organization must include a statement in its current contracting year marketing materials whenever the organization advertises a current year benefit, formulary, pharmacy network, premium or co-payment that may or will change in the upcoming contracting year," the guidelines state.

Some physicians and other patient advocates had complained that insurers could gain enrollees for their drug plans with attractive formularies and then drop the more expensive drugs once everybody already had enrolled. CMS responded to this criticism by directing plans that eliminate drugs to cover them for current enrollees through the end of the year.

Canadians healthier than U.S. counterparts, study finds

Canadians fare far better than Americans when it comes to health, a new study by Harvard Medical School has shown. Research published in the July American Journal of Public Health finds that U.S. residents had higher rates of nearly every serious chronic disease. In the United States, 18% had hypertension compared with 14% of Canadians, while 21% of U.S. residents were obese compared with 15% of their northern neighbors.

One important exception to the health scores was in cigarette smoking. About 19% of Canadians smoke daily compared with 16.8% of U.S. residents. Also, Canadian women were less likely to have had a Pap smear in the last three years -- 79% compared with 88.9% of U.S. women.

But Canadians were 7% more likely to have a regular doctor and 19% less likely to have an unmet health need. U.S. patients were almost twice as likely to go without medicine due to cost, at 9.9% versus 5.1% in Canada. The findings come from a joint Canada-U.S. Survey of Health, the first such study conducted by the neighbors' official statistics agencies.

"These findings raise serious questions about what we're getting for the $2.1 trillion we're spending on health care this year," said David Himmelstein, MD, associate professor of medicine at Harvard and a co-author of the study. "We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier and live two to three years longer."