Contact Information

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Austin, TX 78701-1634
Phone:
(512) 708-8662
Fax:
(512) 708-1415
toma@txosteo.org

In Brief

The Bush Administration Delayed Federal Rules That Govern How Patients Can Appeal Health Plan Decisions

Under the delayed rules, patients would have been given 180 days to appeal a health plan's decision, up from the current 60 days, and plans would be required to fully disclose their procedures and give specific reasons for denials. The administration said that plan sponsors, service providers and state regulators have raised a number of issues concerning the interpretation and application of the various provisions and requirements of the regulation that apply to group health plans. The administration said more guidance was needed to ensure efficient and effective implementation of the new rules, delaying them at least six months and not more than one year. (Associated Press, 7-9-01)

A Significant Number of Working Americans Whose Employers Offer Health Insurance Can’t Get Coverage Because of Eligibility Barriers, According to a Study Published in Health Affairs

The study noted that employer policies such as waiting periods for new employees and exclusions for part-time employees, as well as high employee contributions for health insurance, often deter workers from signing up for coverage even when they are eligible. The study found that only 31 percent of new employees has workplace health coverage that starts immediately; 11 percent of all employees working for employers offering health plans face waiting times of four months or more; only 41 percent of part-time workers are eligible to join a health plan that is available to their full-time co-workers; and health plan participation rates fall sharply as the employee premium shares increase, with the drop-off steepest among firms with concentrations of low-wage employees. (Health Affairs, July/August, 2001; U.S. Newswire, 7-10-01)

President Bush Hopes to Promote the Use of Pharmacy Discount Cards by elderly Americans as an Interim Step to Larger Changes in Medicare

Such cards are issued by buyers' clubs organized by private companies that negotiate discounts with drug manufacturers and pharmacies, such as a discount plan run by Merck-Medco and the Reader's Digest Association. Such pharmacy discount cards are not insurance or a substitute for proposed Medicare drug benefits, but offer seniors discounts of 10 percent to 30 percent or more at pharmacies for a small annual fee. The administration is exploring ways to promote use of the cards by presidential action without a need for immediate legislation or federal spending. (New York Times, 7-11-01)

Blue Cross of California is Launching a Plan to Reward Doctors for Getting High Marks from Patients Rather Than for Cutting Costs

Under the new program, California's fourth largest HMO will survey patients, monitor their grievances and interview people when they switch doctors to determine why, while offering physicians a bonus of up to 10 percent. Physicians also will be evaluated on how well they provide preventive health measures, such as breast and cervical cancer exams. (Associated Press, 7-10-01)

Government Prosecutors and Private Attorneys are Preparing Dozens of Lawsuits Against the Pharmaceutical Industry and Health Care Providers Over Alleged Drug Price Inflation, Fraud and Kickbacks

The U.S. Department of Justice, the Federal Trade Commission, state attorneys general, class-action lawyers and health care whistleblowers are lining up to pursue pricing cases, accusing drug companies of fraud and kickback schemes such as inflating federal drug reimbursement rates, paying physicians to switch patients to their products, and colluding with generic drug manufacturers to delay or halt the release of generic medications. Cases against health care providers accuse them of selling free samples and switching patients to drugs with more profitable reimbursements. (Philadelphia Inquirer, 7-15-01)

Ten Percent of U.S. Hospitals Were Accused of “Dumping” Patients Who Come to the Emergency Department Despite Federal Legislation Barring the Practice

According to findings released by Public Citizen, confirmed violations of the Emergency Medical Treatment and Active Labor Act (EMTALA) occurred at 527 hospitals between 1997 and 1999, while more than 90 percent of violators breached the law's screening, treatment and transfer provisions. The report noted that for-profit hospitals were nearly twice as likely as not-for-profit hospitals to violate the anti-dumping law. The report concluded that some violations may be related to individual hospital practices
and deficiencies, and called for legislation or regulation to force insurers to cover screening and stabilization treatment without prior authorization. (Yahoo News, 7-12-01)

Americans Who Visited a Doctor’s Office in 1999 Were Far More Likely to Receive More than One Drug Than They Were in 1985

A National Center for Health Statistics survey of office-based physicians found that 66 percent of visits to doctors in 1999 resulted in patients receiving a medicine or a vaccine, compared with 61 percent in 1985, with 146 drugs prescribed per 100 visits in 1999, a 33 percent increase over the 1985 figure of 109 drugs
per 100 visits. The increasing reliance on prescription medicines spanned all ages of patients and almost all classes of drugs, with the exception of antibiotic prescribing, which declined by 14 percent in 1999 compared with 1985. The increase in prescribing was attributed to the aging of the population, more and better medicines on the market, new guidelines leading doctors to treat chronic conditions more aggressively, and the promotion of drugs directly to the public. According to the Pharmaceutical Research
and Manufacturers of America, 370 new drugs were marketed during the 1990s, compared with 233 in the 1980s, while generic drugs comprised 47 percent of doctors' prescribing in 2000, compared with 19 percent in 1984. (Washington Post, 7-18-01)

