Friday, January 05, 2001

Harried Doctors Try to Ease Big Delays and Rushed Visits
The transformation of the Anchorage clinic is part of a new movement in the practice of medicine that is trying to improve the age-old and often disheartening experience of a visit to the doctor’s office. It is aimed at placating patients who are fed up with long waits for appointments, jammed waiting rooms and rushed visits. And it is led by some of the very doctors whose patients were so angered. The doctors, annoyed themselves, decided that there had to be a better way.
[NY Times 2001-01-04]


Is Obesity a Disease?
The Food and Drug Administration and the National Institutes of Health consider obesity a disease. But for the most part, the Internal Revenue Service (IRS) and Medicare aren’t buying it.
[Washington Post 2001-01-02]


Showdown looms over Colorado Medicaid
State legislators will consider massive cuts in Medicaid payments to hospitals, HMOs and care providers to comply with voter-mandated spending caps when the Colorado General Assembly convenes next week.
[Denver Post 2001-01-04[


Why provider-sponsored health plans don’t work
Providers hoping to start their own health plans to disengage from third-party managed care payers may not achieve the benefits they expect.
[Healthcare Financial Management 2001?-01-01]


Suit against insurer breaks legal ground
In a typical medical malpractice case, the patient claims negligence. But in this case, the Gordons accuse Optima of illegally practicing medicine by overruling the medical judgments of their daughter’s doctors in Connecticut.
[Pilot News (Hampton Roads, Va.) 2000-12-18]


Thursday, January 04, 2001

‘The Best Is Yet To Come’: Managed Care for Affluent Elderly?
Although they’re an old form of managed care, the best continuing care retirement communities (CCRCs) strive to be life maintenance organizations.


HMO Market Shakeout Continues: Report Shows Some Surprises
The HMO industry shakeout that started 3 years ago continued apace last year. For reasons ranging from mergers and acquisitions to outright failure, 83 U.S. HMOs ceased operations between January 1999 and January 2000, according to the latest InterStudy HMO Industry Report. And as a sector, HMOs lost more than 400,000 enrollees during the same period — the first annual decline since 1973.
[WebMD 2001-01-03]


Rift Forcing Members Of Blue Cross To Switch
Health insurance contract negotiations between Sutter Health and California Care, the Blue Cross health maintenance organization, have collapsed, forcing several thousand people in Sonoma and Lake counties to switch medical groups if they want care at Sutter hospitals.
[Press Democrat (Santa Rosa, CA) 2001-01-03]


Outlook 2001: HMOs benefit from pruning
While the bloom hasn’t yet faded from the managed-care rose, the garden has certainly grown rocky. Though managed-care plans will continue to reap the benefits of hefty premium hikes and tighter cost controls in 2001, the industry’s health could be complicated by threats of new federal regulation, improved bargaining power among providers, consumer distrust and a barrage of lawsuits targeting leading HMOs.
[Modern Healthcare 2001-01-01]


Wednesday, January 03, 2001

A Conversation with Becky J. Cherney: Refusing To Accept The Status Quo
The CEO of a large Florida employer coalition insists that the information that companies are beginning to demand will force the industry to change.


No-Holds-Barred Contracting Clashes Now Norm in California
. . . For example: Physician groups and IPAs once sent termination notices to health plans only as a last resort. Today, the practice has become common, and it’s happening on both sides of the fence — now plans send such notices to physicians when a plan suspects it has overlapping coverage with IPAs.
[WebMD 2001-01-03]


High court doesn’t decide case on health-care lawsuits
The Supreme Court backed out of deciding whether health-care plans can sue to enforce some plan requirements.
[AP 2001-01-02]


Physicians say no to automatic therapeutic drug substitutions
The AMA reinforced its stand against automatic therapeutic substitution by pharmacists without physician authorization and pledged to work at the state level to maintain and establish laws protecting patients from generic substitution of critical-dose drugs.
[AM News 2001-01-08]


Breast cancer survivors battle for follow-up care
. . . to a cancer patient for whom every moment counts, the health insurance industry seems unbearably slow to accept innovations in diagnosis and treatments that could dramatically improve quality of care and cut costs.
[Tennessean 2001-01-01]


Florida doctors charge racial discrimination by Humana after being dropped from panel
Primary care physicians say Humana dropped them because they are members of minority groups.
[AMNews 2001-01-08]


Consumers Visit Health Sites But Satisfaction Remains Low
. . . “People want to be able to do more health-related transactions on the Internet, even if it is just booking their next visit to the doctor or getting their lab results online,” Mr. Taylor says. More than 80% of respondents in one Harris survey for an e-health company said they wanted e-mail reminders for preventive care based on their medical history and follow-up e-mails after visits to the doctor.
[Wall Street Journal 2000-12-29 (subscription reqd.)]


