A $17 million legal victory is good, but triumph in the court of public opinion is even better.
After winning its antitrust case against Marshfield (Wis.) Clinic (now being appealed), Blue Cross and Blue Shield United of Wisconsin ran ads in central Wisconsin newspapers claiming to "set the record straight."
They showed internal memos by Marshfield officials that had been introduced as evidence. One memo said: "If we pass on to Blue Cross the same level of discounts that are available to (Marshfield's own Security Health Plan), the plan will no longer be able to `mark up' rates to the extent it has in the past."
The clinic filed a motion to stop the ads, saying they violated a pretrial agreement that discovery information would not be used for commercial purposes. But the First Amendment prevailed: A federal judge denied the motion because the memos are public record.
Afterward, Marshfield general counsel Reed Hall said the memos were taken out of context. "Certainly, they were not clinic policy documents," he said.
Countered Blue Cross' lawyer, James Troupis: "These are the officers of the corporation. Who else speaks for the corporation?"
`Mama'grams.Medicare, like other payers, is trying to get preventive. This month, it launched a yearlong campaign to make sure at least one benefit-mammogram screenings for breast cancer-is used more frequently. The program will spend $260 million to screen 5 million beneficiaries this year. More than 9 million other women are eligible for mammogram screenings under the Medicare program but don't receive them. The cost in lives is high: Nearly one-third of the 46,000 breast-cancer fatalities in 1994 might have been prevented if the disease had been caught and treated earlier, researchers say.
Watch for President Clinton on television talking about his mother's battle with breast cancer and first lady Hillary Rodham Clinton discussing the successes of survivors. Part of the campaign also included "Mama"grams, pre-printed messages that were to be included in Mother's Day flowers urging women to get mammography screenings.
The drive toward preventive medicine is relatively new to Medicare. Congress authorized coverage for mammography screening in 1990 and for Pap smears in 1989. Historically, the program has paid only for services needed to diagnose and treat illnesses or injuries, not to screen for them.
Not D-Day.The Senate Budget Committee began work on its 1996 budget last Monday, which also happened to be the 50th anniversary of V-E Day, short for "Victory in Europe," commemorating the end of fighting in the European theater during World War II.
Several committee members used the occasion to draw analogies between the battle in Europe and the battle of the budgetary bulge.
Sen. Judd Gregg (R-N.H.) said he was "trying to find a way to tie (the budget deliberations) into V-E Day, but I realized that `Victory over the Deficit' is probably not the letters I wanted to use."
In transition.The National Association of Psychiatric Health Systems just hired a new executive director. He's Mark Covall, current executive director of the American Managed Behavioral Healthcare Association.
For those who aren't up on the constituencies of these two Washington-based groups, the association's hiring decision is akin to the American Hospital Association succeeding Richard Davidson with the head of the Group Health Association of America. In other words, hiring an HMO industry leader to direct a hospital group.
Obviously, this portends a blurring of the lines between mental health providers and insurers. The psychiatric hospital systems and the managed behavioral healthcare companies "are moving closer and closer together," said Covall.
In the past, a certain amount of antagonism divided the two. Managed-care companies often make life miserable for psychiatric hospitals because they dictate whether patients are admitted and how long they stay. For many hospitals, managed-care firms control as much as 50% of their revenues.
Covall's group, the AMBHA, has 18 member companies that provide mental health and substance-abuse treatment coverage for 80 million individuals.
So, is Covall's hiring a first step toward a merger of the two associations? Covall said no but acknowledged "collaboration down the road" between the two. "People want to pay less dues and consolidate what they're doing."
The NAPHS' former executive director, Robert Trachtenberg, resigned to become chief operating officer of the American Psychiatric Association.
Left hook.It seems that the budget-cutting conservatives in Congress aren't the only ones out to skewer the Department of Veterans Affairs healthcare system. Now, a giant of the left, "Doonesbury" creator Garry Trudeau, also has taken some shots.
In a series of comic strips that put the always-helmeted character B.D., a Vietnam and Persian Gulf War veteran, in a VA hospital for Gulf War Syndrome, Trudeau highlighted many of the VA system's weaknesses often cited by critics.
The fifth strip of the series lampooned the VA's overreliance on inpatient beds. A doctor explains to B.D. that the hospital is quiet because only 30% of its beds were filled and that four surgeons hadn't operated in six months. B.D. asks how the surgeons maintain their proficiency, prompting the following response: "Melons. Why? You need some elective?"
The final strip shows B.D. complimenting the doctor on the hospital. The doctor responds that the VA budget is "politically untouchable" despite the healthcare system's shrinking patient base, "which is why you've got a fully staffed, state-of-the-art 300-bed facility virtually all to yourself."
B.D., looking out a window, says, "Nice golf course."
"Actually, that's where the new wing's going," the doctor responds.
The VA, predictably, had no comment.