Substance Abuse, Late Payments, Malpractice Insurance, Health Costs, Postgraduate Training
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Given the magnitude and scope of the World Trade Center and Pentagon attacks, physicians can expect an increase in symptoms of alcohol and drug abuse, says Joseph A. Califano Jr., president of The National Center on Addiction and Substance Abuse (CASA) at Columbia University. During the two years following the Oklahoma City bombing, the number of people using drugs and alcohol to cope grew dramatically, Califano says, and the trauma of Sept. 11 is expected to spawn an even greater increase. Preliminary data from the Drug Evaluation Network System (developed by CASA and the University of Penn sylvania's Treatment Research Institute) show that substance abuse treatment admissions have already increased 10 to 12 percent nationally since Sept. 11.
Insurers' failure to pay claims promptly has left many Texas physicians with severe cash-flow problems, and state Insurance Commissioner Jose Montemayor plans to do something about it. In September, Montemayor ordered 17 HMOs and insurance companies to make restitution to doctors. Since then, the companies say they've paid 5,754 doctors less than $2.5 million, "a mere drop in the bucket of what is owed," says internist Tom Hancher, president of the Texas Medical Association.
Montemayor agrees. Noting that provider testimony and anecdotal evidence suggest the amount should be significantly higher, Montemayor has launched audits "to ensure that HMOs and insurers aren't simply reclassifying claims or using other sleight-of-hand tricks to avoid payments."
If your professional liability insurance is underwritten by The St. Paul Companies, start looking for a new insurer. Forecasting an underwriting loss of about $940 million for last year, St. Paul plans to withdraw from the medical malpractice business. The nation's second-largest medical malpractice underwriter has opted to leave the market by not renewing policies that expire. The Minnesota-based insurer covers about 10 percent of the physicians in the country.
Doctors believe there's a legitimate need for cost-containment and individual physicians should play a role in controlling costs. More than four-fifths believe that clinical practice guidelines are one of the three most useful ways to practice cost-effective medicine and think doctors should consider cost when weighing medical interventions.
While physicians support cost-effectiveness in principle, however, there's no consensus on how to accomplish it in practice. Nearly three out of four doctors believe that determining whether a treatment is "worth the cost" is a decision that should be left to the patient and her doctor, and more than half (53 percent) think they should offer any medical intervention that "has any chance of helping the patient."
Several Democrats in Congress plan to do what the medical community hasn'tlimit work hours for interns, residents, and fellows. Under the Patient and Physician Safety and Protection Act of 2001, the workweek for postgraduate trainees would be limited to 80 hours, and each shift to 24 hours, with ED physicians confined to 12-hour shifts and on call no more than every third night. Postgraduate doctors would be entitled to one out of every seven days off, as well as one full weekend off a month. The measure would allow doctors to file anonymous complaints about violations and impose financial penalties on facilities that violate the rules.
Joan Rose. Practice Beat. Medical Economics 2002;2:16.