News summaries for June 14, 1999 - Top Stories - News Briefs

The last week of May brought four events that augured the future of physician collective negotiation efforts. A ruling from the National Labor Relations Board quashed a hard-fought campaign to establish that physicians who contract with health plans are de facto employees with collective bargaining rights. The same day, Texas enacted legislation giving independent physicians the ability to jointly negotiate with health plans. Expected to go into effect Sept. 1, the law permits up to 10% of physicians in a given market to negotiate fees, discounts and capitation rates when a plan has substantial market power. Meanwhile, the AMA Board of Trustees expanded on its opposition to forming a national collective bargaining unit. Its draft report recommended the AMA continue its private-sector advocacy program, lobby for U.S. Rep. Tom Campbell's (R., Calif.) Quality Health Care Coalition Act of 1999 and support formation of independent housestaff organizations. And finally, the Union of American Physicians and Dentists announced that hundreds of physicians employed by Los Angeles County had voted to join the union. ... Go to full text.

Long-awaited HIV vaccine trial off to surprisingly slow start

Despite the push over the last decade to develop preventive vaccines for HIV, volunteers have been slow to step forward for the first such vaccine to undergo large-scale human testing in the United States. Last June, the Food and Drug Administration approved a Phase III clinical trial for AIDSVAX, a long-awaited genetically engineered vaccine made from the gp120 protein found on the surface of the human immunodeficiency virus. The vaccine stimulates the immune system to produce HIV antibodies, but it's not known whether that response can protect someone later exposed to the virus. Since it is not made from live virus and does not contain HIV DNA, it cannot cause infection, according to manufacturer VaxGen; but inaccurate information about such risks is circulating in the HIV-at-risk population and has scared off some potential volunteers. As of May 24, about 2,500 people had enrolled in the randomized, double-blind, placebo-controlled trial, which was designed to include 5,000 HIV-negative volunteers at 58 sites nationwide. Volunteers being sought are men who have sex with men and high-risk heterosexuals.

Government & Medicine |Plan to boost mental health parity gains advocates' support

The federal government plans to require health plans covering federal workers to make mental health benefits equal to medical/surgical benefits in a move that mental health advocates believe will add momentum to their campaign for parity in coverage. Medical and mental health advocacy groups have been saying all along that putting mental health benefits on par with medical/surgical coverage would cost very little or could even produce savings. The administration's initiative reportedly would prohibit the 285 plans serving federal workers from imposing higher co-payments and deductibles, or more stringent visit limits, on mental health coverage than on medical/surgical coverage. Parity supporters hope the government's action will spark interest in legislation. Both of the two leading bills before Congress would ban discriminatory limits on the number of inpatient and outpatient mental health treatment visits.

Congress rethinks Medicare reform

Legislation crafted from the now-disbanded Medicare reform commission's plan is expected to be introduced shortly in both houses of Congress, and legislators and interest groups are beginning to take sides. The plan developed by the bipartisan commission on Medicare reform was modeled on the federal employees health insurance program, which insures 9 million government workers, including members of Congress. Also called a premium-support plan, it would allow beneficiaries to choose from an array of private health plans or the traditional fee-for-service program for which they would pay, on average, 12% of the premium, with the government paying the rest. Meanwhile, several conservative House members have asked that chamber's leadership to consider the approach developed by the commission, while some liberal members oppose the commission's approach and asked President Clinton, whose Medicare reform bill is expected soon, to "hold the line on Medicare."

Professional Issues |Tighter rules urged for nonprofit links to commercial deals

Sixteen state attorneys general have issued a draft document that says the practice of putting nonprofit organizations' logos on commercial products implies endorsement. The AGs say their recommendations aim to ensure that consumers are protected from misleading advertising and that they are attempting to rein in alliances that confuse consumers with misleading ad campaigns that border on fraud. But nonprofit health advocates fear that lucrative alliances between health groups and commercial sponsors could dry up, depriving them of critical funds they need to promote important public health messages. Partnerships most likely to be affected are those involving commercial product ads that contain the logo or name of a nonprofit health group. The attorneys general cited the dramatic growth in these promotions during the past decade, also referred to as "cause marketing."

N.J. suspends precertification for people hurt in crashes

State Insurance Commissioner Jaynee LaVecchia has suspended draconian precertification plans issued by a number of insurers. Under rules implemented in March, auto insurers were allowed to implement precertification systems and require physicians to adhere to stringent medical care paths when treating people with neck and back injuries from car crashes. The regulations implemented a state law passed last year to help curb statewide auto insurance premiums, the highest in the nation. The department plans to issue more precise standards outlining the type of precertification allowed. But doctors, hoping for a more significant overhaul in the regulations, including the treatment protocols and the precertification systems, asked an appeals court May 12 to force the department to completely revise the rule. A ruling is not expected until at least July.

