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From the May 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

Fewer small businesses offering health care benefits

Fewer than half of all small businesses-- typically organizations with less than 100 employees--offer health care coverage to their employers, according to a report from The Henry J. Kaiser Family Foundation.

The report, which was conducted by KPMG Peat Marwick, found that the number of small business employees who get health care through their employer dropped from 52% in 1996 to 47% in 1998.

The study also said that more businesses ask employees to pay a greater percentage of health care costs, had plans with high copays and deductibles and had restrictive eligibility rules that made it difficult for workers to enroll.

CDC to conduct hantavirus update

The CDC will conduct a satellite training program on the hantavirus on May 27.

The program is designed for physicians and nurses in rural areas, primary care physicians who see patients in emergency rooms and specialists in pulmonary medicine and infectious disease. Continuing education credits may be offered.

For more information on the meeting, see the CDC's Web site or call 404-639-1510.

Joint Commission to create public advisory group

The Joint Commission on the Accreditation of Healthcare Organizations is establishing a public advisory group to get feedback from patients and others outside of medicine.

The new advisory group is expected to identify health care issues that are of interest to the public, identify quality measures that are meaningful to members of the public and refine reports so they can be easily understood.

The Joint Commission is seeking up to 25 prominent individuals who represent the public's interests in health care.

Correction

The story, "State legislatures poised to tackle liability, formulary issues" (March ACP-ASIM Observer, page 4) incorrectly described Texas law regarding the ability of patients to sue health plans. Texas is the only state that allows patients to sue health plans for medical malpractice.

New Governors-elect

At the Annual Session Business meeting, the Board of Governors' new Executive Committee members and new Governors-elect took office.

The 1999-2000 Board of Governors Executive Committee comprises the following individuals:

Chair
Munsey S. Wheby, FACP

Chair-elect
Donna E. Sweet, FACP

Class Representative Class of 2000
Robert C. Aber, FACP

Class Representative Class of 2001
James B. Reuler, FACP

Class Representative Class of 2002
David W. Potts, FACP

Class Representative Class of 2003
Jeffrey P. Harris, FACP

Transitional Governor
William E. Golden, FACP

The following College members are Governors-elect for their chapters. Their terms will begin in the year 2000.

Air Force
Arnyce R. Pock, FACP

Southern California II
Melvyn L. Sterling, FACP

Chile
Jose A. Rodriguez Portales, FACP

Central America
Marco A. Lopez, FACP

District of Columbia
Eugene P. Libre, FACP

Delaware
Virginia U. Collier, FACP

Florida
Frederick E. Turton, FACP (elected to a four-year term)
Kenneth R. Ratzan, FACP (elected to a two-year term)

Idaho
C. Scott Smith, FACP

Northern Illinois
Serafino Garella, FACP

Indiana
Ramon S. Dunkin, FACP

Kansas
Joseph L. Kyner, FACP

Manitoba/Saskatchewan
Wilson J. Fenton, FACP

Mexico
Jorge A. Castanon Gonzalez, FACP

Montana
Phillip E. Griffin Jr., FACP

Nebraska
Laurel C. Preheim, FACP

New Jersey
Francis Lee Griffin, FACP

New York Downstate II
Paul A. Gitman, FACP

Western Pennsylvania
Ralph Schmeltz, FACP

Puerto Rico
Francisco M. Joglar, FACP

South Dakota
David E. Sandvik, FACP

Wyoming
Harmon H. Davis II, FACP

College joins efforts to promote folic acid

ACP-ASIM President-elect Sandra Adamson Fryhofer, FACP, represented the College at the first conference of the National Council on Folic Acid.

The conference was held in late January to raise awareness about the importance of folic acid in women's health. The meeting also highlighted the Council's mass media campaign encouraging women to take 0.4 milligrams of folic acid daily.

The College supported the Council's efforts by mailing information about the folic acid campaign to members in December 1998.

ACP-ASIM supports measure to help low-income seniors

ACP-ASIM is supporting a recent measure introduced by Rep. Ken Bentsen (D-Texas) that would help ensure that all low-income Medicare beneficiaries get the medical benefits to which they are entitled.

Recent reports estimate that almost 40% of all low-income Medicare beneficiaries are not enrolled in the Qualified Medicare Beneficiary and the Specified Low-Income Beneficiary programs, both of which help low-income seniors pay for health care expenses. By directing the Social Security Administration to automatically enroll Medicare-eligible seniors in the programs, the bill would assure that all qualified low-income individuals receive aid for their premiums, copayments and deductibles. The bill would double current funding for critical outreach efforts to $12 million a year.

College says new patient protection proposal falls short

While the Patients' Bill of Rights Act introduced by Sen. Jim Jeffords (R-Vt.) includes some important patient protections, the College says that it falls short in some critical areas.

In a March 15 letter to Sen. Jeffords commenting on the proposed legislation, ACP-ASIM Associate Executive Vice President Alan R. Nelson, FACP, said that the bill expands protections for only those individuals who get their health care coverage through large employers, excluding tens of millions of Americans. Employer-based plans are typically regulated by the Employee Retirement Income and Security Act (ERISA), which does not allow these plans to be held accountable by the courts for medical decisions that hurt or kill patients.

The College's letter also pointed out that the bill does not give physicians participating in health plans a central role in developing utilization review and quality improvement protocols. ACP-ASIM is also concerned that the bill does not address the need to ensure affordable health care coverage.

However, the College did point out that the bill does contain the following necessary protections: requiring managed care plans to have point-of-service options; requiring a prudent layperson standard for emergency room coverage determinations; establishing safeguards to protect individual health data confidentiality; prohibiting gag clauses; and requiring health plans to provide access in a timely way for an independent review when service is denied.

College testimony: Medicare billing requirements 'difficult'

In March testimony before the Practicing Physicians Advisory Council on the Physicians Regulatory Issues Team, the College said that Medicare's billing regulations are becoming too complex. In particular, the College said that the responsibility of "complying with the myriad of requirements during the course of treating patients is becoming increasingly difficult to bear."

One area of major concern to physicians is the Medicare medical review process. While HCFA has contracted with a consulting firm to address this issue, the College suggested several improvements that should be considered in this area.

First, to enhance the medical review process, carriers should use detailed statistical analyses of severity-adjusted provider billing patterns to identify true outliers. Those outliers who show egregious behavior should receive educational coding assistance before being subjected to comprehensive audits.

The College also said that the actual medical review process should be reformed by having HCFA standardize the process by which carriers conduct medical reviews. HCFA also should instruct its carriers to stop random prepayment review of evaluation and management services.

ACP-ASIM also noted that government efforts to curb fraud and abuse have resulted in "an overly complex Medicare regulatory environment" that keeps the health care system "mired in red tape by imposing burdens on all physicians simply to eliminate actions of a few."

For more information on the College's positions and statements, see the "Where We Stand" section of ACP-ASIM Online.

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