Federal Officials Notified Johns Hopkins University That It Must Suspend All Federally Supported Medical Research Involving Human Participants

The order by the U.S. Office for Human Research Protections affects hundreds of clinical trials involving more than $300 million and precludes Johns Hopkins from enrolling any new individuals in those trials for an undetermined period of time. The move came three days after the school's medical leadership released an investigation committee's report on the June 2 death of a healthy young volunteer in a Hopkins asthma study, blaming the project's principal researcher and an internal review board for inadequately scrutinizing the risks of the chemical used and not sufficiently warning participants who would inhale it. (Washington Post, 7-20-01)

Geographic Location Far Outranks Other Considerations When Final-Year Medical Residents are Weighing Practice Options, and Any Community with a Population Less Than 50,000 is Undesirable to Most New Doctors

That's the response from 73 percent of 300 residents nationwide to a survey by Merritt-Hawkins & Associates. Other than the quality of care provided at a hospital or in an area, top considerations included good financial packages and adequate call and coverage areas, while specialty support was only a top priority for two percent of those surveyed. (Dallas Business Journal, 7-16-01)

Two Major Pharmacy Groups Filed a Lawsuit Opposing the Bush Administration’s Drug-Discount Card Proposal for Medicare Beneficiaries

The National Association of Chain Drug Stores and the National Community Pharmacist Association claimed that the administration doesn't have authority to implement the discount program without
permission from Congress, and said the administration violated federal rules because it didn't seek public comment or hold open meetings before formulating the program. The administration's discount card proposal would allow Medicare beneficiaries to sign up for a card that would provide discounts of about 25 percent for prescription drugs purchased in pharmacies, with pharmacy benefit managers to negotiate with drug makers and pharmacies to provide the discounts. (Wall Street Journal, 7-18-01)

The Federal Agency for Healthcare Research and Quality Released an Evidence-Based Report on Clinical Practices to Increase Patient Safety in Hospitals

Based on a study of medical and other scientific literature and consultations with health experts, the report compiled a review of 79 patient safety practices, including: giving patients antibiotics just before surgery to help prevent wound infection, using ultrasound to help guide the insertion of central intravenous lines
and prevent punctured arteries, and giving patients beta blockers to prevent heart attacks during and after certain operations. The agency said the report is not meant to dictate to hospital policy makers, but rather to help foster discussions of procedures and create a culture of safety tailored to patients. (Scripps Howard News Service, 7-17-01)

A Federal Judge has Ordered Medicare Officials to Disclose Their Findings Whenever They Investigate a Consumer’s Complaint That a Doctor or a Hospital Provided Poor-Quality Care or Committed Medical Errors that Injured the Patient

The ruling by a Federal District Court Judge in New York overturns a policy-defended by both the Clinton and Bush administrations-that relied on a physician peer review process rather than disclosure of physician data to Medicare beneficiaries in such cases. The judge rejected the previous policy as contrary to the federal Medicare statute, noting that a beneficiary who files a complaint is entitled to know whether medical services meet professionally recognized standards of health care regardless of whether doctors give their consent, and ordered the Department of Health and Human Services to start disclosing the results of such investigations. (New York Times, 7-17-01)

A National Database was Awarded for its Online System to Publicize Physician Disciplinary Data

The Federation of State Medical Boards recently was elected to the 2001 Associations Advance America Honor Roll for the creation of the Federation Physician Data Center, which offers public access to consolidated state medical board disciplinary data. The data system, accessible by consumers online at www.docinfo.org, contains more than 117,000 actions taken against some 35,000 physicians dating to the early 1960s. The report produced during each search lists the type of disciplinary action, if any, indicates the medical board or agency that initiated the action, and the date and reason the action was taken.
(Federation of State Medical Boards, 7-13-01)

Barriers to the Use of Online Disease Management Coaching Tools are More Likely to Include Lack of Access to Computers and Lack of Time Rather Than Concerns About Privacy or Lack of Interest in the Materials

According to a survey on online disease management coaching tools by the consumer health advocacy organization, Foundation for Accountability (FACCT), 93 percent of survey respondents cited lack of time and access to computers as the key reasons for not making use of the tools, while only two percent cited concerns about privacy and five percent said they weren't interested in the tools. FACCT suggested that widespread use of the instruments will take time to develop. (IPRO Health Care Quality Watch, July, 2001)

