Friday, October 20, 2000
2000 Capitation Survey Shows Rates Improving Dramatically for Providers; Many Seeking More Risk Agreements
Health care provider organizations that have hung tight during the dark days of risk contracting are beginning to see a payoff for their persistence. Respondents to National Health Information’s just-released 2000 Capitation Survey(TM) report significantly higher PMPM rates in nearly all categories and specialties.
[PR Newswire 2000-10-19]
A fight to die without poverty — Legislation would give ALS sufferers Medicare coverage
Congress is considering legislation that would give those afflicted with ALS immediate Medicare coverage, sparing them from raiding their children’s college funds or selling their homes to pay for health care.
[USA Today 2000-10-19]
Insurance in New York — New York ranks HMOs by complaints
The New York Department of Insurance has published its second annual consumer guide to health insurers that ranks the state’s major insurers and HMOs by numbers of upheld complaints.
Hospitals Fail to Report Bad M.D.s, Experts Say/State committee hears malpractice horror story
California’s health care system is failing to identify and deal with problem doctors, posing a threat to patient safety, according to testimony yesterday from health care experts and state regulators.
[SF Gate 2000-10-19]
Florida HMO Layoffs Signal Shutdown
Conversations ending with “goodbye,” and accompanied by tears, punctuated the third floor of Florida Health Choice’s Delray Beach headquarters Wednesday as the financially ailing HMO headed toward extinction.
[South Florida Sun-Sentinel 2000-10-19
Medicare “Giveback” Veto May Harm Seniors
The lead lobbying group for HMOs warned on Wednesday that seniors would lose a “vital safety net” if President Clinton vetoes a $27 billion bill to restore some of the money cut from Medicare provider payments under the 1997 Balanced Budget Act.
[Reuters via Yahoo 2000-10-19]
Doctors, Wellmark in dispute — HMO contract at stake
The Iowa Clinic of Des Moines, one of the largest doctors’ groups in the state, will stop participating in the health maintenance organizations (HMOs) of Wellmark Health Plan of Iowa Inc. on Jan. 1 unless contract issues can be resolved, representatives of the clinic and Wellmark said Monday.
[Des Moines Register 2000-10-17]
Thursday, October 19, 2000
New Jersey fines 21 health insurers and HMOs for late payments
The state has fined 21 health insurance companies and health maintenance organizations a total of $575,000 for failing to pay claims promptly.
No secret handshakes here
They’re not listed in telephone directories or the American Hospital Association Guide. You won’t find minutes of their meetings anywhere; their meetings aren’t even publicized. But an elite group of hospital association heads may exert an influence far greater than the number of its members.
[Modern Healthcare 200-10-16]
Partners cuts Blue Cross deal – CareGroup renews pact with Tufts
It took more than six months of intense negotiations, but Partners HealthCare announced yesterday it will continue to provide health care to Blue Cross customers under a four-year deal.
[Boston Herald 200-10-18]
Closure of Medical Group Creates Chaos
SIMI VALLEY–Doctors and insurance providers scrambled Tuesday to bridge a sea of “utter chaos” created by the abrupt closure of Ventura County’s largest medical group. The demise of Family Health Care Medical Group appears to have already cut 50,000 patients off from their doctors.
[LA Times 2000-10-18]
Wednesday, October 18, 2000
E. Maine hospital group unveils plan to lower drug prices
A hospital subsidiary announced a plan Tuesday to lower prescription drug prices for thousands of Mainers by getting the drugs from a pharmacy in Canada, where prices are much lower.
Officials To Suggest Medicare Veto
WASHINGTON (AP) – Administration officials told Republican leaders Tuesday that unless they do a major overhaul on a multibillion-dollar Medicare package in Congress’ final days, they will ask President Clinton to veto it as too neglectful of patients and too generous to managed care companies.
Boom times for disease management leave doctors wanting more control
William A. Fawcett IV, MD, had no idea that a local health plan had hired a disease management firm to manage members with certain chronic illnesses. But then the Beaumont, Texas, allergist-immunologist started hearing from patients who had received phone calls from the company.
