Quality of Care, Drug Abuse, Tort Reform, Medicaid, Insurance Hassles
The quality of care and service from accredited managed care plans has improved substantially over the last three years, according to the National Committee for Quality Assurance. For example, just 62.5 percent of patients who survived a heart attack in 1996 later received a beta blocker prescription. By last year, the national average was 92.5 percent, with 13 plans reporting rates of 100 percent.
As encouraging as the findings may be, however, the study covers only about one in four insured Americans (and leaves out the uninsured entirely), and NCQA admits that quality varies widely amongand withinthe plans it measures. What's more, a study published in the Journal of the American Medical Association suggests another reason that findings based on NCQA's HEDIS measures may be misleading: Quality data are released only with a health plan's permission.
The number of Americans who could benefit from treatment for drug abuse is significantly higher than previously believed, according to the latest government statistics. The 2001 National Household Survey on Drug Abuse found that the number of persons needing but not receiving treatment grew from 3.9 million in 2000 to 5.0 million in 2001and more than 4.6 million of them fail to recognize their need for treatment.
Mississippi Gov. Ronnie Musgrove has signed legislation intended to ease the state's medical malpractice insurance crisis. The measure provides immunity from liability arising from free, voluntary services and modifies joint-and-several liability laws so that a doctor would generally be responsible only for the portion of damages awarded against him. It also caps noneconomic damages at $500,000, but the cap would increase in 2011 (to $750,000) and again in 2017 (to $1 million).
The new law also prevents plaintiffs' attorneys from steering cases to counties with a history of large jury awards.
A federal appellate court has upheld a Florida law that creates a "preferred drug list" for Medicaid beneficiaries. For their drugs to make the list, pharmaceutical manufacturers must give the state rebates on top of the minimum 15-percent discount already provided under federal law.
Now Pharmaceutical Research and Manufacturers of America is seeking to invalidate a similar program that has already been implemented in Michigan, and it's picked up several patient advocacy groups as allies, including the National Alliance for the Mentally Ill of Michigan and the National Urban Indian Coalition.
The suit also seeks to prevent HHS from approving similar efforts in other states. To date, more than a dozen states have announced or have already implemented programs that share the characteristics of Michigan's program.
If the experience of Texas doctors is any indication, state laws that impose financial penalties on late-paying insurers aren't working well. Despite $50 million in fines and restitution, health insurance plans operating in Texas continue to delay payments to physicians, according to the fourth annual Hassle Factor Log compiled by the Texas Medical Association.
Approximately 1,500 physicians submitted more than 12,000 complaints last year, up 8.5 percent over 2000. Doctors cited slow processing, data entry errors, improper denials and appeals, extensive requests for medical records, bundling, and on-hold time. Managed care plans are still the worst offenders, accounting for more than four times as many complaints as indemnity insurers.
Joan Rose. Practice Beat. Medical Economics 2002;21:16.