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For years, the readers of this magazine have heard me preaching of the dangers of selling out to managed care. Throughout this time, I've warned osteopathic physicians that signing these contracts with the carriers would come back and bite them. Now, with the latest Harris Methodist contract revisions that I've seen submitted to many of our clients in North Texas, along with a Clinton proposed plan, the proof has finally arrived.
For the past couple of years, Texas physician reimbursement from managed care companies has been different (in many ways) from those in the Northeastern states (Maryland, New York, New Jersey, Pennsylvania, etc.). In those states, Medicare has become the highest paying plan among all of the managed care plans. The corporations have convinced the doctors that they have to accept less than what Medicare pays or the doctors are in danger of losing a high percentage of their patients - and the doctors have believed them. Now, a plan in North Texas has revised their payment levels to a percentage of Medicare's allowed amounts a couple of years ago. Yes, they are paying more than Medicare paid in 1987, but not more or equal to what Medicare is paying today. Many physicians are thoroughly convinced that if they do not agree to these new payment levels, they will lose patients and be sitting around with nothing to do, and that getting some money in is better than losing patients. If the doctors in Texas continue to stay in plans that pull these kind of stunts that increase the profits to the carrier while reducing payments to physicians, they can expect to see their own income plummet. If the doctors are not willing to stand up now and say no, then those same doctors have no room to complain when their income drops 25% within the next year.
The Physician's Payment Update, a publication from Medical Economics, reported in its April 2000 issue that the Clinton proposed budget included a provision to reduce laboratory payments by 30% for four common lab tests that government statistics show are "overpaid" by Medicare, compared to the allowances in the private insurance sector.
How long will it be before the government realizes that physicians are now accepting fees under managed care that are sometimes 35% less, in some cases, than the Medicare fee schedule? How long before physicians see Medicare reducing its allowances on all or select procedures in keeping with the downward spiraling of managed care fee acceptance by practitioners?
If physicians continue to accept contracts with private or managed care carriers at these amounts less than what Medicare allows, Medicare will continue to reduce their allowed amounts in accordance with the law, which allows them to reduce it to the lowest level you have agreed upon. Physicians will either continue this until they are making as much money as the sack boy at the grocery store or they will stand up to the insurance carriers to protect themselves. To think it's not going to happen is not just naive - it's stupidity! It's really up to you!
Prolonged services are an excellent way to identify services that exceed the mentioned time frame in the E/M's. The use of these codes is limited; if you look in the current CPT, you will find the range of codes there.
Medicare allows the use of the codes, for face to face time only. They will not consider them in addition to 99271-99275 (confirmatory consult codes).
When you have an evaluation and management service that exceeds the times shown in the CPT by 30 minutes or longer, you really should look at the prolonged service codes. These are add-on codes and should be used in addition to the E&M service billed. Since the reimbursement level for these codes exceed $80 in most places, they can be very helpful for the physician receiving more value for the time spent.
There for awhile, I got caught up in the idea that the 8/99 update "changed" the basic intent of the consultation. That was ideological of me and I was wrong. The "intent" of the requesting physician is still of utmost importance, in my opinion, of the HCFA directive from August 1999. I am now going to revert to teaching the following regarding Medicare, unless the consulting physician has the requesting physician complete a consult request form I have designed and fax it to the consulting physician. (This form can be downloaded for free on my web site.)
I realize that many consultants hold a much more liberal view of allowing consults, but we're taking a conservative viewpoint based on discussions we have had with HCFA personnel.
While reviewing coding at several offices around Texas, we've found quite a few times that the physician was told how to code out the services they are providing by the sales representative or the distributor of medical equipment or diagnostic equipment. Be careful. While I am not at liberty to disclose what companies I have a problem with (I don't enjoy being sued), I am warning every reader to double-check the coding that is given to them by the equipment manufacturers. In some cases, we've seen offices told to unbundle or to stack their coding. In some, I've seen offices told to bill multiple units that did not equal the time that should have been billed. Still, in others, we've seen one device manufacturer tell doctors to use codes that have been expressly related to fraud on HCFA’s own web site.
If you're in doubt, give us a call. We will tell you what we have found, where to find the correct coding or the Medicare Fraud Alert. There is a slight charge for this service, but it's better to be forewarned than to have to suffer $20,000 to $60,000 in recoupment, fines and penalties. Medicare, HCFA, the OIG and the Department of Justice believe ignorance is no excuse.
If you want information on the physicians-only seminar we're
holding on August 23 in Houston, check out our web site at www.donself.com/houston.html.
This seminar is guaranteed to increase your income at least by four times the
tuition amount or you receive a 100% refund on the tuition.
Don Self, CSS, BFMA With a grant of $1 million for the construction of the J. L.
LaManna Center, Dallas Southwest Osteopathic Physicians (DSWOP) has surpassed
the $10 million mark in grants since its beginning in 1983. The J. L. LaManna Learning Center, first conceived in 1997,
finally became a reality on April 18, 2000, with a grand opening ceremony.
