April 2003

Compensation Complaints: HMO Executives See Smaller Salary Increases
The big packages of the 1990s are long gone. Mergers mean stiffer competition for fewer positions.

Ed Silverman

Cover Story

Unprepared for the Boomers
Can MCOs cope with conflicting demands for cost shifting, comprehensive care, and new services for an extremely influential demographic?

John Carroll

Despite Kaiser Settlement Guidelines on Web Unlikely
HMOs are not rushing to follow the lead of the largest not-for-profit health plan because they fail to see how this makes them more competitive.

Maureen Glabman

The Thin Line Between Malpractice and Benefit Determination
A federal court of appeals says that some benefit denials are really medical treatment decisions. Medical directors, take heed.

Jack A. Rovner ; Douglass G. Hewitt

FTC and Justice Department Find Some IPAs Go Too Far in Bargaining
Federal law restricts the leverage given to negotiators for physician associations. Plans should know what is, and what is not, legal.

John W. Jones

Peer-Reviewed

Management of Moderate to Severe Plaque Psoriasis With Biologic Therapy
The impact of this debilitating disease has been largely underestimated, yet new biologic agents offer significant clinical benefit to those afflicted.

David M. Pariser, MD

Editor’s Memo

Boomers Will Want It All

John A. Marcille

Legislation & Regulation

AWP Reimbursement Scrutinized by Several States
Several attorneys general have joined the U.S. Justice Department in questioning some AWP billing and reimbursement practices in Medicaid and Medicare.

John Carroll

Ethics

Non-Face-to-Face Services Deserve HMO Coverage Too
If a doc is compensated when he schedules a patient visit to convey the routine results of a lipid test, but not when he phones the patient, which behavior will he choose?

Michael S. Victoroff, MD

Compensation Monitor

Economic boom of '90s left many physicians behind
The Formulary Files

COX-2s Lose Favor
Tomorrow’s Medicine

Promising Compounds Portend Major Management Problems
It is expected that by 2004, 197 biologic medications will be available. Just what kind of an impact will they have on managed care?

Thomas Morrow, MD

Managed Care Outlook

Managing chronic illness becomes more crucial



News & Commentary

Feds Seek Connection Between Mergers, Escalating Costs

Uninsured Tracked Over 2-Year Period

Some Worry Quality Suffers In Move To Tier Physicians

Consumer-directed plans face employer skepticism

Drug Benefit Called Vital In Medicare DM

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