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July 19, 2000

Top stories:

1. Health plans form coalition, but will they support meaningful patient protections?

2. Senators urged to reconsider vote on Nickles amendment

3. AMA calls $145 billion tobacco verdict a public health victory

4. Women internists earn significantly less than their male counterparts

Federation news

5. MMS wins impressive managed care reform victory

6. NMMS uses research, advocacy to work for Medicare payment increase

7. ISMA undertakes effort to help physicians help pharmacists

8. Beltway coalition tackles regional insurance hassles

9. PaMS tells lawmakers patients and physicians deserve better

10. TMA hits the road for physicians' summer school

Public health

11. AAFP announces Tar Wars winners


12. JAMA theme issue to focus on tobacco

13. CDC launches Internet site en espanol

14. AMA Alliance launches new Web site

Top stories:

1. Health plans form coalition, but will they support meaningful patient protections?

The AMA yesterday called on the executives of 22 health plans and two trade groups to prove their commitment to patients by supporting a strong patients' rights bill. The executives announced they have formed the Coalition for Affordable Quality Health Care.

"Health insurers seem to realize they have a credibility problem with the public," said AMA President Randolph D. Smoak Jr., MD.

''Most of the elements they say they want to improve are in the patients' bill of rights,'' Dr. Smoak told USA Today. ''They ought to show their actions are genuine and join us in seeing that it gets passed.''

The AMA said it will judge the sincerity of insurers by results -- not by rhetoric.

Click here to read Dr. Smoak's full statement.


2. Senators urged to reconsider vote on Nickles amendment

Calling legislation recently passed by the Senate more of an HMO wish list than real managed care reform, the AMA called on senators to take a closer look at Sen. Don Nickles' (R, Okla.) language in an amendment to an HHS appropriations bill. As is, the Nickles amendment would leave patients worse off than under current statutory and case law.

"The liability provisions are a sham," said AMA Executive Vice President E. Ratcliffe Anderson Jr., MD.

"Physicians across the country need to send a strong message to Senator Nickles . . . that we are tired of the foot dragging, smokescreens and posturing," AMA Board Chair D. Ted Lewers, MD, said Tuesday on National Public Radio (NPR).

The Nickles amendment would:

  • Preempt state laws and recent court opinions that have held HMOs liable for medical decisions that injure or kill patients;

  • Allow an HMO to escape responsibility for patient injuries by alleging the patient or treating physician failed to provide "sufficient information";

  • Limit patient protections only to patients enrolled in self-insured plans;

  • Allow health plans to impose narrow definitions of medical necessity;

  • Undermine access to medical specialists; and

  • Subject patients to high levels of uncertainty about potential out-of-pocket costs for clinical cancer trials.

Read Dr. Anderson's letter.

Contact your legislators.

Visit the Tuesday, July 18 NPR Morning Edition program list to hear the full story.


3. AMA calls $145 billion tobacco verdict a public health victory

Big tobacco took a big hit last week when a Florida jury handed down the largest punitive damage award in U.S. history. The tobacco industry's largest producers will have to pay $145 billion to hundreds of thousands of Floridians suffering smoking-related diseases.

"The jurors' message is loud and clear: The tobacco industry must pay for addicting and poisoning people for profit," said AMA President Randolph D. Smoak Jr., MD. "This verdict against Big Tobacco is a victory for public health."

After jurors delivered the verdict, tobacco industry lawyers and spokespeople complained the decision was unfair. However, as Dr. Smoak pointed out, "this unprecedented verdict sends a strong message to the tobacco industry that toying with the health and lives of Americans can be a prohibitively expensive business."

What the tobacco industry will have to pay:

  • Philip Morris: $73.96 billion

  • R.J. Reynolds: $36.28 billion

  • Brown & Williamson: $17.59 billion

  • Lorillard Tobacco: $16.25 billion

  • Liggett Group: $790 million

Click here to read Dr. Smoak's full statement.


4. Women internists earn significantly less than male counterparts

A study of internists in Pennsylvania found that male internists earned 14 percent more per hour than women internists. The data takes into account specialty, training, number of hours worked and practice setting.

Other findings from the study:

  • Women were more likely to be salaried employees and less likely to be partners; and

  • Women were half as likely as men to be in high-earning specialties and twice as likely to be in low-earning specialties.

The authors note that while their findings reflect a gender gap among internists in Pennsylvania, they may not relate to all U.S. physicians. However, they believe that is unlikely -- due to both a lack of state-specific physicians earnings data that suggests gender equity and the fact that Pennsylvania has long been a center for the training of female physicians.