Recipient of the grant was the Dallas County Community College District
Foundation and was totally funded by the doctor’s group. The unique facility features a state-of-the-art
instructional lab, three multi-purpose classrooms, a study area for children,
and offices for the staff as well as offices for Dallas Southwest Osteopathic
Physicians. Mountain View College will operate the facility, offering many
stimulating classes and community events, and DSWOP will continue its granting
programs from the facility. The doctors were also the primary contributors to two other
major facilities which recently opened – the new Dallas Southwest Osteopathic
Physicians Center, featuring the Hoglund Foundation Gymnasium at the Oak Cliff
YMCA; and the new Multi-Purpose Addition to the Widner YWCA. In its 17-year history, the physician’s grants have touched
virtually every facet of life. Joseph LaManna, D.O., DSWOP chairman, stated,
"This has been our way of saying 'thank you' to the community." Over 160
nonprofit organizations, schools, agencies and governmental entities have been
the recipients of that charity. Schools, both pubic and private, have also been
beneficiaries of DSWOP’s grants. In fact, over half of the grants awarded have
been in the field of education –from computers to science equipment to
scholarships to playgrounds for 22 Dallas public schools. Other major construction grants have been to the Texas
Osteopathic Medical Association; Calumet Community Center; the University of
Health Sciences College of Osteopathic Medicine in Kansas City; St. Phillips
School; Girls, Inc; and Oak Cliff Little League Baseball Field. They have been the presenting sponsor of the National
Council of Jewish Women's "Night at the Myerson;" Ramona Logan Tennis Classic;
Mi Escuelita Preschool Golf Tournament; and Dallas Baptist University-Oak Cliff
Partnership Dinner. Other major grants have funded the annual Yitzhak Rabin
Memorial Essay Contest; the American Cancer Society Children’s Party; the
annual Holiday Party for needy children; the Beaux Arts Ball Children’s Art
Program; Friday Morning Live and Saturday Morning Fun at the Dallas Museum of
Art; Continuing Medical Education at Texas College of Osteopathic Medicine; and
a loan/scholarship program at TCOM. Governed by a nine-member board,
Dr. LaManna has chaired the group since July of 1985. DSWOP has become one of
the major charitable institutions in the Dallas metroplex and has brought an
increased awareness of osteopathic medicine to the community. Health professionals are asked to
help reduce difficulties experienced by some patients with self-administration
of Enbrel. The main difficulty is in penetrating the vial stopper with the
needle on the supplied syringe, resulting in bent and otherwise damaged
needles. For a copy of the letter FDA notifies health professionals
of concerns regarding nephrotoxicity associated with botanical products found
to contain aristolochic acid. A copy of the letter and attachments may be found
at the following FDA web site: Health professionals are notified
of a change in the labeling of Actimmune. The expression of potency has been
changed from units to International units. This labeling change is based on
direct calibration of the Interferon gamma reference standard to the WHO
standard in the potency Health professionals, especially
pharmacists, are notified of prescription dispensing errors involving Lamictal Tablets
and Lamisil Tablets resulting in serious adverse events. The error reports
involve dispensing Lamictal Tablets when Lamisil Tablets were prescribed and
the reverse scenario. A copy of the letter may be found at: The Center for Drug Evaluation and
Research has developed and posted information on drug shortages. The
information may be found at: http://www.fda.gov/cder/drug/shortages/default.htm
The Spring Issue of the User
Facility Bulletin contains articles on the
The UFR newsletter may be found at: The Food and Drug Administration
has issued a draft guidance for the development of the adverse reactions
section of labeling for human prescription drugs and biologics. The document,
which was published in the Federal Register on June 21, 2000 is the first in a
series of guidances for industry that are intended to make the labeling more
consistent and helpful to prescribers and patients. The draft guidance emphasizes the
need to focus the label's adverse reactions section on drug safety information
that is important to prescribing decisions, and to convey it in a format that
is clear, easy to find, and consistent across different drugs and drug classes.
The common format provided by the guidance divides the labeling into two
subsections: Although the guidance seeks to
assist industry in bringing greater consistency to the content and format of
the adverse reactions section of the labeling, agency recognizes the critical
role of individual judgment in presenting the adverse reactions data. The
guidance suggests that the adverse reactions section be limited to information
that can be helpful in treating, monitoring and advising patients. Long and
exhaustive lists of every reported adverse event, including those that are
infrequent or minor, should be avoided. The draft guidance is available on
FDA's web site: It is not intended for
implementation until FDA issues a final guidance following a 90-day comment
period. Comments should be submitted to Dockets Management Branch (HFA-305),
Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD
20852. The labeling overhaul is expected to resemble food labeling
and is intended to make it easier for physicians to spot a drug’s biggest risks
quickly. The FDA has banned four drugs over the last 30 months, and plans to
ban a fifth this summer, that killed dozens of Americans in part because
physicians disregarded or did not read warning labels.(Associated Press, 5-15-2000) A report compiled by the National
Cancer Institute, the American Cancer Society, the North American Association
of Central Cancer Registries and the Centers for Disease Control and Prevention
also noted that cancer mortality rates saw their greatest-ever decline from
1995 to 1997, at 1.7 percent per year. The report noted declining lung cancer
incidence and death rates in men since 1990, a declining rate of increase in
lung cancer deaths in women, a stable breast cancer incidence rate, a two
percent annual decline in breast cancer death rate, a 1.6 percent annual
decline in colon cancer incidence rate, a decline in prostate cancer death
rate, and increases in death rates from melanoma and non-Hodgkin’s lymphoma.
