Practice Beat

Joan R. Rose

Abortion: An appellate court turns the table on antiabortionists

"Wanted" posters and a Web site that keeps track of abortion providers are not protected forms of free speech under the First Amendment, the US Court of Appeals for the Ninth Circuit has ruled.

Oregon doctors who had been depicted on posters and featured on the Nuremberg Files Web site sued the American Coalition of Life Activists and others, claiming that these targeted appearances implied that they were next on the hit list. A federal jury in Oregon awarded the plaintiffs $107 million in compensatory and punitive damages. A three-judge panel of the appellate court then overturned the verdict, finding that the content of both the posters and the Web site was protected under the First Amendment. The current ruling—from the full appellate court—restores the original verdict.

At issue was whether the posters and the Web site's "scorecard" represented a "true threat" under the Freedom of Access to Clinics Entrances Act. In three prior incidents, abortion providers who'd been identified on posters were killed after those posters were circulated. (On the Web site's list, their names appeared struck through with a line.) The physician plaintiffs could well believe that activists would make good on the threat, the court concluded, even though neither the posters nor the Web site contained overtly threatening language. The judges ordered the district court to evaluate whether the award for punitive damages was proper.

In the meantime, antiabortionist activists have taken a new tack, currently posting photos of patients entering abortion clinics on a Web site, AbortionCams.com.

Resident Match: Does the NRMP violate antitrust laws?

The Association of American Medical Colleges will challenge a restraint of trade lawsuit filed against the National Resident Matching Program, its sponsoring organizations, and teaching hospitals. The class-action suit charges that the defendants violate antitrust laws by preventing competition for residents' services, artificially depressing and standardizing wages below competitive levels, and conspiring to establish rules that accredit and govern residency programs. Brought on behalf of more than 200,000 resident physicians, the suit seeks unspecified monetary damages and an end to the allegedly illegal restraints.

The AAMC maintains that the NRMP is an important link in the continuum of medical education, helping both students and institutions find the best fit and easing the transition from medical school to residency.

Liability: Malpractice fears compromise care, doctors say

More than three-quarters of the physicians responding to a Harris Interactive poll acknowledged that malpractice concerns have impaired their ability to provide quality care. Three out of five believe that those fears discourage medical professionals from openly discussing ways to reduce medical errors. What's more, nearly all (94 percent) think that doctors generally provide unnecessary or excessive care to keep from being sued.

The poll was commissioned by Washington, DC-based Common Good, a newly formed bipartisan coalition that advocates reform of the US justice system.

Managed Care: Doctors in the know steer clear of HMOs

Physicians who are experts on managed care are less likely than other university professors to choose HMO coverage for themselves and their families, according to a Harvard School of Public Health/RAND study. Researchers compared health plan choices made by 279 "experts" at 17 universities with those of other professors at the same institutions who didn't study health care. (Both groups had the same health plan choices available to them.) Only about 15 percent of the physician experts opted for an HMO, compared with 27 percent of the non-experts.

Although researchers could find no clear reason for the experts' tendency to avoid HMOs, David Studdert, lead author of the study, theorizes that their choices may "stem from special insights into managed care" that non-experts don't have. "It's the physicians who have the most direct experience with managed care who were the least likely to choose HMOs," says Studdert.

Reporting STDs: How well does managed care do?

A CDC study of three large staff or group model HMOs found that reporting of STDs was fairly complete, but slow. In these organizations chlamydia was reported in 78 to 98 percent of cases; gonorrhea was reported in 64 to 80 percent. The median interval between time of specimen collection and a report to the state health department was 19 days.

In contrast, one published study showed only 55 percent of chlamydia cases were reported by private clinicians. Why did the managed care organizations do better? The researchers point to the HMO's centralized reporting system from all affiliated laboratories, established relationships with state STD programs, and the use of Web sites and newsletters to inform member clinicians on STD trends. As for the delays, the study suggests that reporting could be improved by using confidential electronic data transfer systems to communicate with state health departments.

Medicare: Uncle Sam's latest effort to keep physicians abreast of rule changes

The Centers for Medicare & Medicaid Services has just published a new quarterly report listing changes in the Medicare and Medicaid programs. The update should "make it easier for providers to understand and comply with Medicare and Medicaid regulations," says CMS Administrator Tom Scully.

The update will include all regulations published in the Federal Register during the previous quarter as well as a list of rule changes to be published over the following three months. Also included: nonregulatory changes—such as manual instructions and program memoranda—that could affect providers. In most cases, CMS will implement the instructions 90 days after publication in the Provider Update.

Future editions of the Quarterly Provider Update will be published on the first business day of each quarter. You may view the update online at www.cms.gov/providerupdate .

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2002;13:20.