Newsletter - February 15, 2001 - American Family Physician

Newsletter
Rosemarie Sweeney and Toni Lapp

HCFA Offers Answers to Questions on Referral Regulations

Federal officials will reverse a policy that prevented Medicare beneficiaries who filed complaints about the quality of their health care from obtaining data about physicians under investigation, according to an article in the January 2, 2001, issue of The New York Times. Current rules allow patients to request information from investigative findings about a physician, but only with the consent of that practitioner, effectively limiting disclosure to patients. Under the new policy, physicians would no longer have the power to veto disclosure of these findings. Investigators also will have to tell patients who file complaints whether the care they received met "professionally recognized standards of health care" and inform them about actions against physicians or hospitals. While consumer advocates praise the new rules, physician and peer review organizations worry about the repercussions. "If doctors know that anything they provide can potentially be revealed, they will be more worried about lawsuits, penalties and a punitive reaction," said Dr. Ferdinand Richards, medical director of a Florida peer review group, in the report.

HHS Issues Confidentiality Regulations

The Department of Health and Human Services (HHS) released final patient record privacy standards in December 2000. The final regulation, which goes into effect in 2002, applies to health plans, health care clearinghouses and health care professionals who conduct electronic financial and administrative transactions. Under these regulations, patients have significant new rights to understand and have more control of their health information. The new standards: limit nonconsensual use and release of private health information; give patients new rights to access their medical records and to know who else has accessed them; restrict most disclosure of health information to the minimum needed for the intended purpose; establish new criminal and civil sanctions for improper use or disclosure; and establish new requirements for access to records by researchers and others. More information can be found on the following Web site: http://aspe.os.dhhs.gov/admnsimp/.

New Rules Mandate Faster Resolution of HMO Appeals

Among the last-minute regulatory activity accompanying former President Bill Clinton's departure from office in January, the Labor Department issued new rules calling for faster HMO appeals. According to a report in American Medical News, more than 130 million people will be affected by the rules, which apply to employer-sponsored health plans covered by the 1974 Employee Retirement Income Security Act. The Labor Department's regulations call for health plans to "make coverage decisions quickly--within 72 hours for urgent requests--and to provide consumers with meaningful information on their rights and benefits," said former President Clinton when announcing the rules. Although the American Medical Association (AMA) applauded the rules, AMA Trustee Donald J. Palmisano said the rules do not go far enough. For one thing, the rules do not address external appeals of health plans' decisions, a subject that had been addressed in lawmakers' debates on the issue. The rules went into effect January 20.

Family Physicians Eye Legislative Priorities for 2001

In a recent survey to identify the 2001 legislative priorities of American Academy of Family Physicians' state chapters, state funding for graduate medical education for family practice programs ranked at the top of the list for the majority of chapters. Other priorities include seeking an increase in Medicaid reimbursement and mandatory insurance coverage for vaccines and immunizations. Opposing the bid by nurse practitioners to seek independent practice and supporting public health initiatives from the state tobacco settlement funds are other high priorities.

Politically, 2001 promises to be a dramatic year as term limits helped to bring significant membership turnover to state legislatures this year. According to the National Conference of State Legislatures (NCSL), in the 44 states that held elections in 2000, nearly 23 percent of the seats up for election brought new members to those legislatures. NCSL estimates more than 1,300 new legislators will be sworn in this year. Those controlling the legislative power reins will significantly change as well. At least 30 house speakers or senate presidents will be new this year.

CDC Creates Registries for Childhood Diabetes

The Centers for Disease Control and Prevention (CDC) has awarded $1 million to establish a multicenter registry system to define childhood diabetes and to register American children with the disease. Initial reports suggest a recent surge in type 2 diabetes (formerly known as noninsulin-dependent diabetes mellitus) among children and adolescents. "An increase in type 2 diabetes in young people means that we are going to have more people--children and adults--with diabetes and they will have it for a longer time, which increases the rate of severe complications like blindness, renal failure and amputations," said Frank Vinicor, M.D., director of the CDC's diabetes program. The five-year project will register children from four centers. The project will yield a target population of about 4.5 million children (about 6 percent of all American children), more than 6,000 existing cases and about 800 new cases a year. Dr. Vinicor also stated that the registry will study the prevalence, incidence, natural history and quality of care so that future programs and interventions may be improved.

Patient Education Conference Calls for Presentations

The 2001 Conference on Patient Education, taking place November 15 to 18 in Seattle, is inviting proposals for a variety of presentations at the conference. Submissions may cover any area of patient education. Presentations offer various levels of involvement in the conference, including workshops, seminars, lectures, papers, poster displays and special interest discussions. Submissions must be postmarked by March 16 and mailed to the Society of Teachers of Family Medicine, 11400 Tomahawk Creek Pkwy., Ste. 540, Leawood, KS 66211. For more information, contact Priscilla Noland at 800-274-2237, ext. 5410.

Copyright © 2001 by the American Academy of Family Physicians.
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