Practice Beat

Joan R. Rose

Collective Bargaining: A doctor union takes a federal hit

The Federation of Physicians and Dentists (FPD) has settled US Department of Justice charges that its attempt to unionize private physicians in Delaware violated antitrust laws. Under the agreement, the union generally is prohibited from becoming involved in collective bargaining activities on behalf of independent physicians. The decision, which applies to the union's conduct nationwide, also enjoins FPD from participating in arrangements in which competing physicians conduct contract negotiation "exclusively through a messenger rather than individually or through other channels." The agreement doesn't affect the union's efforts to organize noncompeting physicians.

FPD traditionally has acted as a certified bargaining unit for doctors employed by public hospitals and other entities. But in recent years, it has targeted independent physicians. After Blue Cross Blue Shield of Delaware announced plans to slash doctors' fees by 10 to 40 percent, the federation successfully recruited nearly all of the state's orthopedic surgeons. Those doctors then rejected the new fee schedule, ended their Blues contracts, and designated the federation as their agent in fee negotiations. The Blues cried foul to the Justice Department, which responded by filing an antitrust complaint.

The union claimed that it was acting as a legitimate "third-party messenger," carrying information between health insurers and physicians. But Justice maintained that the union had misused the messenger arrangement to "facilitate illegal collusion by doctors to maintain high fee levels."

Medicare: The fee squeeze gets tighter

Although Medicare Part B payments to physicians and other practitioners will increase by about 1 percent overall next year due in part to added coverage, fees generally will be 5.4 percent lower than in 2001 (see "Medicare will cut your pay—unless Congress intervenes"). History suggests other insurers will follow suit.

The Centers for Medicare & Medicaid Services (formerly HCFA) blames the slowing economy and high levels of expenditures for physicians' services. CMS Administrator Tom Scully points out that physician payment rates have risen cumulatively 15.9 percent since 1998, while medical inflation has increased only 9.3 percent. "The formula [used to calculate the fee updates] locks us in—there's no wiggle room," he adds. But physicians long have argued that the formula, mandated by the Balanced Budget Act of 1997, is flawed and have asked Congress to freeze fees until an alternative method can be developed.

Physician Licensure: California mandates palliative care CME

To renew their licenses, California physicians will now have to complete 12 hours of continuing education in pain management and end-of-life care. The new law also requires the state medical board to investigate and track complaints of undertreated pain.

The California Medical Association supported the bill, which was prompted by the case of an elderly man who spent his final days in "uncontrolled pain." (See "Treating pain: Damned if you don't" Nov. 19, 2001).

Credentialing: Will this cure at least one paperwork headache?

The Coalition for Affordable Quality Healthcare, a nonprofit organization of 26 of the nation's largest health plans and insurers, will attempt to simplify physician credentialing. CAQH will gather and electronically store data from more than 600,000 providers nationwide and make those records available round-the-clock to authorized health plans and hospitals.

Instead of having to satisfy credentialing requirements of individual entities, physicians could submit a single application to a central database. Doctors would update their information online or by fax at any time, and they would verify the data each quarter.

CAQH will begin testing the system early next year and expects it to be available to providers nationwide beginning next summer. To view an interactive demonstration of the CAQH credentialing database, go to www.geoaccess.com/caqh/reviewdemo/ .

Handheld Computers: IMs are crowding on the bandwagon

Nearly half the 489 internists responding to an ACP-ASIM survey say they use personal digital assistants in their practices. And another one-fifth expect to be doing so by the end of next year. Doctors who currently use PDAs access drug information (80 percent) and references for normal lab values (32 percent), read medical textbooks (21 percent), and consult software for billing or coding (21 percent).

Doctors' growing interest in PDAs has prompted the internists' organization to develop a PDA Portal on its Web site (www.acponline.org/pda ) that includes clinical references from its publications, Ethics Manual, a weekly newsletter, and other materials.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2001;24:11.