[ACP-ASIM Observer, October 2000]
Region’s Largest Medical Group Fails
SIMI VALLEY–Under the weight of a growing $6-million debt, Ventura County’s largest medical group laid off 300 employees and moved toward dissolution Monday, leaving 135,000 displaced patients to contact their health insurers to arrange for future coverage.
[LA Times 2000-10-17]
Column by Dave Barry
Aside From God, who has been endorsed by both major political parties, the big issue in the presidential campaign is health care. Every time we turn on the TV, we see either an ad from the Republicans telling us how horrible Al Gore’s health care plan is, or an ad from the Democrats telling us how horrible George W. Bush’s plan is.
[via Washington Post 2000-10-15]
Texas health plans want doctors’ groups to meet strict new financial standards
Frustrated by the turmoil created when physicians’ groups run into financial trouble, Texas health plans now want the doctors to meet some of the same financial standards they do.
[Wall Street Journal 2000-10-18]
Washington state welcomes back individual health insurance
Group Health, Premera Blue Cross, and Regence BlueShield all say they will begin offering individual health plans in December. The move is the direct result of the state’s new market-reform law, enacted on Oct. 5, that allows insurers to use an approved 13-page health-screening questionnaire to reject the sickest 8 percent of applicants.
State allows purchase of HIP by physician
Dr. Steven M. Scott, who already controls three struggling HMOs, took on perhaps his biggest challenge Tuesday when the Florida Department of Insurance allowed him to buy financially troubled HIP Health Plan of Florida Inc. and a smaller affiliated company for $40 million.
[Florida Sun-Sentinel 2000-10-17]
State takes over HMO
The state took over an HMO covering 70, 000 people in southeastern Wisconsin under a court order Monday. All enrollees of Family Health Plan Cooperative Inc. will be covered by other providers, including Compcare Health Services Insurance Crop., Blue Cross and Blue Shield United of Wisconsin and Aurora Health Systems.
[Minneapolis Star Tribune 2000-10-16]
Tuesday, October 17, 2000
Health care system gets ‘Critical’ diagnosis
“We have a system in America where it’s almost impossible to find out who’s doing the best job, who’s doing the worst and who’s average,” Critical Condition producer Hedrick Smith says. “It’s stunning. In New York state, you would be better off someplace in Buffalo or Albany than in one of those fancy East Side (Manhattan) hospitals, and the same is true in Washington (D.C.) and L.A. and Houston.”
PBS series airs Wednesday 10/18
[USA Today 2000-10-16]
Web site helps cancer patients get help
A new Web site — www.findcancerexperts.com — is designed to help those who have been diagnosed with cancer obtain a second opinion. It can put them in touch with a nationwide network of 50 leading cancer diagnosticians.
[USA Today 2000-10-16]
Outreach to Children and Families Helps Boost Medicaid Rolls
Medicaid enrollment rose by 1.1 million people, or 3.6%, in the year ended in December, according to survey results released today.
[Reuters via Medscape 2000-10-15 (reg.)]
The Price Is Wrong
Most doctors know that the cost of the drugs they’re prescribing is important to patients, according to a new study, but many of them don’t know the price of even common medications.
[Bergen Record 2000-10-16]
WebMD Goes Into Post-Op
After the founder and co-CEO resigns, can the online health company recover?
HMO Consolidation Wreaking Havoc With Physician Reimbursement
. . . Matthews’ point is that the larger physician networks and IPAs have the clout to negotiate better rates, so the HMOs go to smaller groups with “their less favorable contracts, to make up for what they left on the table” with the larger groups. “There are good plans and bad plans — and if you’re not a large [group], you’re not going to even be invited to the party. You’re going to get the dregs,” Matthews says, when the contracts are passed out.
Site reading: Physicians grapple with recommending web sites
Doctors have different opinions on referring online-savvy patients to Internet health sites, but they agree that you should be aware of what your patients are seeing.