The study appears in the latest issue of the Annals of Internal Medicine , published by the American College of Physicians-American Society of Internal Medicine.

Read a summary of the findings.


Federation news:

5. MMS wins impressive managed care reform victory

Perseverance paid off for the Massachusetts Medical Society (MMS) when the state legislature last week passed managed care reform legislation that provides patients with comprehensive, tangible and immediate protections. MMS has championed patient protection legislation as its top advocacy priority since 1997 and called the action "a strong framework of high quality care for all the people of Massachusetts."

"We thank and congratulate the leaders and members of the House and Senate for remaining focused on this legislation," said Virginia T. Latham, MD, MMS president. "We commend the contributions of physicians, the rest of the health care community, consumer groups and other advocates who worked with us toward this shared goal. It is clear to me that everyone played an important role in making this a reality."

Highlights of the legislation:

  • Establishes a nine-member Managed Care Oversight Board (MCOB) representing state agencies;

  • Creates a 14-member Advisory Committee, including MMS, with authority to advise MCOB on managed care issues and review proposed rules, regulations and guidelines issued by state agencies at least 60 days before they become final, except in emergencies;

  • Applies the "prudent layperson" standard for emergency services;

  • Requires development of an annual Health Plan Report Card, allowing consumers to evaluate and compare managed care plans;

  • Requires health plans to make "timely payment" of all claims or face interest that will accrue at the rate of 1-1/2 percent per month (18 percent per year) from the receipt of notice of claim;

  • Strengthens "anti-gag" provisions, allowing providers to discuss with their patients the provisions, terms or requirements of plans as they relate to those patients' needs, or the general method by which the provider is compensated;

  • Forbids financial incentives that specifically induce the non-provision of covered medically necessary services, but allows capitation and shared risk arrangements with physicians and physician groups;

  • Establishes an independent external review procedure to appeal rejected internal grievances process; and

  • Creates medical necessity guidelines to be developed using national standards and with input from practicing physicians.

The legislation also calls for MMS participation in the establishment of a special commission to study physician compensation and an advisory committee to arrange for and evaluate a study of universal access to affordable health care.

MMS said it expects Gov. A. Paul Cellucci to sign the legislation.

For more information, e-mail MMS's Frank Fortin or phone (781) 434-7099.


6. NMMS uses research, advocacy to work for Medicare payment increase

The New Mexico Medical Society (NMMS) wants the government to take a hard look at how New Mexico's socioeconomic picture is hurting its patients and physicians. NMMS recently released findings that demonstrate poverty, a shortage of physicians and insufficient health care financing are creating a health care crisis.

NMMS presented its findings to New Mexico's congressional delegation and will continue to emphasize how:

  • More than 20 percent of New Mexicans are uninsured;

  • 35 percent of New Mexico's children under age 5 live in poverty;

  • 31 of New Mexico's 33 counties do not have enough health care professionals;

  • New Mexico's extremely low Medicare reimbursement rates have led to fewer provider choices, greater expenses and higher mortality rates; and

  • A $25 million Medicare increase is required simply to raise New Mexico to the national average.

"It's unacceptable to say that 'some states are fortunate and some are not,'" said G. Randy Marshall, NMMS executive director. "We want our elected officials to know that they need to work a little harder to protect the health of all of New Mexico's citizens."

For more information, e-mail NMMS's Bonnie Smith or phone (505) 828-0237.


7. ISMA undertakes effort to help physicians help pharmacists

In response to increasing demands on pharmacists' time to help patients, the Indiana State Medical Association (ISMA) recently highlighted to its members how they could best help pharmacists ensure accuracy when filling prescriptions.

"Pharmacists are part of the overall team to deliver quality health care to patients," said Richard King, ISMA executive director.

ISMA recommends a series of steps for physicians to follow to help pharmacists and reduce potential errors:

  • Write legibly;

  • Print out the name of the prescription;

  • Write the number and then spell out the number in parentheses;

  • Avoid abbreviations;

  • Include the indication(s) for the medication on the prescription;

  • Have a nurse include the indication(s) for the medication if the prescription is phoned in; and

  • Remember to advise patients to review medication refills before leaving the pharmacy.

There is not currently a shortage of pharmacists in Indiana, but ISMA reports that more pharmacists are seeking jobs outside the community pharmacy setting. A good portion of a pharmacist's time also is spent on the phone with insurers trying to negotiate various drug formularies as well as overseeing their technicians. The Indiana State Board of Pharmacy currently allows pharmacists to supervise four technicians at a time.

