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

College applauds UnitedHealthcare but worries about other cost controls

While the College applauded UnitedHealthcare's announcement that it would give doctors, not administrators, the final say on medical necessity, it warned internists to watch for other measures the health plan may substitute to control costs.

UnitedHealthcare has indicated that it may increase its use of physician profiling when deciding which providers to allow into its network. Although ACP­ASIM realizes that physician profiling can be used appropriately, it argued that profiling should not be used to drop physicians whose practice patterns may be classified as more expensive because they treat sicker patients.

The College also noted that UnitedHealthcare's decision to reverse its review policy does not affect the need for legislation protecting consumers' rights. "UnitedHeathcare's action in no way eliminates the need for Congress to enact productive patients' bill of rights legislation," said ACP­ASIM President Whitney W. Addington, FACP. "Federal legislation is the only way to assure that doctors, not health plan administrators, make patient care decisions."

While UnitedHealthcare will no longer review and overturn physicians' treatment decisions, it still plans to ask doctors to justify decisions to order surgery or expensive diagnostic tests.

At College-sponsored meeting, Armey calls for tax credits to help uninsured

House majority leader Richard Armey (R-Texas) attended an Oct. 26 breakfast meeting of the National Health Council that was sponsored by an ACP­ASIM educational grant. He told health care analysts and lobbyists that Congress should create a new tax credit that would let Americans without health insurance "buy decent health coverage without new bureaucracy or costly mandates.

"I believe that in 2000, we are going to have a principal focus on the uninsured," Mr. Armey said. "I think the time is ripe for Congress and the presidential candidates to debate this issue next year in a serious way."

Earlier this year, he introduced a bill, called the "Fair Care for the Uninsured" (H.R. 2362), that would offer all Americans without public or employer-provided health coverage a certificate to help pay for private health insurance. Individuals receiving this certificate would be free to choose their own insurers, their own physicians, their own benefits and their level of coverage.

ACP­ASIM President Whitney W. Addington, FACP, who introduced Mr. Armey at the meeting, noted that the College underwrote the event "because as physicians, we are increasingly concerned about the growing health menace threatening more than 44 million Americans.

"Our medical experience, combined with the results of more than 130 scientific articles, has shown that the lack of health insurance is a devastating health risk factor--as dangerous as smoking cigarettes, failing to wear a seat belt and drinking too much alcohol," Dr. Addington said. "No health insurance is enough to make you sick."

College turns to petitions in new campaign for access

ACP­ASIM has joined with the Catholic Health Association (CHA) to sponsor a new initiative called "Be Heard for Accessible and Affordable Health Care."

The initiative aims to focus attention on the needs of those without health insurance. The campaign is encouraging Americans to sign petitions that urge national leaders to put health care on the top of the American election agenda. ACP­ASIM and CHA plan to use these petitions to show the White House, Congress and presidential candidates that a significant number of Americans are concerned about access to health care and price issues.

"Millions of people are subject to unnecessary suffering and run an increased risk of death because they lack health insurance," said ACP­ASIM President Whitney W. Addington, FACP. "America has a health problem, and health insurance for all Americans is the cure."

"Because of its importance, there needs to be a national conversation on health care reform as significant as the discourse surrounding the bill of rights and women's suffrage," said CHA's president and chief executive officer Michael D. Place. CHA represents 2,000 Catholic sponsors, health systems, facilities, health plans and related organizations.

Vote for the College in AMA balloting

ACP­ASIM is asking College members to designate the College as their specialty representative in the AMA's House of Delegates. Ballots must be sent to the AMA by Dec. 31.

For every 1,000 physicians who designate ACP­ASIM as their specialty representative this year, the College will gain one seat in the AMA's House of Delegates. A seat in the House gives the College more influence over AMA policy by allowing ACP­ASIM officials to participate in reference committees, sponsor resolutions and support internists seeking elected positions.

Prior to 1997, each specialty society seated in the House of Delegates had one delegate, while state medical societies received one seat for every 1,000 AMA members. While both ACP and ASIM represented tens of thousands of AMA members, each organization received only one delegate.

To correct this inequity, the AMA House changed its bylaws. In 1997 and 1998, specialty societies were allocated an extra delegate for every 2,000 votes they received. ACP received three seats and ASIM was allocated two. Since the merger in 1998, ACP­ASIM has had five AMA delegates and five alternates. This year, the new rules will give specialty societies one seat for every 1,000 votes they receive.

If you have previously designated ACP, ASIM or ACP­ASIM as your designated specialty society, you do not need to submit a ballot. Designations remain in effect from year to year until physicians change their designation or leave the AMA.

There is no paper ballot. To make your designation, contact the AMA, provide your AMA membership number and indicate ACP­ASIM (specialty code 312) as your specialty society representative. You can send a written request to AMA/Specialty Society Allocation Ballot, c/o W.J. Weiser & Associates, 1111 N. Plaza Drive, Suite 550, Schaumburg, IL 60173; call: 800-652-0605; fax: 847-517-7229; or e-mail: ballot@ama-assn.org.

ACP­ASIM part of new effort to alleviate lab test hassles

ACP­ASIM has helped create a plan to standardize how clinical laboratory tests are ordered and reimbursed.

The College worked with 17 other organizations as part of a federal "negotiated rulemaking" committee to standardize laboratory test policies. Internists are frustrated by problems caused by the current laboratory test ordering process. They complain that the policies of some Medicare carriers, which limit coverage of certain tests to specific diagnosis codes, are the greatest cause of day-to-day hassles in their medical practices.

The new proposal would include the following actions:

  • Set reasonable standards regarding the information an ordering physician must provide when ordering a lab test.
  • Create a uniform process that Medicare carriers must use when reviewing the medical necessity of lab claims.
  • Prevent Medicare carriers from denying claims based solely on the physician's frequency of ordering tests without identifying a recommended frequency.
  • Provide uniform coverage for 23 lab tests that account for about 70% of Medicare allowed charges for lab tests.
  • Prohibit Medicare carriers from developing local policies that contradict the 23 national policies.

The proposal has some downsides for physicians. While coverage for the 23 lab tests will be more inclusive than most existing local policies, all physicians will have to work within the restraints of a new policy. In addition, physicians will have to identify those tests that are for screening purposes when sending a requisition to the lab.

HCFA is expected to publish its proposal (which is open to public comment) within the next few months. The proposal will be implemented some time after the comment period ends. For more details about the proposed rule, see the "Where We Stand" section of ACP­ASIM Online at www.acponline.org.

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