If one organization has its way, physicians could soon get paid not only for providing tests and treatments, but also for the time they spend giving information to patients.
Boise, Idaho-based Healthwise, a not-for-profit company that provides consumers with medical information, has mounted a national campaign to have health insurers reimburse doctors for referring their patients to places where they can bone up on the particulars of their disease. The concept has been dubbed "information therapy."
Instead of writing a prescription, a doctor would write instructions for where the patient could find details about treatments or conditions, such as relevant Web sites. This would be designated on a prescription pad with an Ix, instead of the traditional Rx.
According to Healthwise, current doctor-patient communication is inadequate because it isn't paid for. So last month, the company launched the Center for Information Therapy in Washington, which will begin trying to sell the nation on the idea that information is just as important as medication and should, therefore, be reimbursable.
The center makes the case that "prescription-strength" information therapy qualifies as a reimbursable medical service, because it is evidence-based, documented and directed at a diagnosed patient condition.
"Information therapy looks at patients as healthcare partners, not recipients," says Margaret O'Kane, president of the Washington-based National Commission for Quality Assurance and one of the 11 members of the center's governing commission. "Engaging patients in their own healthcare consistently is one of the best ways to improve outcomes."
Two prominent managed-care executives also are members of the commission: John Rowe, Aetna's chairman, president and CEO; and Paul Wallace, executive director of Kaiser Permanente's Care Management Institute. But whether other health insurers will take to paying for a service that some see as already a given part of medical care remains to be seen.
"Plans are very supportive of the decision to provide information to patients. But the key question (for insurers) is whether employers and workers are going to want to pay for it," says Susan Pisano, spokeswoman for the American Association of Health Plans. "Is this something worth investing their premium dollar in?"
At least the Rolls wasn't new
Outliers wonders whether being in the slammer is going to slow Joyce Lee Hickman, the Texas woman who just can't help herself when it comes to healthcare fraud.
When we last checked in with the indefatigable 46-year-old (Aug. 6, 2001, p. 40), she had just been convicted in Houston federal court of 32 counts of falsely billing Medicare, Medicaid and private insurers for more than $29 million. Late last month, U.S. District Judge Lynn Hughes sentenced Hickman to one of the longest prison terms to date for healthcare fraud: 171/2 years. Hughes also ordered her to repay $9.3 million, and authorities confiscated land worth $500,000, a fishing boat, a Rolls Royce sedan, a Mercedes sports utility vehicle, a Dodge Viper, $300,000 in jewelry and a $3,500 Louis Vuitton golf bag. Asked about the Rolls, Hickman said it was hardly new, being only a 1989 model.
Before her conviction, Hickman ran sham clinics, billed for services supposedly rendered to dead people and caused grief for innumerable physicians under whose identification numbers she falsely billed. She was first indicted in April 2000, but continued her illegal activities while awaiting trial, according to court documents. A second indictment followed in May 2001. She was arrested and her bond revoked. But the tenacious Hickman somehow persuaded the judge that she would commit no further crimes and was again released. After that, prosecutors discovered she had set off anew to forge the signatures of a dead physician on drug prescriptions and submit more false claims to an insurer.
But Hickman wasn't done yet. At the sentencing hearing she provided documents that pointed the finger for the crimes at a number of physicians. It turned out the doctors were fictitious, says assistant U. S. attorney Amy Lecocq.
Hickman then requested leniency, pleading for a second chance.
"You've had two chances already, Ms. Hickman," Hughes said. "You only get three chances in baseball."
Aboard the Starship Tenet
When Jeffrey Barbakow, CEO of Tenet Healthcare Corp., was named to Business Week's "Top 25 Managers" list recently, the magazine got a little caught up on a picture on Barbakow's office. The photo, in which Barbakow's face is plastered on the body of Captain Kirk, the character played by William Shatner in the "Star Trek" television series, was a gift from 238-bed Hollywood (Fla.) Medical Center.
The Hollywood hospital is one of 99 Tenet facilities that Barbakow has visited since pledging last May that he would visit 100 hospitals within a year; the company operates 116 hospitals. The gift tied in with the hospital's theme for Tenet's "Target 100" program, in which each hospital aims to provide 100% satisfaction on the part of patients, doctors and employees, Barbakow tells Outliers.
At the Hollywood hospital, "they had a Star Trek theme," Barbakow says. "In Memphis, for instance, where we have a big operation, they have an Elvis theme. Or in New Orleans, where we were recently, the theme was Mardi Gras."
Barbakow laughs when asked about his allegiance to Kirk, Spock and the Starship Enterprise. "The Star Trek thing was very minor. They got a kick out of it," he says.