VETO THREAT. California Gov. Gray Davis opposes a bill that would give physicians the right to collectively negotiate rates with health plans and will veto the bill despite amendments offered by supporters.
Davis says he plans to veto Assembly Bill 1600 if it reaches his desk unless changes offered by the Department of Managed Health Care are incorporated, Davis' spokespeople say. The California Medical Association says doctors need the law to level the playing field. Health plans and others, including some unions and business groups, oppose the bill, saying it would drive up the cost of healthcare.
Davis and DMHC Director Daniel Zingale say they remain hopeful that a compromise can be brokered. Zingale has called AB1600 bad public policy, saying his concern is that "patients will be used as pawns." He wants to substitute an independent outside review panel to break potential logjams.
LESS CHARITY. The proportion of physicians providing charity care dropped to 72% in 1999 from 76% in 1997, according to a report from the Center for Studying Health System Change.
Researchers say increases in the ranks of physicians who are employees, not owners; mounting pressures from payers and employers to cut costs; and growing time pressures on physicians due to increased administrative loads have combined to dampen physicians' ardor for providing charity care.
"Policymakers should take note that an important part of the safety net--physician charity care--is in danger of fraying," says Paul Ginsburg, president of Washington-based HSC. Physicians who do provide charity care still devote the same amount of time to the task--11 hours a month, researchers say.
PLANS SUED. The Medical Society of the State of New York sued several insurers in mid-August over payment issues. The suit against Aetna, Cigna, Empire Blue Cross/Blue Shield, Excellus, Oxford and UnitedHealthcare alleges the health plans systematically downcode claims, put patients at risk by denying care, breach contracts with physicians and fail to have adequate staff to process claims in a timely manner.
Several of the plans declined to comment or didn't return phone calls seeking comment.
PAY AND PRODUCTIVITY. Relative value units, service quality and net charges are replacing gross billing and cost containment measures as key factors in physician compensation in large group practices, according to a survey by the American Medical Group Association. The annual survey examines trends for the 2000 calendar year.
Administrative responsibilities continue to be the most often cited compensation factor, growing to 49% in 2000 from 40% in 1999, though work RVUs were cited by more than a quarter of the survey's 220 respondents, up from about 8% a year earlier.
Gross charges fell for the fourth consecutive year, likely because practices are realizing that billed charges rarely are accurate reflections of actual revenue collected, AMGA says.
Cardiac surgeons remain the highest-paid, though their compensation was flat in 2000 at $389,926 and down by 2.5% since 1997. Ironically, heart surgeons billed at a median level of $1.97 million last year, nearly 25% higher than the previous year, strengthening the theory that gross revenue is a poor indicator of income.
TENNCARE OUTCOMES. TennCare, the program for Medicaid-eligible and otherwise uninsurable Tennessee residents, is allowing a private-sector outcomes research firm to study prescription drug usage patterns to determine why hospitalization rates are down statewide.
Applied Health Outcomes, a research unit of Chicago-based Navigant Consulting, joined state officials on Aug. 28 to launch the quality improvement initiative, called the TennCare Centers of Excellence Program. AHO, based in Tampa, Fla., will examine drug usage among the 150,000 TennCare enrollees eligible for both Medicare and Medicaid and among the more than 300,000 state residents who submit claims to the program's behavioral health organization each month, says TennCare spokesperson Lola Potter.
"If there are any positive health outcomes, is it because of higher drug use or is it because we're managing care better?" Potter asks in expressing the purpose of the study. AHO says it will pay for the program with grants from the pharmaceutical industry and other research organizations.
FLORIDA SUES. The Florida Medical Association on Aug. 29 joined three other state societies in suing some of the nation's largest health plans for alleged violation of anti-racketeering laws.
The suit, filed in conjunction with medical societies from California, Georgia and Texas, names Aetna, Cigna, Coventry Health Care, Humana, UnitedHealth Group, Aetna's Prudential Health Care, Health Net and Wellpoint Health Networks as defendants. Several plans declined comment but have called the original suits "frivolous" and without merit.