(Washington Post, 5-15-2000) A study published in the Journal
of the American Medical Association surveyed 504 urologists and 559 radiation
oncologists as to what treatment they would recommend to a hypothetical
65-year-old patient with prostate cancer that has not spread. The survey found
that 91 percent of urologists recommended surgery, while 91 percent of
radiation specialists instead recommended external radiation. (Journal of the American Medical
Association, 6-28-2000, Associated Press, 6-27-2000) HCFA is expanding the treatment options for Medicare
beneficiaries with severe rheumatoid arthritis who have failed to respond to
conventional drug therapies. A new national coverage decision by HCFA makes
treatment through the use of protein A columns, a blood processing therapy,
available to rheumatoid arthritis sufferers. Review of this coverage issue was
initiated internally at HCFA under the agency’s new National Coverage Policy,
which bases coverage decisions on the best available scientific evidence. Protein A columns are used with an
apheresis machine, a device that removes selected blood constituents from whole
blood. During therapy, blood is drawn from the patient and a cell separator
divides the plasma from the blood cells. The plasma passes through the protein
A column and is rejoined with the blood cells that are retransfused into the
patient. The column through which the blood is funneled works by binding and
subsequently remodeling immune complexes. Although the exact mechanism for
improvement is unknown, it is believed that this effect on immune complexes
plays a role in protein A columns’ therapeutic effect. Since 1991, Medicare has covered the protein A column, marketed under the trade name
Prosorba, as a treatment for Idiopathic Thrombocytopenia Purpura when other
treatments have failed. The new coverage decision, posted May 3, 2000 on HCFA’s
web site at www.hcfa.gov, extends the
coverage to some rheumatoid arthritis patients. (Medicare news release, 6-6-2000) Indiana University School
of Medicine researchers said that the IOM medical error report relied on flawed
methodology by failing to establish that medical errors caused the deaths
tallied and failing to eliminate other risks to sick patients before drawing
conclusions, noted the Associated Press. Lucian L. Leape, M.D., a co-author of
the IOM report, defended the report’s methodology and maintained that its
screening criteria eliminated extremely ill or complicated patients. (Journal of the American Medical
Association, 7-5-2000; Associated Press, 7-6-2000) Noting that hospitals' financial status has deteriorated
significantly over the past two years, MedPAC recommended that Medicare
reimbursements to hospitals in 2001 be increased two percentage points more
than an inflation-based increase previously approved by Congress, the
Associated Press reported. The panel also recommended developing a more precise
hospital compensation system to deal with payments for Although the U.S. leads the world in the responsiveness of
its health system, measuring efficiency and degree of respectfulness of
treatment, it ranks 24th in life expectancy and 32nd in
degree of premature death. Japan was ranked first in the WHO’s overall health
index, while Canada was ranked seventh and the United Kingdom was ranked tenth.
(Washington Post, 6-21-2000) The court overturned a decision that an HMO and its
physicians breach a duty under the Employee Retirement Income Security Act of
1974 (ERISA) by rewarding physicians financially for cost containment policies.
The ruling said that such financial incentives are how Congress intended HMOs
to work. (Associated Press, 6-12-2000) The OIG recommended that Congress reduce Medicare payments for the drugs by altering the current
reimbursement formula or by developing a new reimbursement method. A one-month
supply of albuterol for a patient, the OIG noted, costs Medicare $117.50, while
state Medicaid programs can purchase it for $60 and also charge patients lower
copayments than does Medicare. (USA
Today, 6-21-2000) The potential change is part of a fundamental redesign of
JCAHO’s accreditation survey, which would be required of hospitals and other
institutional providers every 18 months rather than every three years if the
policy is adopted. JCAHO is considering the policy change to reduce dips in
quality assurance efforts by institutions between surveys, while surveys could
be customized to individual institutions and become internalized as part of
their normal quality assurance. (Modern
Healthcare, 6-12-2000) The 43-page set of guidelines, scheduled for publication in
the June 12 Federal Register, precedes a final set of guidelines expected this
fall and is based on seven elements: implementation of written policies and
standard of conduct; designation of a compliance officer or contact;
development of training and education programs; creation of communication
channels to update practice employees about compliance activities; performance
of internal audits to monitor compliance; enforcement of standards through
well-publicized disciplinary directives; and prompt corrective action of
detected offenses. (Delaware Valley
Healthcare Council, 6-9-2000) The move, effective January 1 next year, will require
104,000 seniors nationwide to find new health insurance, reported the Inquirer.
Cigna is keeping its Medicare HMO in Phoenix and in Albuquerque. Health plans
have dumped 734,000 Medicare HMO beneficiaries from their rolls since 1998, of
whom 604,000 switched to other Medicare HMOs and 130,000 returned to
traditional Medicare coverage, the Inquirer noted, citing the Health Insurance
Association of America. An estimated 6.5 million Medicare-eligible Americans
are enrolled in Medicare HMOs. (Philadelphia Inquirer, 6-3-2000) The OIG exemption, intended to protect information on law
enforcement queries to the data bank, will allow reports of adverse actions to
be available to subjects of the records in the data bank but will not release
details to subjects on access and use of such information by law enforcement
agencies. The data bank, created by the Health Insurance Portability and Accountability
Act of 1996, includes information An InterStudy survey of executives from the country's 25
largest PPOs also found that PPOs reported profit margins of 15 percent or
higher, compared to margins of five percent by the few HMOs that have returned
to profitability, reported WebMD. Reasons cited by PPO executives for increased
market share include effective marketing to employers and insurers, broad
provider choice and growing convergence of HMO and PPO premium prices, while
InterStudy attributed PPO profitability to their restricting operations to
network development and management rather than taking on broader administrative
functions and full-scale medical management, WebMD added. (WebMD,
5-30-2000) The hospitals claimed that Medicare underpaid hospitals nationwide
by $342 million during fiscal 1985 and 1986 and up to $3 billion through the
1990s by failing to make additional retroactive payments to meet
federally-established minimum payments for treating high-cost patients,
required by federal law to be The Department of Health and Human Services will revise
Medicare guidelines to explicitly authorize payment for such care and HCFA is
expected to instruct Medicare contractors that routine patient care costs
during clinical trials are reimbursable. The change is designed to encourage
greater clinical trial participation by elderly Americans, currently only one
percent of whom participate. (Associated Press, 6-7-2000) United Healthcare has shifted to fee-for-service
reimbursement for 90 percent of its physician contracts nationwide, Cigna
Healthcare of Colorado has dropped capitation altogether and switched back to
fee-for-service, as did Blue Cross Blue Shield of Florida in Jacksonville,
while PacifiCare Health Systems said it will use discounted fee-for-service
reimbursement for medical groups that request it. The percentage of revenue
that medical groups derive from capitated contracts is decreasing, according to
MGMA data, while InterStudy data show that the percentage of HMOs that
reimburse primary care physicians by capitation declined from 78.7 in July 1998
to 65.7 percent in July 1999. (American Medical News, 5-22/29-2000) The Senate defeated the White House-backed patients’ rights
measure by a 51-48 vote, with all but four Republicans opposing the measure,
after months of talks on a bipartisan compromise broke down. Among other
things, the bill would have given all Americans with private health insurance
authority to sue their HMO for denial of care. Sen. Don Nickles (R-OK) promised
to renew compromise efforts on a patient protection measure and said
Republicans may attempt to draft a measure designed to win Democrat support.
