Practice Beat

June 4, 2001

Medicare Fraud and Abuse, Telemedicine, Nursing Shortage, Long-term Care, The Abortion Conflict, Coverage Denials, Managed Care Complaints, Cancer Research, Bankruptcy for Phycor?

 

Practice Beat

Jump to:Choose article section...Medicare Fraud and Abuse: Congress may give you a new weapon against Uncle Sam Telemedicine: Ohio moves to regulate telemedicine Nursing Shortage: Your hospital patients may face growing peril Long-Term Care: Help now for paying future costs? The Abortion Conflict: Will First Amendment rights prevail over physicians' safety? Coverage Denials: Missouri's high court makes medical directors professionally accountable Managed Care Complaints: Internet aid for patients and doctors Cancer Research: You can help "stamp" out breast cancer Bankruptcy for Phycor?: A onetime star continues to fall How PhyCor’s star has dimmed

By Joan R. Rose, Contributing Writer

Medicare Fraud and Abuse: Congress may give you a new weapon against Uncle Sam

Disagree with Medicare that you've been overpaid? If a bill in Congress becomes law, you'll have new recourse in fighting the charge. The measure would allow doctors to contest auditors' findings and submit additional information, without waiving the right to appeal.

Other provisions would stop Medicare from automatically recovering overpayments by withholding future reimbursements, and would allow doctors instead to choose to set up schedules for refunding excess payments caused by billing errors. In addition, the bill would prohibit the prosecution of providers who voluntarily disclose overpayments and return the funds within one year.

Telemedicine: Ohio moves to regulate telemedicine

A law passed by the Ohio General Assembly will require out-of-state doctors who treat Buckeye patients via electronic technologies to apply for a telemedicine certificate. To qualify, doctors must hold an unrestricted license issued by a state that requires 50 hours of CME every two years. Their primary practice must be in that state. They'll also have to certify to the Ohio medical board that they've complied with the CME requirement.

Nursing Shortage: Your hospital patients may face growing peril

One in five nurses polled for the Federation of Nurses and Health Professionals plans to leave the profession within five years. That could put your hospitalized patients at greater risk.

A new federal study has found a direct relationship between patient outcomes and nursing staff levels in hospitals. Nonsurgical patients in hospitals with a high number of registered nurses had shorter stays and were less likely to develop UTIs, pneumonia, shock, and upper GI bleeding.

The study, based on more than 5 million patient discharges from 799 hospitals, was conducted for HHS by the Harvard School of Public Health.

Long-Term Care: Help now for paying future costs?

Twin bills in Congress would help taxpayers defray the cost of nursing home and other long-term care needs. Under the bipartisan measures, individuals could deduct 60 percent of the cost of their LTC insurance in the first year. That proportion would increase by 10 percent each year that continuous coverage is maintained until it reaches 100 percent.

Patients or their caregivers also could be eligible for a tax credit to help offset out-of-pocket expenses for medical supplies, nursing care, or other related expenditures. The credit, to be phased in over five years, would begin at $1,000 and max out at $3,000.

Lawmakers failed to enact an identical measure last year. Its five-year cost had been estimated at $10 billion.

The Abortion Conflict: Will First Amendment rights prevail over physicians' safety?

The American Medical Association has asked a federal appellate court to reconsider its decision lifting an injunction against a Web site with content that doctors call a deliberate threat to their safety.

A jury had found that "The Nuremberg Files" Web site and "wanted" posters created by an antiabortion group were deadly threats, and awarded the physician plaintiffs $107 million in actual and punitive damages. The trial court also issued an injunction, effectively closing the Web site. The appellate court, however, ruled that it is protected by the First Amendment.

While the site's content may have encouraged violence against the abortion providers it targeted, the tribunal noted, the defendants didn't authorize, ratify, or directly threaten violence. "Political speech may not be punished just because it makes it more likely that someone will be harmed . . . in the future by an unrelated third party," the court explained.

Coverage Denials: Missouri's high court makes medical directors professionally accountable

The Missouri Supreme Court has upheld the state's right to question health plan medical directors about their coverage decisions.

The court found that a Prudential HealthCare medical director had "used medical training and judgment to make a decision about the 'medical necessity' of surgical treatment." Consequently, he was subject to review by the state's Board of Registration for Healing Arts.

The ruling, says state Attorney General Jay Nixon, ensures that medical decisions will be made by treating physicians—"not by bureaucrats based on rules designed to save HMOs money."

Managed Care Complaints: Internet aid for patients and doctors

A new Web site (www.ctpatientsrights.org) is available in Connecticut to assist with grievances against health plans. It was created by the doctors who started Citizens for Patients' Rights, a grassroots initiative to obtain fair treatment from insurers.

The site lists government agencies, professional organizations, and community resources that Connecticut residents can turn to for help. If a visitor to the site requests personal assistance, the site will forward the person's e-mail describing the problem to the appropriate person or agency. Complainants may also choose to add their cases, anonymously, to a database the doctors are building.

Cancer Research: You can help "stamp" out breast cancer

The next time your practice needs postage stamps, consider buying the Breast Cancer Research stamp. The first-class stamp costs 6 cents more than a regular one, but those additional funds are earmarked for research organizations. Since its launch in 1998, the breast cancer stamp has raised nearly $20 million.

Congress recently approved a request to extend the sale of the stamps through July 29, 2002. You can purchase them by calling 1-800-STAMP24 or online at www.stampsonline.com .

Bankruptcy for Phycor?: A onetime star continues to fall

Nashville-based PhyCor could be nearing fiscal flameout. Over the last few years, the company—which develops and manages IPAs and provides contract management services to physician networks—has suffered severe losses.

In its recent filing with the Securities and Exchange Commission, PhyCor reported that it had defaulted on its obligation to make an interest payment of approximately $4.4 million in February. Furthermore, the company warned, its negative cash flow is expected to continue this year, and it might seek protection from its creditors.

 

How PhyCor’s star has dimmed

199819992000
Affiliated clinics56416
Physicians in those clinics3,6932,581471
   
Markets with PhyCor IPAs352514*
Physicians in those IPAs22,90024,40016,600

*The company's interests in eight of those markets were earmarked for sale, and the company bailed out of two others during the first quarter of this year. Source: PhyCor's Annual Report

 

Joan Rose. Practice Beat. Medical Economics 2001;11:21.

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