Practice Beat

Joan R. Rose

Stress Disorders: Preparing for the aftermath of terrorist attacks

Americans—including those not at the scenes—may experience aftershocks from the Sept. 11 attacks for weeks and months. To help medical professionals deal with patients' and employees' psychological trauma, the American College of Occupational and Environmental Medicine (ACOEM) has prepared a resource package and set of guidelines on coping responses.

The guidelines, available at www.acoem.org/member/guidelines.htm , include discussions of pertinent topics, suggested follow-up, and additional resources.

Docket Watch: Doctors fire another legal volley at health plans . . .

The 27,000-member Medical Society of the State of New York has sued six of the nation's largest managed care carriers, seeking to end what MSSNY President Robert Bonvino calls "the continued intrusion of insurance bureaucrats in the patient-physician relationship."

The suits—brought individually against Aetna, Cigna, Empire Blue Cross Blue Shield, Excellus Health Plan, Oxford Health Plans, and UnitedHealthcare—claim that the companies systematically engage in illegal practices such as treatment denials, payment delays, and downcoding. In addition, the medical society has filed six parallel class action suits against the same insurers.

The targeted health plans control nearly half the managed care contracts in New York.

. . . and head to court over privacy regs

The South Carolina and Louisiana medical associations are challenging a section of the Health Insurance Portability and Accountability Act of 1996. Of primary concern is a provision that enables HHS to write privacy regulations because Congress didn't enact a privacy law within three years after the bill became law. That's unconstitutional, the group says, because the power to legislate is vested in Congress.

The Association of American Physicians and Surgeons will contest the rules, too, contending that HIPAA violates the Paperwork Reduction and Regulatory Flexibility Acts as well as the Constitution. "These rules obliterate any remote notion of patients' rights," says Kathryn Serkes, AAPS public affairs counsel.

Of particular concern is the requirement that doctors must show federal bureaucrats a patient's entire record—including handwritten notes and psychiatric records—with or without the patient's consent, Serkes adds.

Right-To-Die-Ruling: A high court says No to verbal declarations

A California Supreme Court ruling has placed even more emphasis on the need for terminal patients to have an advance directive or health care surrogate. The court refused a woman's request to remove a feeding tube from her conscious but severely brain-damaged husband, despite testimony that the man had stated on several occasions he wouldn't want to live that way.

A decision to withhold life-sustaining treatment is not reversible, the court noted, so it requires a clear and convincing standard of proof. Because the patient hadn't executed a "legally cognizable" document outlining his desire not to receive extraordinary care, the California court said, the plaintiff hadn't met that standard.

The patient died while the case was pending.

Rx Discount Card: Debunked by Stark, derailed by court

Just days after Rep. Pete Stark (D-CA) filed an amicus brief in a suit seeking to stop the Bush Administration from implementing what he calls its "illegal and ill-advised" Medicare Rx Discount Card Program, a US district court issued a preliminary injunction. Stark contended that the program would adversely affect Medicare beneficiaries and Congressional efforts to enact a meaningful drug benefit. "Now, if the program is to go forward," he notes, "the Administration will be forced to work with Congress and with beneficiary representatives."

The congressman argues that limiting seniors to a single discount card will harm them, rather than help. Private companies already offer discount cards for various drugs, he says, and Medicare beneficiaries can use as many of the cards as necessary. Under the Bush program, Stark suggests, it's unlikely that any one pharmacy benefit management program would offer discounts on the wide variety of drugs that a Medicare patient needs.

Stark's brief supports a motion for a preliminary injunction brought by the National Association of Chain Drug Stores and the National Community Pharmacists Association.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2001;19:16.