Practice Beat

August 23, 2002

Quality Care, Reimbursement, Physician Profiling, Fraud and Abuse, Our Web Poll

 

Practice Beat

Joan R. Rose

Jump to:Choose article section... Quality Care: Is America overlooking the importance of primary care? Reimbursement: Doctors go to court for higher fees Physician Profiling: Will the Golden State tarnish doctors' reputations? Physician Profiling: Uncle Sam's senior patrol marches on—but to a slower beat

Quality Care: Is America overlooking the importance of primary care?

The better a country's system of primary care, the better its health. That's the conclusion researchers at the Johns Hopkins Bloomberg School of Public Health drew from a study of 13 industrialized nations with populations of 5 million or more.

They found that countries with the weakest primary care infrastructures—Belgium, France, Germany, and the US—performed poorly on major aspects of health, such as life expectancy and child survival rates. By comparison, Denmark, Finland, Netherlands, Spain, and the UK, nations considered to have the strongest primary care networks, posted the most favorable results.

Reimbursement: Doctors go to court for higher fees

The Academy of Medicine of Cincinnati and individual physicians have charged that four insurers—Aetna, Anthem Blue Cross and Blue Shield, Humana, and UnitedHealthcare—illegally used their market power to force doctors and hospitals to accept unreasonable reimbursement rates.

According to class action suits filed in Ohio and Northern Kentucky, the fee schedules are much lower than prevailing rates in comparable regions nearby—and, in many cases, don't even cover the actual cost of providing care. Moreover, the plaintiffs say the carriers' actions have forced hospitals to close and made it difficult for medical groups to recruit physicians.

The doctors are seeking unspecified damages and a change in the insurers' reimbursement policies.

Physician Profiling: Will the Golden State tarnish doctors' reputations?

The California Medical Association and the state medical board are at odds over a provision in a bill reauthorizing the board's operation. The board wants to disclose all malpractice settlements of $30,000 or more on its Web site. (The board currently publishes malpractice judgments, but not settlements.) The board would also provide benchmarks to show how the number of a physician's settlements compares to that of other physicians in the same specialty. The CMA believes that such information could be misinterpreted, unfairly marking some physicians as substandard.

The bill, which has received Senate approval, awaits Assembly action.

Physician Profiling: Uncle Sam's senior patrol marches on—but to a slower beat

Last year, the Bush administration invested $9.3 million in a program that recruits and trains retired professionals (including doctors, nurses, and lawyers) to identify waste, fraud, and abuse in the Medicare program. This year the government will spend only $4.5 million.

The five-year-old Senior Medicare Patrol Project has already trained more than 48,000 volunteers to work in senior citizen centers teaching Medicare beneficiaries how to spot problems—such as overbilling, overcharging, and unnecessary or inappropriate services—in EOB statements.

 

 

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2002;16:15.