For more information, e-mail ISMA's Adele Lash or phone (317) 261-2060.


8. Beltway coalition tackles regional insurance hassles

Fairfax County Medical Society Executive Director Roberta Sorensen knew medical societies surrounding the D.C. beltway experienced similar managed care hassles, and she thought it would be helpful to physicians if the medical societies combined efforts.

Sorensen took the lead and recently brought together a coalition of representatives from the Medical Society of the District of Columbia and county medical societies in Northern Virginia and the Maryland suburbs to address what they consider the objectionable practices of area insurance companies.

The coalition will collect data concerning how insurers affect physicians and patient care throughout the region. The data will be used in discussions with health plans and will be shared with the insurance departments in D.C., Maryland and Virginia.

"Managed care has a strong foothold in the beltway area," said Sorensen. "It seemed natural for us to share information about how each jurisdiction interacts with health plans and develop ways in which to effectively advocate for the shared concerns of our physicians."

The coalition also includes representatives from the Arlington County and Alexandria Medical Societies in Virginia, and the Montgomery County Medical Society in Maryland.

For more information, e-mail Soresnen or phone (703) 848-8810.


9. PaMS tells lawmakers patients and physicians deserve better

The Pennsylvania Medical Society (PaMS) yesterday told state legislators that dominant health insurance companies are limiting physicians' abilities to provide appropriate patient care and that it is time to level the playing field so that patients and their doctors have a greater say in the delivery of health care. Economist Stephen E. Foreman, PhD, explained to lawmakers that one or two dominant insurers control each of Pennsylvania's markets.

Donald H. Smith, MD, PaMS president, told lawmakers that insurers with unusually large shares of the market are "beating down the delivery of health care by deciding what kind of care to deliver, who will deliver that care, when to deliver the care, and where that care will be delivered."

Read Dr. Smith's testimony.

For more information, e-mail PaMS's Chuck Moran or phone (717) 558-7820.


10. TMA hits the road for physicians' summer school

The Texas Medical Association (TMA) recently announced its summer schedule of seminars. TMA staff will travel to 12 cities to teach courses including:

  • Beginner ICD/CPT Coding;

  • Clean Claims;

  • Employing a Non-Physician Practitioner;

  • Alcohol and Other Drug Abuse Among Physicians;

  • Nicotine Dependence and its Treatment; and

  • Basics of MEDLINE Searching.

For more information, visit the TMA Web site.


Public health:

11. AAFP announces Tar Wars winners

Fifth grader Jenny Beck wants everyone to have healthier lungs and live a longer, happier life -- by choosing NOT to smoke. Beck's message was part of her first-place poster in the national Tar Wars poster contest, sponsored by the American Academy of Family Physicians (AAFP).

For winning first place, Jenny and her family are going to Disney World.

Developed in 1988, the Tar Wars poster contest aims to increase students' awareness of attitudes about tobacco use and the effects of tobacco on the body. Creating the posters also allows students and educators to discuss and examine the different messages in tobacco advertising and how these ads influence people.

For more information, e-mail AAFP's Kelly Cannon or phone (800) 274-2237.



12. JAMA theme issue to focus on tobacco

During the 11th World Conference on Tobacco OR Health (WCTOH), JAMA will hold a media briefing to release new research on tobacco. The briefing will be held on Tuesday, Aug. 8 at the Chicago Hilton and Towers, 12:15 - 2:45 p.m.

For more information, visit the WCTOH Web site.


13. CDC launches Internet site en espanol

The Centers for Disease Control and Prevention (CDC) recently launched a Spanish language Web site -- CDC En Espanol. This is not a translation of the English language CDC Web site. Rather, it is tailored for the specific needs of the Hispanic/Latino population. Health information is supplemented by information focusing on adolescents, students, teachers, patients, health care providers, women and men.


14. AMA Alliance launches new Web site

The AMA Alliance last week launched its redesigned Web site to better serve its members and the public. The new site features the well-known Alliance Stop America's Violence Everywhere (SAVE) program, links to its many educational publications, links to state and county Alliances, and information about the Alliance Health Awareness Promotion Awards.

Visit the AMA Alliance Web site.


External links to Web sites and e-mail addresses are offered to provide readers with additional sources of news and information. The AMA is not responsible for the content contained in these external sources.

If you have any questions regarding this newsletter, or if you have difficulty opening the attached files, please e-mail Daniel Blaney-Koen or call (312) 464-4415.

Last updated: Apr 11, 2001

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