Practice Beat

By Joan R. Rose, Senior Editor

Health Care Reform: The current system can't achieve quality, says the IOM

A new Institute of Medicine report, "Crossing the Quality Chasm: A New Health System for the 21st Century," has called for a fundamental restructuring of health care delivery. To that end, the IOM's Committee on Quality of Health Care in America has developed a five-part agenda to improve the quality of care over the next 10 years. The goal: to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. And while the committee shied away from creating a specific how-to list, it advanced a number of recommendations, including 10 rules to guide "private and public purchasers, health care organizations, clinicians, and patients" in the restructuring effort. For example, care should be:

• Based on continuous healing relationships—and access should be provided 24 hours a day over the Internet, by telephone, and by other means in addition to face-to-face visits.

• Designed to meet the most common types of needs, as well as individual patients' choices and preferences.

• Based on the best available scientific knowledge, not vary illogically from clinician to clinician or from place to place.

The recommendations are intended to make the health system more responsive to patients' needs and preferences and to encourage their participation in decision-making.

You can read the full report at the IOM Web site, www.iom.edu.

Collective Bargaining: Alaska may bring doctors in from the cold

The 49th state may be next to allow competing physicians to negotiate collectively with health plans. Noting that a plan's market dominance can virtually dictate the terms of the contracts it offers physicians, lawmakers in Alaska hope to level the playing field.

A measure passed by the state senate would allow individual and group physicians to band together to negotiate fees and other contract terms when a plan's market share exceeds 15 percent. But no single negotiating group could comprise more than 30 percent of the doctors practicing in an area, and doctors would be prohibited from threatening retaliation, such as boycotts or strikes.

Texas has a similar law on the books, and Washington allows doctors to negotiate jointly over noncompensation issues.

Take Note: There's still time to let your voice be heard

The Health Care Financing Administration has extended the comment period to June 4 on the latest round of revisions in the Stark II regulations on physician self-referral. For your opinion to be considered, send a letter (original and three copies) to: Health Care Financing Administration, Department of Health and Human Services, Attn: HCFA-1809-FC, PO Box 8013, Baltimore, MD 21244-8013.

Health Benefits: Will more patients have trouble paying bills?

With premium increases for employee health coverage projected in the double digits—11 percent, on average, in 2001—businesses say they'll pass more of their costs on to workers. And the bigger the employer, the more likely it will shift costs.

Of the more than 3,300 employers surveyed, 40 percent said they would increase employee contribution levels, and 17 percent will raise deductibles, copayments, or out-of-pocket costs. Among employers with 500 or more workers, nearly 60 percent plan to require larger contributions, while 26 percent will hike other cost-sharing provisions.

Patient Communication: Wasn't e-medicine supposed to cut down on paper?

Survey after survey shows that patients want the convenience of communicating with their doctors via e-mail. Now at least two Web sites enable patients to send nonurgent e-mail requests—for appointments, referrals, or prescription refills—directly to their doctors' fax machines. Medical practices listed in The Little Blue Book are available to Internet surfers who visit www.MDhub.com —but only if you activate the service. On the other hand, www.EveryMD.com requires physicians to call to deactivate the service. The latter site currently includes over 80 percent of US physicians.

Online Pharmacies: PA knocks out a "potentially dangerous" service

A Pennsylvania court has approved a consent agreement permanently banning Louisiana-based 4 Health Drugs (www.4-health-drugs.com), At-Cost-Drugs (www.at-cost-drugs.com ), and their owner, FP Henry Eugene Jones, from selling and delivering prescription drugs to Pennsylvania consumers. In addition to financial penalties, the Web sites must post notices that their products are not available to the state's residents.

According to Attorney General Mike Fisher, the defendants sold Viagra, Propecia, and Xenical to undercover investigators without obtaining a Pennsylvania medical license or pharmacy permit. Investigators were able to buy the drugs by agreeing to a waiver of liability and claiming to have answered limited medical history questions truthfully.

Some of the questions included already-marked answers that required no consumer response at all.

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

Bills in both houses of Congress would help taxpayers defray the cost of nursing home expenses and other long-term-care needs. To encourage young people to prepare for the future, the bipartisan measures call for a tax deduction for LTC insurance premiums. In the first year, individuals could deduct 60 percent of the cost of their policy. That proportion would increase by 10 percent each year of continuous coverage until it reaches 100 percent.

Pharmacists: Call them health care providers?

Two of the nation's premier pharmacy organizations— the American Society of Health-System Pharmacists and the American College of Clinical Pharmacy—have joined forces to lobby Congress for a change in Medicare law that would recognize pharmacists as health care providers. Some 30 states allow pharmacists to collaborate with physicians in providing drug therapy management services. But without a change in the law, pharmacists cannot bill Medicare directly for those services. Instead, they're relegated to billing at the lowest level code—"incident to" a physician's service.

Docket Watch: Malpractice plaintiffs can't have it both ways

The Illinois Supreme Court has ruled that a patient cannot sue a physician for both malpractice and breach of fiduciary duty over the same act of alleged negligence. The suit charged that a doctor's failure to authorize an angiogram constituted not only medical negligence but a breach of fiduciary duty to act in good faith—specifically, by not disclosing the HMO's offer of financial incentives to limit care.

The state Supreme Court threw out the latter claim, finding that the plaintiff essentially claimed the same cause of action and the same damages in both allegations—that the doctor failed to disclose his incentives. Appellate courts in at least four other states—Arizona, Colorado, Minnesota, and New Mexico—have also held that a breach-of-fiduciary-duty claim is duplicative of a negligence claim. And the US Supreme Court recently refused to recognize a breach-of-fiduciary-duty claim under ERISA.

Euthanasia: The Netherlands finally makes it legal

Physicians in the Netherlands who terminate life on request or assist in a patient's suicide no longer have to fear criminal prosecution, provided they satisfy due-care criteria and report the death to the appropriate review committee.

The government pushed for legalization of euthanasia—long tolerated in the Netherlands—in the hope that physicians will be more willing to bring such actions to light. About 400 people in Holland die with the help of a physician each year, but it's estimated that only about half the doctors who participate in assisted suicides report the incidents.

 

Joan Rose. Practice Beat. Medical Economics 2001;10:16.