(Associated Press, 6-8-2000) Medicare administrator Nancy Ann DeParle sent a letter to
HMOs nationwide announcing reductions in their paperwork and regulatory
requirements for participation in Medicare and pledging that no regulations or
policies that create significant new operational costs would become effective
before January 1, 2002, unless required by Congress. HMOs had until July 3 to
decide whether to participate in Medicare for 2001. DeParle added that
congressional action would be needed to grant requests by HMOs for higher
Medicare reimbursements. Of Medicare’s 39 million beneficiaries, 27 million have
an HMO open to them and 6.5 million are enrolled in one. (Associated Press, 6-8-2000) Financed with a $1 million grant from the Susan G. Komen
Breast Cancer Foundation, the Harvard University and RAND Corp. study is
reviewing medical records of 600 breast and colon cancer patients to assess
care levels, treatment types and the extent of follow-up, and is conducting
interview with patients about their treatment experiences. The study was
prompted by an Institute of Medicine recommendation last year that information
be improved nationwide about the quality of cancer care. (Associated Press, 5-20-2000) Sterling Life Insurance, hoping to capture market share in
areas of low Medicare HMO penetration, will roll out a $55-per-month health
plan that allows beneficiaries to choose their physician, charges a $10
co-payment for office visits, carries a $300 deductible for hospital stays, but
does not cover prescription drugs. The program was set to being July 1 in
Alaska, Idaho, Kentucky, Minnesota, Nebraska, New Mexico, Nevada, Oregon, South
Dakota, Tennessee, Utah, Arkansas, Louisiana, Mississippi, Ohio, Texas and West
Virginia. (USA Today, 5-9-2000) Approval of the $120 billion acquisition requires the
companies to divest drugs prescribed for depression and Alzheimer’s disease,
and divest research on a cancer drug. The companies will also sell one of two
competing over-the-counter lice medications. (Bloomberg News, 6-20-2000) A Kaiser Family Foundation study of patients who experienced
a conflict with their health plan found that only six percent filed a formal
appeal, 89 percent said they didn’t know which agency in their state regulates
health plans and 40 percent didn’t know whether they had the right to appeal a
health plan’s decision to a state or independent agency. The study also noted
that 88 percent of patients with conflicts took some action, 73 percent
contacted a plan representative or their physician, 46 percent sought
information from their plan documents, 25 percent asked a friend or family
member for help, 21 percent contacted someone outside the plan and 10 percent
changed their plan. (American Medical News, 6-26-2000) Filed in a Miami federal district court by attorneys who
were involved in large tobacco company settlements, the suits accuse Aetna,
Cigna, Foundation Health Systems, PacifiCare Health Systems, Prudential Health
Care and United Healthcare of failing to disclose to plan members that they
offered rewards to doctors and other employees who denied payments for care and
who limited hospital admissions. The suits also contend that the companies
defrauded members in violation of the federal anti-racketeering law, which
provides for treble damages. (New York Times, 6-26-2000) Key changes in the final regulations, according to DVHC,
include increasing the flexibility in establishing a provider network, offering
beneficiaries a point-of-service option, allowing plans that leave the
Medicare+Choice program to return in two years instead of five years and
eliminating the self-reporting component under the compliance plan requirements
of the program. The rules become effective in 30 days. (Delaware Valley Healthcare Council, 6-23-2000) The legislation, sponsored by Rep. Tom Campbell (R-CA) and Rep. John Conyers (D-MI), enjoyed majorities among
both Republicans and Democrats when brought to a final vote at 2:00 a.m. Prior
to the final vote, six amendments were debated and voted on. Amendments to
exclude fees from collective negotiations, to require certification of
negotiations by the Federal Trade Commission or the U. S. Justice Department,
and to prohibit forcing physicians to join a union in order to be employed by a
health plan were defeated, while an amendment to prohibit making abortion
services subject to collective bargaining passed by a narrow margin, primarily
on Republican votes. Proponents of H.R. 1304 had warned that the abortion
amendment would force many co-sponsors to oppose the bill and lead to its
defeat. In the end, Conyers noted that abortion-rights organizations were not
scoring the vote and urged his colleagues to support the bill. Physician’s News Digest, 6-30-2000) The following articles are prepared by the American
Osteopathic Association for physicians’ use. They may be copied onto
physicians’ letterhead and sent to local newspapers; printed in hospital
newsletters; and/or copied and used as reading material in patient waiting
rooms. What are migraine headaches? What are the symptoms? What causes them? And, most
importantly, what prevents them? A common type of chronic headache, migraines
affect six out of every 100 people. In other words, that's 28 million
Americans. More common among women, they usually strike people between the ages
of 10 and 60. Migraine headaches are usually accompanied with throbbing,
pulsating pain on the left, right, or both sides of the head, and the pains are
either severe or dull. Depending on the severity of the attacks, these
headaches usually last six to 48 hours. Even though symptoms of migraine headaches vary from person to person, there
are still some common symptoms that are evident in most migraine cases. The
symptoms can include nausea, vomiting, blurred vision, sensitivity to sound and
light, and a tingling sensation. The symptoms of more severe migraine What causes migraine headaches? While migraine is most often inherited
