March
6, 2000
Newsletter Archive
Top
Story
On
March 1, the College issued an action alert to
targeted ACC Key Contacts urging them to contact
their representatives concerning the physician
collective bargaining bill H.R. 1304, the "The
Quality Health Care Coalition Act of 1999."
H.R. 1304 is scheduled for mark-up in the House
Judiciary Committee on March 8. House Speaker
Dennis Hastert, R-Ill., has promised to bring
the bill to the floor for a vote this spring.
The ACC issued the action alert in an effort to
attract additional cosponsors to the bill and
to shore up the support of current cosponsors.
The ACC has learned, however, that the mark-up
could get pushed back to March 15. H.R. 1304,
sponsored by Reps. Tom Campbell, R-Calif., and
John Conyers, D-Mich., would allow health care
professionals to join together and negotiate the
terms and conditions of their contracts with health
plans without violating the antitrust laws. Check
Advocacy Weekly for updates. To obtain
a copy of the action alert and the target list,
go to http://www.acc.org/advocacy/collective.html.
Legislative Affairs
Federal
News
On February 10, the Senate passed a resolution
designating Feb. 14-18, 2000 as "National Heart
Failure Awareness Week." The resolution, S.Res.256,
was sponsored by Sen. Arlen Specter, R-Pa. Thanks
to all ACC members who contacted their senators
and asked them to cosponsor the resolution.
President
Clinton is calling for the expansion of the State
Children's Health Insurance Program (SCHIP) to include
uninsured parents whose children are eligible or
enrolled in Medicaid or SCHIP. According to
the president, his FamilyCare program would reach
an estimated four million uninsured adults. Clinton
is again calling for a Medicare buy-in for individuals
age 62 to 65 and displaced workers age 55 to 65.
Clinton has also embraced the politically popular
idea of tax credits for purchasing health care coverage.
Specifically, Clinton wants to make a tax credit
(equal to 25 percent of the premium) available to
individuals who participate in the Medicare buy-in.
Clinton would also give small businesses –
that have not previously offered health insurance
– a tax credit equal to 20 percent of their
contribution toward health insurance obtained through
purchasing coalitions.
A
House committee has reopened the debate about whether
the public should have access to the National Practitioner
Data Bank. At a hearing on March 1 before the
House Oversight and Investigations Subcommittee,
both Commerce Committee Chairman Tom Bliley, R-Va.,
and Sen. Ron Wyden, D-Ore., reportedly expressed
their support for opening the data bank to the public.
There is some speculation that Chairman Bliley's
call to open the data bank to the public is retaliation
against the AMA for supporting Democrats in the
patient protections debate. Chairman Bliley rejects
such a claim stating the public's right is of primary
concern.
State News
The ACC's Department of Legislative Affairs is available
to help ACC Chapters and members in promoting their
respective state legislative agendas and priorities.
Contact Enzo Pastore at either 800-435-9203 or epastore@acc.org
to find out about the College's resources and how
we can help you.
In
Kentucky,
the House last week overwhelmingly passed a bill
that would treat "all products clauses" as an unfair
trade practice. The bill was specifically aimed
at Aetna in Kentucky– the only insurer in the
state that imposes the "all products clause" on
its physician network, a practice that has led physicians
to drop out its network. HB371 passed by
a vote of 96-1. The bill is now in the Senate Committee
on Banking and Insurance.
In
other Kentucky news, several trade associations
are promoting legislation (HB 632) that would
allow new insurance companies to pay a monthly fee
for access to the physicians and hospitals that
participate in area managed care plans. In effect,
the trade associations want the dominant health
insurers to share their networks with competitors.
Not surprisingly, the existing dominant insurers
(Humana, Anthem Blue Cross and Blue Shield and others)
oppose the measure. The insurers claim that their
provider networks and the fee discounts they have
negotiated are their property and the state has
no right to force them to share the information
with any competitor. The bill defines dominant market
share as 25 percent or more of the statewide market.
Managed care plans could pay other plans that have
a dominant share of the market a monthly rental
fee of $5 per policyholder for access to the networks
of hospitals and doctors. It is uncertain whether
the bill has any chance of passage.
