Practice Beat

Joan R. Rose

Reimbursement: A prompt-pay bill dies, and doctors erupt

Texas Gov. Rick Perry's 11th-hour veto of a prompt-payment bill that might have been the toughest in the nation triggered a firestorm of criticism by Lone Star State physicians. Texas Medical Association vice president Kim Ross described the reaction as "a spontaneous combustion of nuclear proportions." Doctors have flooded newspapers and the governor's office with angry letters. TMA President Tom Hancher stated that the veto "gives the profit-driven managed care industry in our state a license to steal."

The law would have closed several loopholes that have let health plans and insurers delay or avoid payments to providers. But Ross predicts that the TMA* will add complaints about slow payments and bundling of charges to its ongoing class-action suits, and work with the state's insurance commissioner and attorney general to create stricter payment rules and tougher enforcement.

*See "America's best medical society?" Aug. 6, 2001.

Minority Physicians: Do they face greater hurdles arranging for care?

Hispanic and African-American physicians are more likely than their white counterparts to encounter difficulty in getting hospital admissions approved and making referrals to specialists, a new study suggests. The report comes from the Center for Studying Health System Change, which is supported by the Robert Wood Johnson Foundation.

Even allowing for differences in training, experience, practice location, managed care participation, local resources, and patients' ability to pay, the study authors found that minority physicians still reported more problems. Hispanic physicians were more likely to have difficulty with referrals, while African-American doctors encountered greater problems in arranging hospitalizations.

E-Medicine: Accreditation comes to the Web

URAC—an organization that provides accreditation to health plans—has developed 53 specific standards for health care Web site accreditation, including complaint mechanisms, disclosure of financial relationships and sponsorship, health information content, and security.

"We expect 25 to 50 applications for accreditation by the end of the year," says Guy D'Andrea, senior vice president. The accreditation fee is $5,000, and each site will be reviewed annually. "Accredited sites' home pages will post a URAC seal of approval, as well as a link to URAC that will allow the user to report complaints or concerns," D'Andrea notes.

Managed Care: Pfizer deal could jump-start disease management

Pfizer recently agreed to save Florida's Medicaid program $33 million over two years through disease management programs for congestive heart failure, diabetes, asthma, and hypertension. In return, the state added Pfizer's drugs to its new Medicaid formulary without extracting any price concessions.

This innovative quid pro quo, if it works, could supply a template for other financially hard-pressed state Medicaid programs. It could also attract the attention of other pharmaceutical companies, many of which tried and failed to use disease management in their business strategies a few years ago.

Pfizer's 6-year-old disease management subsidiary, Pfizer Health Solutions, offers programs for several chronic diseases and is preparing to add Web-based home monitoring. Its approach pairs "best practices" with patient management strategies. In Florida, the company will hire 60 nurse case managers to educate and monitor about 50,000 high-risk patients in "consultation" with their physicians.

Access to Care: HMOs charged with neglect of AIDS patients

The AIDS Healthcare Foundation has launched a public awareness campaign in California, urging HMO enrollees to report problems in obtaining access to AIDS specialists. At the same time, AHF, an HIV/AIDS care provider, filed suit against PacifiCare Health Systems for mismanaging HIV/AIDS patients by neglecting to refer them to specialty care.

A new state law guarantees HMO enrollees with HIV or AIDS referral to "a provider with demonstrated expertise" in treating the condition. But many of these patients are denied such access, AHF charges.

Because many reputable AIDS practitioners do not have commercial HMO contracts, such referrals are not profitable for the plans, an AHF spokesman claimed. Ironically, he added, many AIDS patients can get better medical care through public funding such as Medi-Cal than when they return to the workforce and are covered by private insurance.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2001;18:16.