NO CHOICE. Another 500,000 Medicare enrollees will lose their Medicare+Choice coverage at the beginning of the year.
That count stems from health plans that have told the Center for Medicare and Medicaid Services (CMS) that they won't cover Medicare beneficiaries after January and is about half of the number who lost Medicare+Choice coverage at the end of 2000.
According to figures released Sept. 24, 58 health plans are either eliminating or reducing their participation in the program.
"Steps taken by Congress and this administration have helped slow the erosion of Medicare+Choice, but more remains to be done," says American Association of Health Plans CEO Karen Ignagni.
Tom Scully, CMS administrator, says 90% of the 5.6 million Medicare beneficiaries enrolled in the Medicare+Choice program will continue their coverage next year.
UNINSURED CREDITS. A coalition of industry executives says it will seek federal help to end the problem of having 43 million citizens without some form of health insurance coverage.
"It's embarrassing," says Ronald Dollens, president and CEO of Guidant Corp., one of several Healthcare Leadership Council members touting a campaign to reduce the number of uninsured.
The HLC plan calls for tax credits and other government incentives to induce employers and employees to buy insurance from the private sector to address the 81% of the uninsured who are employed or have a family member who is.
Many of the remaining 19% could be covered by improving the outreach of existing programs, the coalition says.
Dollens says 43 million is a snapshot taken at one point in time. It does not include Americans either threatened by the lack of insurance or just ending a period without coverage due to employment changes, he says.
PHYAMERICA DEAL. The plan by physician-entrepreneur Steven Scott, M.D., to privatize PhyAmerica Physician Group took two large steps forward last month, as the Durham, N.C.-based PPM settled a major lawsuit by disgruntled shareholders and board members approved Scott's buyout.
Scott and PhyAmerica, a PPM specializing in emergency medicine, cleared their largest hurdle by agreeing to pay a total of $4.65 million to an undetermined number of shareholders to settle a class action lawsuit. The deal is expected to close by the end of the year.
Two PhyAmerica shareholders filed suit in March 2000 alleging that Scott and several associates violated federal anti-racketeering laws by intentionally driving down the value of the company. The two sued again late last year to block Scott's attempt to buy the 45% stake in the company he does not control for 15 cents a share, or $2.76 million.
Scott's offer values the entire company at just $6.4 million. Predecessor firm Coastal Physician Group, which Scott founded in 1977, paid $69.3 million to acquire rival Sterling Healthcare in 1999.
DRUG BRIBES. Pharmaceutical companies are using the Medicare pricing system "in order to bribe physicians to prescribe their drugs," said Rep. Fortney "Pete" Stark (D-Calif.) following congressional hearings into the ongoing drug "spread" scandal last month.
"The investigation confirms what many of us have been saying for years," Stark said in a Sept. 21 statement after testimony was presented by the General Accounting Office and the HHS' office of the inspector general. The GAO recommended scrapping the system of Medicare reimbursements for physician-administered drugs based on the average wholesale prices self-reported by the drug industry.
The GAO recommended switching to a payment system based on physicians' actual purchase costs of these drugs. The inspector general's office says Medicare and beneficiaries making co-payments are overbilled $1.9 billion a year by drug companies and doctors abusing the AWP. "Pharmaceutical companies manipulate the AWP to increase profits, which increases costs to patients and taxpayers by influencing physician-prescribing practices," Stark said. "Certain physicians will not be pleased with the findings of the IG and GAO."
ORTHO ART. The touring art show "eMotion Pictures: An Exhibition of Orthopaedics in Art" is not your usual exhibit. Sponsored by the American Academy of Orthopaedic Surgeons, it features the work of patients and physicians, 81 artists in all from 10 countries. In the collection is a pencil sketch by William Loscher, M.D., of Clinton, Wash., titled "I Wish I Could Have Done More" (left).
In opening the exhibit Sept. 21 at the Chicago Cultural Center, William Tipton Jr., M.D., executive vice president and CEO of the academy, said the works are "about the human spirit, illustrating the essence of our humanity: compassion, pain, joy, sorrow, recovery, strength, healing and renewal."
The exhibition will remain in Chicago through Nov. 25, then will move to the United Nations building in New York to run Jan. 21 through Feb. 28.
MATTER OF TRUST. The terms "managed care" and "HMO" conjure up feelings of distrust among the general public, as managed care companies rate only above the tobacco industry and the oil industry when it comes to trustworthiness and customer service, according to a new Harris Interactive poll.
When asked, "How much would you trust the following industries to do the right thing if faced with a serious problem with one of their products?" 58% of respondents say they either "somewhat distrust," "distrust" or "strongly distrust" health insurance or managed care companies such as HMOs. Only 26% view the industry favorably.
In contrast, pharmaceutical companies--not exactly popular among physicians--are deemed trustworthy by 48% of those questioned by Harris Interactive, while 36% expressed distrust. The verdict remains out on biotechnology companies, as 43% of respondents have neutral opinions on this sector. Hospitals scored significantly higher, fourth-best among the 13 industries examined on customer service, with 67% of those surveyed expressing positive sentiments.