For more than 60 years, urban phone users have paid a small fee that goes to reduce the rates of those in rural areas. The charges were enacted because of the high cost of bringing equipment to remote areas.
The same theory is being applied to telemedicine.
In the Telecommunications Act of 1996, Congress authorized the Federal Communications Commission to allow rural health providers $400 million in long-distance phone rate discounts to make it easier for them to afford expensive telemedicine services.
But as anyone who has ever tried to get an adjustment on a phone bill knows, the phone companies don't like giving discounts.
So in an effort to thwart the rural health providers, the phone companies have begun to display the rural health discounts as taxes on phone bills. That has led to a spate of phone calls to Congress from phone users wondering what this new tax is.
Not surprisingly (remember, this is an election year), this has led the FCC to reduce the amount of discounts available to rural health providers from $400 million to $100 million for fiscal 1998.
Last week, the National Rural Health Association sent a letter to Congress attacking the phone companies. They note that since May 1, the first day rural providers could begin applying for the program, nearly 1,000 have sought the discounts.
But the phone companies aren't done yet. There is talk that they may seek an amendment to an appropriations bill that will end the program.
Isolationism loses out. Leaders of the American Medical Association vigorously defended its $342,000 annual membership in the World Medical Association this month after an attempt by some members to torpedo its participation in the global body.
The Arizona contingent to the AMA House of Delegates proposed cutting ties, saying the WMA amounts to little more than a travel club.
AMA President Nancy Dickey, M.D., who chairs the AMA delegation to the world body, said it offers the AMA a chance to "reach a hand out to our colleagues in other countries who haven't got the same opportunities."
The WMA, with some 5 million members in more than 70 countries, sets standards in medical ethics and education.
The resolution died, which was good news for the WMA. It elected former AMA President Daniel Johnson Jr., M.D., to be its next president. Johnson will be installed in October.
Marginal problem. If you are one of the people who wait anxiously for the Medicare Payment Advisory Commission to release its calculation of the Medicare hospital inpatient margins, you may be waiting a while.
It seems that HCFA, which supplies the raw numbers MedPAC uses in its calculations, has moved so many of its personnel to work on the year 2000 computer problem that it can't get the data to MedPAC.
That should come as welcome news to the American Hospital Association. For the past several years, the AHA has been attacking MedPAC for releasing the margin data. The AHA argues that the margins give a misleadingly rosy picture of hospitals' financial condition.
Billing indictments. Two California physicians have been charged with bribing an auditor who was investigating claims they submitted to Medicare.
Prosecutors say the two physicians paid thousands of dollars in cash to an auditor from Transamerica Occidental Life Insurance Co., an HHS contractor. The auditor had been looking into whether the government overpaid them.
In the first case, Edgardo Devera Penez, M.D., was indicted on one count of conspiracy and two counts of paying $5,000 to bribe the auditor in exchange for the closure of the inquiry. Penez faces a maximum sentence of 35 years in prison and $750,000 in fines.
In the second case, Salvacion Lee, M.D., is charged with one count of conspiracy to bribe another Transamerica auditor in exchange for ending the probe into Lee's Medicare claims. Lee allegedly gave the auditor a $10,000 bribe in cash through the same intermediary used by Penez. Lee faces a maximum sentence of five years in prison and a $250,000 fine.
Hacked off. The biggest computer phobia these days may be the pesky millennium bug, but hospitals trying to beat the bug should be wary of whom they hire to do it.
A computer software engineer who was helping install software for Highland Park (Ill.) Hospital was indicted recently for allegedly hacking into the hospital's computer system and shutting it down for nearly two days in May 1996.
The disruption cost the hospital thousands of dollars to secure its system, assess the extent of the harm and restore lost files, according to the indictment.
The engineer, Robert Porter, 38, of Spring, Texas, was working for Shared Medical Systems in Malvern, Pa., at the time he allegedly entered the hospital's system without authorization.
Porter was charged with entering a command that caused the system to start deleting the hospital's computer files until the operations manager forced him out. Porter also was accused of trying to cover up his activities by deleting the log of users.
ER at sea. The "Love Boat" is back on the air, and "ER" is a smash hit. So perhaps it was only natural that a cruise ship would come up with a full operating room for its passengers.
Princess Cruise lines, Los Angeles-based Cedars-Sinai Medical Center and telecommunications company Image View have introduced the SeaMed system onboard Princess' new 2,600-passenger, $450 million Grand Princess cruise ship.
The SeaMed system uses a two-way live video linkup allowing ship physicians access to medical staff at Cedars-Sinai. Ship physicians will be able to treat cardiac and pulmonary emergencies by sending radiographs and electrocardiograms via satellite to a 24-hour physician base at Cedars-Sinai.
Princess is also offering a complete travel insurance package, called Love Boat Care, which includes up to $20,000 in medical coverage. Passengers who do not sign up for the coverage still will be able to receive medical assistance with billing handled directly through their own insurance companies.
Quotable. "Get a life."-Richard Corlin, M.D., speaker of the AMA House of Delegates, on what the editors of the Chicago Tribune could do following an editorial that flayed the AMA for being a spoilsport in calling on professional athletes not to smoke cigars in public.