[American Medical News 2000-10-23]
Facing down the drug giants
If Eli Lilly executives expected Dr. Annette Hanson to back down when they paid her a visit last fall, they must have been disappointed.
[Boston Globe 2000-10-17]
Advertising giant will track what you read on the Web
Omnicom, a company that represents major drugmakers, is acquiring e-health firms to obtain access to physicians’ and patients’ personal information.
[American Medical News 2000-10-23]
Monday, October 16, 2000
FROM MANAGED CARE MAGAZINE
COMPENSATION MONITOR: Capitation: How well is your back covered?
[Charts] Make no mistake: Capitation — despite the beating its reputation has taken of late — isn’t out of fashion. In fact, its prevalence is increasing, with 14 percent more physician groups having some involvement in capitation last year than in 1998. But to succeed under capitation, physicians and other providers need a strategy for protecting themselves in the face of catastrophic loss. A new survey by Evergreen Re, a Florida-based health care reinsurance broker, suggests that an understanding of this is dangerously lacking among many providers.
Poll: Prescription Drugs Major Issue
About six in 10 Americans consider prescription drugs a “very important” issue in their vote for president, an Associated Press poll indicates, and about that many say either they or someone in their family takes such medicines regularly.
Would drug imports help or hurt the consumer?
Congressional moves to give consumers access to cheaper prescription drugs from abroad are raising a host of questions, with often-contradictory answers. The legislation, which will permit pharmacies and wholesalers to import medicines approved by the Food and Drug Administration, was passed by the House earlier this week and will be passed by the Senate in coming days. President Clinton, despite reservations, has indicated he will sign it.
[MSNBC/Wall Street Journal 2000-10-13 (free)]
Experiments shifting decisions on health-care plans to workers
MINNEAPOLIS – The state that helped launch HMOs is now watching two experiments that could transform how patients receive and pay for medical care. Both projects try to shift responsibility for health-care decisions to workers and eliminate managed-care companies as negotiators, rule makers and second-guessers.
[Dallas Morning News 2000-10-15]
Doctor comedy duo out to make a point too
Doctors frustrated with the endless red tape and bureaucracy associated with managed health care could take a page out of Barry Levy and Greg LaGana’s book. In addition to fighting it, the classmates from Cornell Medical School decided to spoof it.
Michigan: Specialist Shortages Cause Patient Care Delays
In a “largely unanticipated shift,” a shortage of specialists exists outside of the Detroit metropolitan area, the Detroit Free Press reports. Patients can expect to wait “a month or longer” for care from specialists across many parts of the state.
Despite Costs, Employers Stick with Health Benefits
. . . Yet many employers remain wary of “defined contribution,” one of the most talked-about strategies in health benefits today. Only 45% of William M. Mercer survey respondents are interested or moderately interested in such a strategy, while merely 8% report a high level of interest.
[Reuters via Yahoo 2000-10-13]
Orange County, Calif., Health Care System Plans to Retain Few HMOs
St. Joseph Health System, Orange County’s largest medical provider, said Friday it will drop all but four HMOs next year a move that could force as many 150,000 patients to choose between their doctors and their health plans.
[Orange County Register 2000-10-14]
PacifiCare in Grave Condition With No Quick Cure in Sight
Company sees business model crumble and stock drop more than 80%.
[LA Times 2000-10-14]
Highmark clients wondering what tests are covered
As many as 200,000 Highmark Blue Cross Blue Shield customers have been receiving letters saying the insurer may no longer pay for common medical tests it covered in the past.
[Pittsburgh Post-Gazette 2000-10-13]
HMOs experience life without the upper hand
Hospitals, once desperate for market share, are now raising contract rates for managed-care companies
[Dallas Morning News 2000-10-16]
Week of: 11/19/2000 – 11/25/2000
Week of: 11/26/2000 – 12/02/2000
Week of: 12/03/2000 – 12/09/2000
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Paul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweißen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen.