Medical Licensure, Patient Safety, Reimbursement, Claims Denials, HMO Premiums
|Jump to:||Choose article section... Medical Licensure: Will bedside manner count as much as medical knowledge? Patient Safety: JCAHO sets new goals for reducing errors Reimbursement: Lone Star doctors take on workers' comp Claims Denials: New York hammers two HMOs for claims denials HMO Premiums: Patients will shoulder even more of their health care costs|
The Federation of State Medical Boards and the National Board of Medical Examiners have authorized the addition of a "clinical skills" test to the current nationwide licensing exam. The program, still in its pilot phase, requires students to gather a history from a mock patient, conduct a focused physical exam, and provide feedback and counseling to the "patient." To pass the exam, a doctor-to-be would have to prove that both his clinical and communication skills are satisfactory.
Graduates of the Class of 2005 are likely to be the first medical students who will have to prove they can interact effectively before being granted a medical license. Some medical schools already use a version of this clinical test, but this is the first national exam to require it.
The Joint Commission on Accreditation of Healthcare Organizations rolled out safety goals in late July, targeting six specific types of health care errors. Its recommendations are designed to reduce patient misidentification, caregiver miscommunication, wrong-site or wrong-procedure surgery, medication mix-ups, infusion pump breakdowns, and alarm-system snafus.
Beginning next January, JCAHO will evaluate its more than 17,000 accredited membershospitals, health care networks, nursing homes, clinical laboratories, and othersfor compliance with these recommendations. Said JCAHO President Dennis S. O'Leary, MD, in announcing the new measures: "The know-how to prevent these errors exists. We now need to focus on making sure that health care organizations are actually taking these preventive steps."
The Texas Medical Association has joined with the AFL-CIO in asking a state district judge to invalidate a new state workers' compensation rule. Doctors contend that the "Medical Fee Guideline," which regulates the maximum allowable reimbursement for physicians' services, illegally ties workers' compensation reimbursement to Medicare fees.
In Aprilover the objections of TMA, the Texas AFL-CIO, and Gov. Rick Perrythe Texas Workers' Compensation Commission adopted the fee schedule, cutting reimbursement by 17 to 42 percent for generalists, pathologists, physical medicine specialists, radiologists, and surgeons.
Doctors already considered workers' comp rates to be too low, says FP Fred Merian, the TMA president. He warns that the cuts will force doctors out of the system.
Two health insurers in New York state are reconsidering claims that were denied between 1994 and 2001. A state Insurance Department report found that Aetna's EOBs notified patients of denials without providing "any information" on how to appeal those decisions, and UnitedHealthcare's merely "referred members to their handbooks." The department fined UnitedHealthcare $1 million and Aetna $1.5 million.
HMO premiums are expected to increase an average of 17 percent next year, according to preliminary results of Milliman USA's annual HMO Intercompany Rate Survey. That would mark the third consecutive year of double-digit increases, and the increase is the largest in the survey's 11-year history. If those projections hold, employers are likely to shift a greater portion of their premium costs to workers and require higher copays as well, Milliman USA says.
Joan Rose. Practice Beat. Medical Economics 2002;17:18.