A National Nonprofit Organization Plans to Issue Accreditation Standards for Health Web Sites by the End of July

The American Accreditation Health Care Commission, which sets quality standards for managed care companies and is known as URAC from a former name, will issue more than 50 criteria that Internet health sites must meet to win its seal of approval, including guidelines for advertising, privacy policies and reliability of information. URAC expects 25 to 50 companies to apply for accreditation this summer and will charge a $5,000 application fee plus additional charges for further assessment, but is considering a sliding scale for smaller sites. URAC said it will conduct annual reviews of each site it accredits to verify compliance, will investigate consumer complaints, and may require corrective action or revoke accreditation. (Wall Street Journal, 7-20-01)

Two State Medical Societies Sued the Federal Health Department, Claiming That New Rules Governing Patient Access to Medical Records are Burdensome and Unconstitutional

The South Carolina Medical Association and the Louisiana State Medical Society want to overturn the U.S. Health and Human Services Department's regulations that grant patients the right to see their records and to control who reviews them, claiming that the new rules will increase health care costs, create more paperwork and impede hospital pre-admission procedures. The medical societies also claim the rules are unconstitutional because they were drawn up by the federal agency with little congressional input.
(Associated Press, 7-16-01)

Studies Suggesting That Medical Errors Kill Up to 98,000 U. S. Hospital Patients Each Year Overestimate the Problem, According to a New Study Published in the Journal of the American Medical Association

The new study said that studies such as one by the Institute of Medicine are flawed because there was little consensus among the doctors consulted on what constitutes a deadly error, and because previous studies did not consider whether the patient would have died even if the error hadn't occurred. The new study, which looked at 111 hospital deaths at seven Veterans Affairs hospitals from 1995 to 1996, estimated that between 5,000 and 15,000 deaths annually are due to errors, and found widely varying opinions among doctors on whether an error directly led to death, and even on what constituted an error. (Associated Press, 7-24-01)

HCA Inc.’s Shares Rose to a Four-Year High on Second-Quarter Earnings Results

Propelled by increased admissions and the extraction of better prices from government and managed care insurance payers, the national, for-profit hospital chain reported net income of $263 million for the quarter ended June 30, compared to a $272 million loss during last year's second quarter. Combined same-facility hospital admissions for the quarter rose a healthy 4.2 percent, while revenues per inpatient admission increased 10.9 percent on a same-facility basis. (Tennessean, 7-24-01)

Unauthorized Disclosure of Medical Information Can Be Malpractice

In a recent ruling, the Washington Supreme Court held that a breach of confidentiality can form the basis of a medical malpractice claim. In Washington, a medical malpractice claim exists if a health care provider fails to exercise the degree of care exercised by a prudent health care provider, and that failure proximately causes injury. The state also has a Uniform Health Care Information Act that bars health care providers from disclosing health care information about a patient without the patient's written consent. In this case, the court held that patient was entitled to file a claim against her physician for unauthorized disclosure of confidential information, and that Uniform Health Care Information Act was not the sole or exclusive remedy for the disclosure. The patient/plaintiff's physician discussed her condition with the plaintiff's ex-husband, also a physician, without the patient's consent. The patient then sued her physician under the state's medical malpractice statute, seeking damages for emotional distress and litigation expenses allegedly resulting from her physician's disclosure of confidential information to her ex-husband. The Supreme Court upheld the plaintiff's right to sue under the malpractice statute. (Vinson & Elkins Health Headlines Newsletter, 7-30-01)


A Bill Introduced in Congress Would Prevent Companies From Changing Health Benefits After a Worker Retires

The proposal by Rep. John Tierney (D-Mass.) would also require companies to undo changes they've already made, such as requiring retirees to pay more in contributions. The bill was criticized by the Washington-based trade association known as ERIC-the Erisa Industry Committee-as penalizing companies that offer retiree health benefits, and as being likely to cause even more employers to drop retiree coverage. Currently, only 37 percent of companies nationally offer health coverage to early retirees and 26 percent to those over age 65, according to a recent General Accounting Office report. (USA Today, 7-26-01)

A Bill That Would Help Public Hospitals Provide Free and Discounted Preventive Care to Undocumented Immigrants Without Running Afoul of Federal Law was Introduced in the U. S. House

The measure, introduced by Rep. Gene Green (D-Houston), would give local authorities, such as a county or a hospital district, the power to decide whether to provide preventive care to undocumented immigrants. Green introduced the bill in response to a recent legal opinion by Texas Attorney John Cornyn which said that the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 prohibits public hospitals from providing most preventive health care to people in the country illegally. (Houston Chronicle, 7-25-01)

© 2002 Texas Osteopathic Medical Association
Last updated 01/14/2004