genetically, many researchers are taking a closer look at the changes in the
brain and blood vessels occurring with migraines. "One theory is that
migraines result from the increased sensitivity of the nervous system to
changes in either your body or the environment," explains (insert name),
D.O., an osteopathic (insert specialty) from (insert practice) in (insert
town). "Researchers believe that changes in the brain activity or
environment cause the nervous system to respond. This leads to inflamed blood
vessels and nerves around the brain which result in a migraine." Environmental factors can also trigger migraines to flare up, such as specific
noise pitches, lighting situations, weather, and high altitudes. In addition,
flare-ups can be instigated by physical factors and eating habits. These
include too much sleep or too little sleep; stress; certain foods
containing monosodium glutamate (MSG) like seasoning salts and sauces; and
foods containing high levels of nitrates such as sausage, hot dogs, and smoked
fish. While migraines may be caused by environmental factors, they may also be
associated with gender. For instance, many women have migraine attacks linked
to their menstrual cycles. In these cases fluctuating estrogen levels are
believed to play a role. "However, there is some good news for women At this time, no definite cure exists for migraine headaches, which poses a
concern for physicians. In an effort to gather as much information as possible
about this chronic condition, the American Osteopathic Association, which
represents 44,000 osteopathic physicians, recently joined six other national
physician organizations to form the U.S. Headache Consortium. The group
developed a set of practice guidelines for physicians to use when diagnosing
and treating patients who suffer from migraines. Although a cure for migraines has yet to be found, those suffering from this
condition do not have to live with the pain. One way to overcome these chronic headaches
is to learn how to manage them. Migraine management consists of drug therapy
and lifestyle management. There are many migraine drugs available, but it is
important that you find one that is best for your migraine condition. You may
require drugs to stop an attack when it occurs or to treat the symptoms. For
people who experience frequent attacks, there is a medication that can be taken
regularly so that migraines will strike less often and last a shorter amount of
time. Along with prescriptions, adjusting your lifestyle to avoid environmental
elements that can trigger migraine headaches such as dusty rooms, bad lighting,
humid areas and noise levels may also help to decrease the likelihood of
attacks. Even though migraine headaches can be incapacitating at times, they should not
stop you from living your life comfortably. With the proper knowledge about
migraines and a physician's care, the frequency and severity of migraine
attacks may decrease dramatically. A highly contagious bacterial infection, impetigo often
starts when a small cut or scratch becomes infected. Though this type of
bacterial infection can affect adults, it is much more common in children. "The symptoms of impetigo are honey-colored, crusty
sores that often appear on the face between the upper lip and nose,"
explains (insert name), D.O., an osteopathic (insert specialty) from (insert
practice) in (insert town). "The rashes consist of red spots or blisters
that rupture, discharge, and become encrusted." He/She warns people not to
scratch the sores because they may inadvertently spread the infection to other
parts of their bodies.
This skin infection is caused by one of two bacteria, group A streptococcus,
which is the bacteria also responsible for "strep throat," or
staphylococcus. If impetigo is caused by streptococcus it will begin with
tiny blisters. These blisters will eventually erupt revealing small, wet
patches of red skin. Gradually, a tan or yellowish brown crust will cover the
affected area giving the appearance that it is coated with honey. If
caused by staphylococcus, people will notice larger blisters that appear to
contain a clear fluid. These blisters stay intact for a longer period of time
compared to the smaller ones. "Impetigo usually affects pre-school and school-aged
children, especially during the summer," says Dr. (insert name).
"This type of infection has a special preference for skin that has been
affected by other skin problems, such as eczema, poison ivy, or a skin allergy
to soap." Impetigo is highly contagious. Children can spread this skin
infection from one area of the body to another by touching the infected area
and then touching other parts of their bodies. The infection can also spread
to other household members through clothing, towels, and bed linens that have
been in contact with the infected person. Classmates and playmates also hold
themselves at high risk of infection by coming in contact with the infected
person or anything that he or she has touched. The most important way parents can prevent impetigo is by keeping their child's
skin clean. "This includes giving your child daily baths or showers with
anti-bacterial soap and warm water," explains Dr. (insert name). "
Remember to pay special attention to areas of the skin that has
cuts or scrapes, as well as rashes on the skin." If the infected areas are relatively small, health care
professionals suggest trying simple home remedies. "It is good to try to
remove the crusts by soaking the infected area in warm water for 15 to 20
minutes, then scrub the area gently with a washcloth and antibacterial
soap," he/she recommends. Another common remedy used is applying
antibiotic ointments. However, the biggest issue to focus on is preventing
impetigo from spreading. For instance, when your child has a runny nose, keep the area
between the upper lip and nose clean. Physicians recommend spreading a thin
layer of anti-bacterial ointment under the nose as well as applying it in the
nostrils with a Q-tip. The nose is most often the source of impetigo germs.