Medical Markets |TennCare gets last-minute financial fix

Tennessee physicians are elated by the Legislature's May 28 approval of $600 million for the TennCare managed care program for Medicaid recipients and other mostly low-income people. Almost all of the new funds will be passed directly through the program's troubled HMOs to fatten scanty reimbursements for hospitals and 6,000 participating physicians. A state-commissioned study found that both groups were being paid below their costs. The money also will be used to fund a sweeping reform plan released May 10, invoking the biggest changes since the program began in 1994. It seeks to stabilize TennCare's financially troubled HMOs, improve the balance of healthy and sickly enrollees, and keep doctors from fleeing. Lawmakers had to dip into one-time state funds, meaning the Legislature will have to find new sources next year to fund the $4 billion program, which covers 1.3 million people or one in four Tennesseans.

Illinois OKs external review but balks at HMO liability

After four years of debate, the Illinois Legislature enacted a sweeping HMO reform bill May 27, but the bill arrived late and is expected to have limited impact. Key provisions in the 74-page measure, such as independent external review for HMO coverage decisions, already are law in many other states. HMO liability was passed by the House, but it was opposed by the Senate and by Gov. George Ryan over cost concerns and was removed from the final version. No state has passed such a law this year, leaving it on the books only in Texas and Missouri. Despite the HMO liability defeat in Illinois, medical society officials declared they were satisfied that a patient protection law finally was passed. But the bill, expected to be signed by the governor, may be anticlimactic. Illinois HMOs say they already adopted many of the provisions.

Organized Medicine |Plan OK'd to bolster JAMA editorial integrity

Five months after the controversial firing of a journal editor, AMA leaders have agreed to an independent oversight body as a buffer between the next editor and the Association. The committee charged with finding a new editor in chief for JAMA and the AMA's Archives journals can begin that task in earnest now that they have hammered out an agreement with the AMA that sets new editorial independence parameters for the post. The agreement calls for a new Journal Oversight Committee that annually will evaluate the performance of the editor and must be consulted before that editor could be fired. The editorial independence of the journal was called into question in January, when AMA Executive Vice President E. Ratcliffe Anderson Jr., MD, fired George D. Lundberg, MD -- JAMA's popular but controversial editor for 17 years. The firing garnered international attention. See the full text of the governance report on the JAMA site.

Health & Science |Researchers decry lack of steady funding

The report, released in May, of a panel studying funding for biomedical research says the current budget quagmire highlights the imperative for creating a stable, long-term source. The American Assn. for the Advancement of Science and the Funding First Program of the Mary Lasker Trust convened the panel of experts from science and government earlier this spring to develop a series of potential solutions. It noted that, with biomedical research emerging as a national priority, the National Institutes of Health enjoyed inflation-adjusted budget growth from $2 billion in fiscal year 1960 to $16 billion in 1999. But instability in the process creates room for concern about the future. For example, the House's current $78.1 billion allocation for the Labor-Health and Human Services appropriations, which includes NIH spending, is $6.6 billion or 7.7% below the 1999 funding level. Despite the volatility that seems to plague the annual appropriations process, the Funding First-AAAS panel still concluded that it should be the primary source of federal funding for medical research. It also suggested, however, that a secondary source -- a trust or reserve fund -- be created to supplement this stream.

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Wisconsin court upholds abortion procedure ban

Madison, Wis. -- A Wisconsin law that bans a particular type of late-term abortion is constitutional, a federal judge ruled. The ruling said the law was not vague and would not place an undue burden on women, as opponents had argued.

Wisconsin is one of only two states where courts have found laws banning "partial birth" abortions to be constitutional. Almost 20 states have blocked or limited the law on constitutional grounds. The ban is in effect in eight states.

A federal bill to ban the procedure has passed Congress twice before, but was vetoed by President Clinton. A similar bill is pending.

Planned Parenthood and the six physicians who sued the state to overturn the law will appeal the decision to the 7th Circuit, which enjoined the law a year ago, before sending it to the district court for trial.

Humana buys 50 FPA medical centers

Louisville, Ky. -- In a $13.5 million agreement announced late last month, Humana Inc. will acquire the operations of 50 medical centers from FPA Medical Management Inc.

The agreement, effective June 1, was approved by FPA's lenders and a federal bankruptcy court. Given that about 121,000 Humana members are served by the clinics, the HMO described its acquisition as a "necessary transitional step because of FPA's current financial circumstance."

Humana is evaluating its options for the clinics, which are in Kansas City, Kan.; Kansas City, Mo.; San Antonio; and several cities in Florida. The firm said it would consider transferring the responsibility for some or all of them to different provider groups.

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