Patients’ rights legislation reaches Senate floor

Patients’ rights legislation, which has been under consideration in Congress for nearly five years, was recently given a new lease on life when Sen. Jim Jeffords (I-Vt.) decided to leave the Republican party, giving control of the Senate to the Democrats. On June 21, the Senate began several weeks of debate on the Bipartisan Patient Protection Act of 2001, which was introduced by Senators Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.). This bill would enable patients to sue health plans in state court for denial of benefits or quality-of-care issues and in federal court for contract disputes. In addition, the bill would cap damages awarded in federal court at $5 million; state courts could award as much money in damages as the state allows.

An alternative bill, the Bipartisan Patients’ Bill of Rights Act of 2001, sponsored by Sens. Jim Frist (R-Tenn.), John Breaux (D-La.) and Jeffords, has been introduced in the Senate and would allow lawsuits only in federal court. Damages would be limited to $500,000.

Both bills would guarantee coverage for specialty and emergency care and would eliminate “gag clauses” that restrict communication between patients and physicians. The AAFP supports the Kennedy-McCain-Edwards legislation. President Bush endorses the Frist-Breaux-Jeffords bill and has threatened to veto the others.

In the House of Representatives, work has begun on a new bill that will challenge the House version of the Kennedy-McCain-Edwards bill, sponsored by Reps. Greg Ganske (R-Iowa), John Dingell (D-Mich.) and Charlie Norwood (R-Ga.). If the two chambers of Congress end up passing different patients’ rights legislation, the bills will then be sent to Conference Committee to be reconciled. Congressional observers believe congress may be closer to agreeing on a bill that can go to the President than they have been in years.

National FP salaries

Although demand for primary care physicians has lessened since the early ’90s, it remains strong, according to the 2001 Martin, Fletcher Annual Physician Compensation and Benefits Report. Family physicians can expect the following salaries in today’s market:

More docs job hunting

Job turnover among doctors is at an all-time high, reports the May 22 New York Times. Before 1990 only 1 percent to 2 percent of practicing physicians changed jobs throughout a 20-year career. Now, more than 10 percent of physicians change jobs in a given year. The average physician who entered practice after 1990 was likely to have had at least three jobs by 2000.

This “nomadic” career path can be attributed to a number of factors, reports the Times, including professional dissatisfaction, diminishing job security and a growing number of intrusions on the practice of medicine.

“Older doctors are riding out these changes and waiting to retire. Middle-aged physicians are angry that the rules have changed so markedly in midstream, and a number of them are leaving medicine entirely. But it’s the younger doctors who are on the move,” said Sharon Buchbinder, an associate professor of health sciences at Towson State University in Maryland.

It’s estimated that high rates of physician turnover cost the health care industry millions of dollars annually in recruitment and replacement fees, which average $250,000 for a primary care physician. High physician-turnover rates can also be costly to health plans whose patients disenroll when their doctors leave the plan and to patients who lose continuity of care when their doctors change jobs.

PRACTICE PEARLS from here and there

Improving CPT coding accuracy

It’s been estimated that proper coding can increase the typical family physician’s income 10 percent to 30 percent. To improve your coding, start by buying the current CPT manual and reading the first 36 pages, which deal with evaluation and management (E/M) coding, says Douglas E. Henley, MD, AAFP executive vice president and former co-chair of the AMA’s CPT Editorial Panel. “If you don’t do that,” Henley says, “you can never code properly. There’s no excuse for not having that book, no excuse for not reading those 36 pages.”

– Jancin B. Go buy the CPT book, then go by the book. Fam Pract News. Jan. 1, 2001:38.

PRACTICE PEARLS from here and there

Aim for Tuesday

Efforts to make improvements within an organization often fall short because too much time is spent in the planning stage – considering ideas, debating them and holding countless meetings. If you’re serious about improving your organization, do the necessary planning but then proceed quickly with the rest of the process: testing your change on a small scale, checking to see whether it worked and altering or expanding the change as needed. To maintain momentum, ask “What steps can we take by next Tuesday?”

– Lynn J, Schuster JL, Kabcenell A. Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians. New York: Oxford University Press; 2000. In: Continuous Improvement newsletter. Boston: Institute for Healthcare Improvement. June 2001.

A renewed bureaucracy

The Health Care Financing Administration has undergone its first big change under the Bush administration: It has changed names. After an employee contest to solicit ideas, the Centers for Medicare and Medicaid Services won out over Health and Death Evaluation Services (or HADES) and the Medicare and Medicaid Agency (or MAMA), among others. Health and Human Services Secretary Tommy Thompson says the new name symbolizes a new organization that promises to be more service-oriented and less bureaucratic. No word yet as to how much the change will cost taxpayers in terms of new signs, forms and stationery.

Reporting errors

When it comes to the subject of medical mistakes, it seems no one’s talking. Although required by federal law to report physician incompetence and misconduct to the National Practitioner Data Bank, 84 percent of managed care organizations did not report any incidents between 1990 and 1999, according to a recent study by the Office of the Inspector General. During those same nine years, physician groups reported only 60 incidents.

Drug spending

Last year, pharmaceutical companies had median profits of 18.6 percent after taxes – compared with an average 4.9 percent for all other Fortune 500 companies, according to The Profit in Pills, a report from the Alliance for Retired Americans. The organization, which is affiliated with the AFL-CIO, is lobbying for lower prescription drug prices and a Medicare drug benefit. Meanwhile, according to the 2001 Merck-Medco Drug Trend Report, drug spending is predicted to double over the next five years.

Needle in a haystack

Patients using the Internet may have a difficult time finding complete and accurate health information even on the most highly rated Web sites, according to a recent study conducted by the RAND Corporation. Researchers studying English and Spanish health information Web sites found it difficult to locate information using simple search terms and found the information to be accurate and complete only 45 percent of the time on English sites and 22 percent of the time on Spanish sites. An estimated 70 percent of Americans who go online in search of health information say that what they find influences their treatment decisions.

Persistence pays

Aetna U.S. Healthcare announced recently that it’s been overpaying physicians and other providers by possibly millions of dollars, according to the June 8 Hartford Courant. Aetna chief executive officer John W. Rowe, MD, attributes many of the overpayments to poor record keeping, which caused the company to pay duplicate claims. Such claims occur, says Rowe, when health care providers submit claims more than once because they don’t trust the company to pay their claims the first time.

PDAs become standard issue

Beginning in August, Harvard Medical School will become one of the first educational institutions to issue personal digital assistants (PDAs) to its students, reports the May 7 Boston Globe. The program, which is expected to cost about $350,000, will help students manage their time and information better. Using PDAs, they will be able to store class schedules, lecture notes, anatomy illustrations and other items electronically and receive announcements from faculty, who will also be using PDAs.

Misery loves accuracy

A researcher at the University of Alberta may have found the secret to preventing errors in the work-place: employee dissatisfaction. According to the study, employees who arrive at work feeling unhappy make half as many mistakes as “those who show up at the job all sunshine and smiles,” reports the June 14 Washington Times. “Happy people feel attention to detail takes away from their happy thoughts,” said the researcher. “[S]ad people use their task to distract from their sadness and so they pay more attention to detail.”