These precautions can help eradicate the "bug" that causes the
infection. "If impetigo is not improved after three to four days, or any new infected
areas appear, a physician should be called immediately," advises Dr.
(insert name). If left unattended, this infection can cause serious problems,
such as pain; swelling; tenderness of the infected areas; discharge of pus; or
a fever of 100 degrees or higher. Even though impetigo is not life threatening, it could lead to life-threatening
situations. People need to understand that this infection is very manageable.
With the proper medical attention, it can be easily treated. Ray Stowers, D.O., has been appointed by General Accounting
Office (GAO) Comptroller General David Walker to advise Congress on Medicare
physician payment issues as a member of the Medicare Payment Advisory
Commission (MedPAC). "Dr. Stowers' vast state and federal experience in physician
payment, graduate medical education and rural physician manpower will be a
major asset to MedPAC," said AOA's Council on Federal Health Programs Chairman
Marcelino Oliva, D.O. "I am most pleased Comptroller General Walker has
appointed an osteopathic physician to serve on MedPAC. This appointment has
been a priority for the Council and the Washington Office staff." Established by the Balanced Budget Act of 1997, MedPAC
advises the U.S. Congress on Medicare payment policies. The 17-member panel of
diverse professionals issues reports to Congress in March and June. MedPAC
comments on reports to Congress by the Secretary of the Department of Health
and Human Services and provides testimony and formal comments on proposed
regulations. Briefings for members of congress and staff are an additional
responsibility of MedPAC. The legislative language that created MedPAC indicates
congressional intent that a D.O. serve on the Commission. Dr. Stowers is the
first and only D.O. to serve on the panel. Under the direction of the Council on Federal Health
Programs, the AOA’s Washington Office orchestrated an on-going grassroots
campaign to encourage the GAO to appoint Dr. Stowers to MedPAC. After hundreds
of grassroots letters and calls from Republican and Democrat members of
Congress, the nomination was secured. "There are many areas of urgency for Congress to consider in
our healthcare delivery system and MedPAC stands the best poised to give advice
on those issues," said Dr. Stowers. "I look forward to applying my experience
to a process that will ultimately help Congress identify solutions for health
care system flaws." On the national level, Dr. Stowers served on the Physician
Payment Review Commission for two years, the American Medical Association’s
Relative Value Update Committee (RUC) for seven years and continues to be
active in the Health Care Financing Administration’s Medicare Payment
Refinement Panel process. He currently represents the osteopathic medical
community on the national level as a member of the AOA’s Council on Federal
Health Programs and the Board of Governors for the American College of Osteopathic
Family Physicians. As the Director of Rural Health at the Oklahoma State
University College of Osteopathic Medicine in Tulsa, Dr. Stowers shares his
experiences with osteopathic medical students and residents, while designing
training programs to prepare them for practice in rural and underserved areas.
Before joining OSU-COM, Dr. Stowers spent over 25 years in a solo family
medicine practice providing care to rural northwest Oklahoma and neighboring
Kansas communities. He established the first federal rural health office in
Oklahoma with the help of the Oklahoma Rural Health Association. Appointed by
the Governor of Oklahoma to the Board of the Task Force and Rural Planning
Committee, Dr. Stowers advised the Governor on the state’s health care manpower
needs. The approval of collective bargaining legislation by the U.S. House of
Representatives is a major victory for the American public, says the AOA. "When the House overwhelmingly approved the Quality Health Care Coalition
Act of 2000 without harmful amendments, it took the health care decision-making
process from insurers and handed it back to patients and their
physicians," says AOA Executive Director John Crosby, J.D.
"Representatives Tom Campbell (R-CA) and John Conyers (D-MI) should be
applauded for a legislative success that will ultimately improve patient
care." The AOA-backed bill allows health care professionals to bargain collectively
with health plans regarding the terms and conditions of their contracts. The
bill, H.R. 1304, will improve patient care by restoring the balance to
negotiations between health plans and health care professionals. "If all
health care professionals can bargain collectively with health plans regarding
terms that affect patient care, decisions about patients' health care will be
made by health care professionals, not insurance companies," says Crosby. While Representatives proposed six amendments to the bill, the House only
approved two. The bill includes an amendment written by Representative Tom
Coburn, MD (R-OK) to exempt discussions regarding abortion coverage
requirements from collective bargaining negotiations. It also includes an "Approving this bill in near-original form is a major victory for all
health care providers and their patients, as the rejected amendments would have
watered down the intent of this important legislation," Crosby explains.
"However, our work is not done. The AOA is prepared to resume discussions
with members of the Senate to introduce a companion bill the President can sign
into law." Over the past year, the AOA organized the osteopathic community in support of
H.R. 1304 under the direction of its Council on Federal Health Programs. In May
1999, the Council recommended the AOA support the legislation because the bill
addresses the rapid changes in the managed care environment and Read AOA's white paper on collective bargaining at http://www.aoa-net.org/Government/relations/dgrcollective.pdf. AOA’s Department of Governmental Relations worked with the
Federation of American Societies for Experimental Biology (FASEB) to have
osteopathic physician included in its principles for establishing a loan
repayment program. In its original description of the program, only M. D. s
were listed. AOA’s Washington office picked up on this oversight and requested
a correction. FASEB seeks to encourage physicians to pursue careers in
research by instituting a national medical school debt forgiveness program. AOA
supports efforts to address the shortage of physician-scientists in all areas
of research. Physicians would be eligible to receive up to $105,000 for repayment of their educational loans. This sum would
be paid in equal installments over the duration of the three-year program, with
a maximum of $35,000 disbursed per year for debt repayment. The University of North Texas Health Science Center at Fort
Worth launched a new web site in early May, which culminated more than two
years of planning and development. The site now includes information about all the UNT Health
Science Center’s Programs in education, research, patient care and community
service. The web site is designed to be easily navigated from the home page. There are front-page links to the institution’s Texas
College of Osteopathic Medicine, Graduate School of Biomedical Sciences, School
of Public Health and Physician Assistant Studies Program sites. There are also direct links to specific information about the
health science center’s research Institutes for Discovery, the Gibson D. Lewis
Library, Continuing Medical Education and employment opportunities. The site
also contains an expert’s guide listing the clinical and research expertise of
the health science center’s health professionals and researchers. The goal in the design of the site is to make it front door
functional to allow a simple navigation through the various areas of the site.
It is set up in a dynamic format that allows for immediate updates of content
and easy redesign of pages. For the design and development portion of the project, the
health science center contracted with KnightRidder.com, a new online services
division of the Fort Worth Star-Telegram. To view the new site, please go to www.hsc.unt.edu. Incoming UNT president Lt. Gen. Ronald R. Blanck, D.O., was
named a recipient of Mastership in the American College of Physicians
American Society of Internal Medicine. The College has a membership of 120,000, and out of this
group, only 500 are selected to the Masters level by a committee of their
peers. This honor is bestowed upon Fellows of the College in recognition of
their personal character, positions of honor and influence, eminence in
practice or in medical research, or other attainments in science or in art of
medicine. Lt. Gen. Blanck is currently the Surgeon General of the U.
S. Army and commander of the U. S. Army Medical Command, with more than 46,000
military personnel and 26,000 civilian employees throughout the world. He has
most recently served as commander of Walter Reed Medical Center North Atlantic
Region Medical Command and director of professional services and chief of
Medical Corps Affairs in the office of the Surgeon General of the U. S. Army. Lt. Gen. Blanck joins Fort Worth’s health science center
this August. The University of North Texas Health Science Center at Fort
Worth is collaborating with a national renal management group to establish a
chronic care outpatient dialysis facility on the center’s Cultural District
Campus. The facility, which will be known as The Renal Center of
Fort Worth, LLLP, is being created by a partnership between Renal Ventures
Management, LLC, of Golden, Colorado, and Dallas nephrologists to service the
medical needs of the chronic renal population in the Fort Worth area. The new
facility will also allow for educational opportunities for the UNT Health
Science Center’s medical students and residents. Plans call for a 16-chair dialysis facility in the health
science center’s currently existing Office of Clinical Trials building. The
facility is expected to eventually serve 48 dialysis patients per day. Renovation of the building began in June, and the facility
is expected to open in August. The management company, Renal Ventures
Management, LLC, is overseeing the building renovation and will be leasing the
space from the health science center. Dr. Ira Epstein, chief of the nephrology division in the
department of internal medicine at the health science center, will serve as
medical director of the facility, which will be staffed by Renal Ventures
Management, LLC. Diabetes is the number one cause of renal failure, and 50
to 60 percent of all diabetes patients must have dialysis treatments, said Dr.
Epstein of the health science center. With this location, the family members
of dialysis patients will be surrounded by Cultural District attractions while
their loved ones are receiving treatments, making access to care more
convenient. The facility will allow for the development of student
rotation and residency programs to support the educational mission of the
health science center. The development of future education, research and
patient care programs will be on-going, including plans for the creation of a
satellite transplant center and clinical trials for nephrology-specific
research.
Don Self & Associates, Inc.
P.O. Box 1510,
Whitehouse, TX 75791-1510
903-839-7045; Fax 903-839-7069
E-mail: donself@donself.com
Web: http://www.donself.com
DSWOP Surpasses $10 Million Mark in Grants
Health Notes
Herceptin (trastuzumab)
Genetech, Inc. notifies health professionals about serious adverse events with
Herceptin (trastuzumab). There have been 62 postmarketing reports of serious
adverse events related to the use of Herceptin; some of these events resulted
in a fatal outcome. These serious adverse events are characterized by one or
more of the following categories: hypersensitivity, infusion, and
pulmonary reactions. Fifteen patients experienced pulmonary and other adverse
events following Herceptin use, which culminated in a fatal outcome. Nine of
these patients had onset of symptoms within 24 hours of infusion and
subsequently died. A copy of the letter may be found at:
http://www.fda.gov/medwatch/safety/2000/safety00.htm#hercep
Enbrel
see: http://www.fda.gov/medwatch/safety/2000/safety00.htm#enbrel
FYI
http://www.fda.gov/medwatch/safety/2000/safety00.htm#aristo
Actimmune Labeling Change
assay. A copy of the letter may be found at:
http://www.fda.gov/medwatch/safety/2000/safety00.htm#actimm
Lamictal and Lamisil Dispensing Errors
http://www.fda.gov/medwatch/safety/2000/safety00.htm#lamict
Drug Shortages
User Facility Bulletin Online
following topics:
http://www.fda.gov/cdrh/fusenews/ufb30.pdfGuidance for Adverse Reactions Labeling
The FDA Plans to Simplify Warning Labels on
Pharmaceuticals to Encourage Physicians to Read and Comply with Them
The Number of New Cancer Cases in the U.S. Declined an Average of 0.8
Percent a Year from 1990 to 1997
Prostate Cancer Treatment
Recommendations Vary Significantly According to a Physician’s Specialty
Medicare to Cover Device for Treating Severe Rheumatoid Arthritis
In Brief
The Statistic that Between 44,000 and 98,000 Hospitalized
Americans are Killed Each Year by Medical Errors, Cited in a Report Last Year
by the Institute of Medicine (IOM), is Greatly Exaggerated, According to a
Recent Study Published in the Journal of the American Medical Association
The Medicare Payment Advisory Commission (MedPAC)
Recommended a Payment Increase for the Nation’s Hospitals
Medicare patients who require more expensive than average treatment, the
Associated Press added.
(Associated Press, 5-31-2000)The U. S. Ranked 15th
Among the World’s Nations on an Overall Index of Health Goals Released by the
World Health Organization
The U. S. Supreme Court Unanimously Ruled that Patients
Cannot Sue HMOs Under Federal Law for Improper Medical Treatment Resulting from
Cost-cutting Incentives Given by HMOs to Physicians
Medicare Could Save Up to $167 Million Annually if it
Reimbursed for a Set of Six Emphysema, Asthma and Dialysis Drugs at State
Medicaid Rates, According to Recent OIG Studies
The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) is Considering Shortening its Accreditation Cycle
The Office of Inspector General (OIG) Issued Draft
Voluntary Compliance Guidelines to Help Physicians in Solo and Small Group Practices Prevent Errors, Fraud and Abuse
When Coding and Billing for Federal Health Programs, Including Medicare and
Medicaid
Cigna Corp. is Abandoning its Medicare HMO in 13 of its 15
Markets Because of Law Federal Reimbursement Levels
The Office of Inspector General (OIG) Published its Final
Rule Exempting the New System of Records for the Healthcare Integrity and
Protection Data Bank from Certain Provisions of the Privacy Act
on civil judgments against health care providers, suppliers and practitioners
in federal or state courts related to the delivery of a health care item or
service, with the exception of malpractice judgments; federal or
state criminal convictions; final adverse actions by federal or state agencies
responsible for the licensure and certification; and exclusion from
participation in federal or state health care programs. (Delaware Valley Healthcare Council, 6-2-2000)
PPOs Now Account for 50 Percent of the Commercial Managed
Care Market Nationwide, While HMOs Claim a 40 Percent Share
The U. S. Supreme Court Turned Away Without Comment an
Appeal from 181 Hospitals Claiming that they were Underpaid for Care Provided
to High-cost Medicare Patients
between five and six percent of the total projected payments for a given year,
reported the Associated Press. The hospitals sued the government after the
Department of Health and Human Services based the additional payment amounts on
projections made at the beginning of fiscal 1985 and 1986 that fell short of
actual payments. The Supreme Court deferred to the government's decision that
retroactive payments were not required, but ordered the government to explain
how it projected its Medicare reimbursement rates upon which the payments for
high-cost treatment were based, the Associated Press added. (Associated Press, 5-30-2000)President Clinton Directed Medicare to Cover Routine Patient Care
Associated with Clinical Trials
Health Insurers Appear to be Rethinking Capitation and
Shifting to Discounted Fee-for-service Reimbursement
The U. S. Senate Voted to Table the Federal HMO Patient Bill of Rights
The Clinton Administration is Offering to Simplify
Regulatory Requirements to Slow the Departure of HMOs from the Medicare Program
A Pilot Study is Underway Examining the Possibility of
Setting Up a National System to Monitor the Quality of Cancer Care
A Chicago-based Health Insurer Plans to Offer a
Fee-for-service Alternative to Traditional Medicare and HMOs in 17 States
The FTC Approved Pfizer Inc.’s Purchase of Warner-Lambert
Co., Creating the World’s Largest Manufacturer of Pharmaceuticals
A Small Percentage of Patients Use External Appeal
Mechanisms Available Under State Law to Appeal Conflicts Over Managed Care
Decisions
A Fresh Batch of Lawsuits has Been Filed Against Managed
Care Companies Alleging That They are Misleading Health Plan Members
HCFA Published its Final Medicare+Choice Rules
The House Passed the Quality Health Care Coalition Act,
Which Would Enable Independent Health Professionals to Collectively Bargain
with Health Plans, By a Vote of 276 to 136
Health for the Whole Family
In an effort to gauge the effectiveness of the Health for the Whole
Family series, the AOA asks that they be notified as to where the articles have
appeared and who is featured as the spokesperson. This information may be faxed
to 312-202-8340 or mailed to: Mary Ann M. Pagaduan, Public Relations
Specialist, AOA, 142 East Ontario Street, Chicago, IL 60611. Meet the Villain: Migraines
headache cases may incapacitate a person. People should also keep in mind that
physical activity may exacerbate the headache.
suffering from migraines," says Dr. (insert name). "They typically
decline in frequency as women age."Impetigo - A Common Skin Infection Among Children
News from the American Osteopathic Association
Osteopathic Community Celebrates Victory of D.O. Appointment to MedPAC
American Public Wins Back Quality Health Care With Collective Bargaining Victory, Says the AOA
AOA-backed measure crafted by Representative Danny Davis (D-IL) to ensure
medical treatment decisions are made by health care professionals and the
patient. The House approved H.R. 1304 by 276-136-2
their impact on quality health care.Repayment Program to Include D.O.s
News from the University of North Texas Health Science Center at Fort Worth
UNT Health Science Center Launches New Web Site
Incoming UNT Health Science Center President Receives National Honor
UNT Health Science Center Establishes Dialysis Center