In
Oklahoma,
a bill granting patients the right to sue HMOs
passed in the House by a vote of 93-8. House bill
2711 has now been moved to a conference committee
where some of its provisions will be examined once
again. If enacted, Oklahoma would be the fourth
state, behind Texas, Georgia and California, that
allows HMOs to be sued by people employed in the
private sector.
When
the Florida
legislature resumes on March 7, several prefiled
bills, including HB 291, SB 424, and SB 788,
will be considered. All the bills address the issue
of a health plan's responsibility to its patients
and to what extent a patient will be able to
sue the plan.
In
California,
a bill was introduced in the House
that would exempt physicians in private practice
from antitrust laws and allow them to negotiate
contract terms with managed care plans. Look
for SB2007, the Quality in Health Care Contracts
Act, to receive a strong grassroots lobbying effort
from the ACC California
Chapter. Similar bills have recently
been introduced in Illinois
(HB4478) and in New
Jersey (SB1033).
Regulatory and
Legal Affairs
The
Medicare Coverage Advisory Committee's (MCAC)
Executive Committee met March 1 to consider the
criteria needed to determine Medicare coverage
for a procedure. The MCAC is focused on two
questions in evaluating evidence: 1. "is the evidence
concerning effectiveness in the Medicare population
adequate to draw conclusions about the magnitude
of effectiveness relative to other items or services?"
2. and "how does the magnitude of effectiveness
of the new medical item or service compare to
other available interventions?" Commenters expressed
concern that the panel's desire for evidence gathered
through random controlled trials is not always
available and suggested that other data sources
be considered. Panel members responded that they
would not use the lack of random controlled trial
data as a basis for denying coverage. Several
commenters recommended that HCFA provide "provisional
coverage" to alleviate coverage delays while additional
evidence is being considered.
The
National Institutes of Health (NIH) announced the
launch of a database with information on more than
4,000 federal and private clinical trials at more
than 47,000 locations nationwide. The database
can be accessed through http://clinicaltrials.gov/
and is designed to give the public easy access to
information about the location of clinical trials,
their design and purpose, criteria for participation,
and, in many cases, further information about the
disease and treatment under study. There are also
links to individuals responsible for recruiting
participants.
The
National Academies' National Research Council recently
released a report, "Networking Health: Prescriptions
for the Internet," addressing health care on the
internet. According to the report, the Internet's
"full potential for health services and the biomedical
sciences will require more advanced technical capabilities."
The
National Academies press release can be found
online.
Practice Organization
and Management
The
Florida Medical Association (FMA) and Humana,
Inc. have reached an agreement that will begin
to address Humana's controversial policy of automatically
downcoding physicians' services. The agreement
will ensure that physicians are coding services
correctly and that claims are being reimbursed
in a fair and timely manner. The terms of the
agreement include: 1) coding seminars for physicians
and their office staff jointly sponsored by Humana
and FMA 2) an expedited review process for physicians
3) a letter clarifying steps needed for appropriate
and timely payment 4) follow-up meetings between
FMA and Humana to assess the effectiveness of
the agreement. FMA President, Mathis L. Becker,
M.D., stressed that the FMA does not see this
agreement as a comprehensive solution to problems
associated with managed care.
Aetna/US
Healthcare's board called for the resignation of
its CEO, Richard Huber, on Feb. 25. Since August
1999 Aetna's stock price has dropped by 50 percent,
from a high of $99.25 in May 1999 to a low of $38.50
in February 2000. William Donaldson, former chair
of the New York Stock Exchange and an Aetna board
member, was named as his replacement. Troubles in
Aetna's healthcare division such as increased medical
spending, a high volume of consumer complaints,
and lawsuits by physicians for unpaid claims have
contributed to the company's problems. The board
is also considering a letter of interest it received
from ING America Holdings and WellPoint Health Networks
to takeover Aetna for approximately $10.5 billion.
ING is a Dutch financial company and WellPoint is
a California- based national managed care company
interested in expanding into new markets.
Advocacy Weekly is a product of
the Advocacy Division of the American College of
Cardiology. Questions or comments regarding this
publication should be directed to the Advocacy Division
at 800-435-9203 or to advocacydiv@acc.org.
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