Drug Shortages Become Worry at Hospitals Around the Country
Doctors, pharmacists and federal regulators are increasingly concerned about what they say is a growing number of drug shortages, particularly at hospitals. Where a few years ago a hospital might experience a shortage of one or two critical drugs a year, the number in the last year has been closer to two dozen at some hospitals, doctors and pharmacists say.
[NY Times 2001-01-03]


Out-of-pocket expenses for Medicare beneficiaries projected to skyrocket
The amount of money that seniors and other Medicare beneficiaries pay out-of-pocket for healthcare services is expected to rise drastically over the next 25 years, with some groups projected to spend over 70% of their personal income simply to meet costs that Medicare does not cover, according to a report released Tuesday by the Urban Institute think tank.
[Reuters via Newsrounds 2001-01-03 (reg.)]


Wrong MDs Got Patient Records / Psychiatric privacy violated
Health Net violated patient confidentiality for 12,000 members being treated for depression and anxiety by accidentally sending their names to the wrong doctors, a spokesman for the state’s third- largest health insurer acknowledged yesterday.
[San Francisco Chronicle 2000-12-30]


Tuesday, January 02, 2001

Shalala Halts Bid To Lower Drug Costs
Health and Human Services Secretary Donna E. Shalala yesterday refused to implement a Republican-sponsored measure intended to reduce drug prices by allowing the reimportation of prescription drugs from abroad, concluding that it is unworkable and would not lower costs.
[Washington Post 2000-12-27]


Clinton Offers to Help Rework Drug Import Measure
President Clinton offered Wednesday to help Congress craft new legislation giving U.S. consumers access to cheaper prescription drugs, a day after his administration refused to implement a drug reimportation plan.
[Reuters via Yahoo 2000-12-27]


H.M.O.’s to Drop Many Elderly and Disabled People
Across the nation, 933,687 elderly and disabled people will be dropped on the first day of 2001 by H.M.O.’s pulling out of the Medicare program, the government says. These Medicare recipients — a sixth of those enrolled in H.M.O’s — are likely to be poorer, less educated and in worse health than others in the program, according to a recent survey by an independent public policy research group of those dropped last Jan. 1.
[New York Times 2001-01-01]


Aetna, doctors make peace
An agreement between Aetna U.S. Healthcare and the California Medical Association is being hailed as a first step toward resolving a decade of strife between the managed-care organization and the doctors.
[Silicon Valley/San Jose Business Journal 2001-01-01]


Care shift by HMO will test for-profit
A company promising to cut costs and intensely scrutinize patients’ visits to therapists and hospitals will take over mental health care services for financially troubled Harvard Pilgrim Health Care tomorrow, sweeping about 900,000 members into the controversial world of for-profit medicine.
[Boston Globe 2000-12-31]


O.R. model could reduce high death rate among kidney dialysis patients by up to 20%
. . . The annual death rate for American patients with End Stage Renal Disease (ESRD) is 20 – 25%, double the rate in European countries. Experts suggest two explanations for the higher mortality rate: one, the larger number of critically ill patients accepted for treatment in the US compared to Europe; and, two, an American dialysis reimbursement rate that is 50% lower.
[Eurekalert 2000-12-28]


Healthcare Futurist Urges: Get on the ‘Coming-Soon’ Benefits Bandwagon — Now
. . . Traditional employer-based healthcare has been eroding over the past decade, with employers gradually reducing benefits and pushing more of the cost to their workers. But when those employees finally learn exactly how many dollars get funneled into their health benefits and how those dollars are spent, an uproar will ensue, healthcare futurist Steve O’Dell believes — propelling the healthcare industry into a new era that in some respects has already begun.
[WebMD 2000-12-27]


* Behind-scenes look shows how firm chose health plans
. . . Typically, employees don’t get to peek behind the veil of secrecy associated with benefits selection, receiving little information besides an enrollment kit each fall. But for this article, GTE provided exclusive and unprecedented access – and candidly discussed the factors that affected decision-making. That included access to internal meetings, visits with health insurers, company documents and employee interviews.
[Dallas Morning News 2000-12-24]


Many diabetes cases may go undetected by afternoon tests
If current diagnostic criteria for diabetes are applied to patients tested in the afternoon, about half of cases of undiagnosed diabetes may be missed, according to an article in the December 27 issue of The Journal of the American Medical Association.
[Eurekalert 2000-12-26]


Physician-Favored PacifiCare Falls Out of Favor on Wall Street
PacifiCare Health Systems, one of the nation’s largest health insurance companies and the biggest provider of Medicare HMO members in the U.S., expected to have some internal problems in 2000 due to cuts in Medicare reimbursement and rising medical costs. Yet, no one could have predicted that the California-based insurer would have three different CEOs, an 80% drop in its stock price and layoffs involving nearly 1,000 employees inside of a year.
[Medical Industry Today 2001-01-02]


Medicare Shifts to End Doctors’ Control of Disclosing Errors
WASHINGTON, Jan. 1 — Reversing a policy that has kept medical errors secret for more than two decades, federal officials say they will soon allow Medicare beneficiaries to obtain data about doctors who botched their care.
[New York Times 2001-01-02]


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