MEDICAL GROUP FILES BANKRUPTCY. On the heels of a failed emergency loan plan, the largest medical group in Simi Valley, Calif., filed for bankruptcy in late October, leaving more than 900 physicians and 135,000 patients in the lurch.
Family Health Care Medical Group laid off 300 employees and moved toward dissolving its corporate structure, according to published reports. The medical group, formed seven years ago, operated four clinics and was a go-between for network doctors and HMOs.
Last month the California Medical Association sought a $3 million loan to keep Family Health Care in business, but those plans crumbled.
A recording at the Simi Valley offices states that the group is reorganizing. A message left for a spokesperson wasn't returned.
Family Health's largest contractors are California Care Blue Cross, Health Net and PacifiCare.
AETNA LOOSENS RESTRICTIONS. AetnaUSHealthcare will offer a plan allowing patients to see specialists without a referral, yet another restriction loosened by the nation's largest insurer.
Aetna Open Access, which was announced in early October, will be available Jan. 1. The plan will let enrollees have the benefits of managed care--primary care physicians, access to preventive screenings and lower co-pays--coupled with what consumers and physicians have begged for: the ability to see a specialist without having to call the insurer or go through the primary care physician.
It's another step by Aetna to improve relations with physicians and patients who tired of the company's restrictive products and rules. The new plan is nearly a 180-degree change in an industry that requires enrollees to get permission to see anyone other than their primary care physician.
The company also announced an online program to bring health information and resources to enrollees. Aetna Navigator combines resources and information from a number of Aetna programs, including its prenatal care, disease management and women's health programs.
PA PRESCRIBING RIGHTS. The Kentucky Board of Medical Licensure's Physician Assistant Advisory Committee will meet Nov. 9 to hammer out new regulations related to a PA prescribing law. The 2-year-old law gives physician assistants the authority to write non-narcotic prescriptions for patients with private health insurance.
Kentucky legislators this year expanded the statute to allow PAs to prescribe drugs for Medicaid and Medicare recipients, and PAs have been writing such prescriptions since spring. But regulations were not updated, leaving a gap between the statutory and regulatory language.
The prescription drug regulators have yet to enforce the technicality, but the Kentucky Academy of Physician Assistants, representing the state's PAs, was concerned enough to press for a solution. An attorney sits on the board's nine-member advisory committee and encouraged regulators to address the technicality.
TENN. MED SCHOOLS LOSE FACULTY. Medical schools across Tennessee are losing faculty at an alarming rate because of a shortage of public funds, prompting at least one major university to consider reducing enrollment of new students next year.
Administrators of the University of Tennessee Health Science Center in Memphis have proposed limiting the next incoming class to 150 students at its medical school and related professional schools, down from the current 165. The school lost 9% of its 700-member faculty this year, mainly because of an increase in the number of indigent patients treated under the state's underfunded TennCare program.
Other medical schools say that the increase in TennCare volume is making it harder for them to recruit and retain faculty, who lately have been choosing higher-paying jobs with more research opportunities and lighter workloads at institutions in neighboring states.
TennCare, established in 1994, is the state's alternative to the federal Medicaid program. It serves about 1.3 million Tennessee residents who otherwise would not have health insurance.
MINNESOTA SUIT. Following in the footsteps of other state attorneys general, Minnesota's attorney general sued Blue Cross and Blue Shield of Minnesota last month, accusing the plan of refusing to pay for inpatient mental health treatment for children.
Mike Hatch, who last year unsuccessfully sued HCFA over Medicare payments, filed the lawsuit in Hennepin County Court. Hatch accuses the Blues, one of Minnesota's largest health plans, of shifting the cost of treatment to taxpayers and families. He says that Blue Cross instructs parents to put their children in foster care or the juvenile justice system. The suit cites six Minnesota families that were denied coverage.
Blues officials denied the allegations and say their treatment programs are based on community standards and scientific evidence. Company officials declined to comment on the specifics of the six families.