The editors and reporters of Modern Physician chose the following as the 12 most important stories of the past year:
1: The year of living dangerouslyWhen 2003 began, physicians set out to convince Congress and state legislatures that the medical malpractice insurance crisis was out of hand and that caps on noneconomic damages were needed.
Physicians temporarily halted elective procedures to protest the med mal "crisis" in Wheeling, W.Va., Mississippi's Gulf Coast and New Jersey, where thousands took part in the protests . . . and faced intense criticism for doing so. Yet, after a yearlong battle, the lines in the med mal wars hardly budged, with doctors, insurers and many Republicans still jousting with trial lawyers, many Democrats and a few vocal consumer groups--with little change.
As 2003 draws to a close, Texas has passed a $250,000 cap and an accompanying constitutional amendment to make sure it is not overturned in the courts. But Congress and most state legislatures have failed to pass any caps on noneconomic damages.
"We've been to the state Legislature multiple times to discuss this issue, and it doesn't seem that they want to," said Ruth Schulze, M.D., a key organizer of the New Jersey demonstrations and then-president of the Bergen County Medical Society.
Lacking reforms, the Medical Society of New Jersey reports that one New Jersey carrier is increasing its rate for 2004 by 43%; another will seek a 49% hike.
The society says one neurosurgeon, when quoted a $190,000 premium for 2004, decided to cut out brain surgery and limit her work to the spine, which cut her rate in half.
2: Fraud, scandal, drama and the feds"Now healthcare has its Enron" was the quote headlining a May Modern Physician story about the $2.7 billion scandal at HealthSouth Corp.
Since then, 14 former executives of the beleaguered Birmingham, Ala., rehabilitation and ambulatory surgery center giant have pleaded guilty to federal fraud charges. In October, founder Richard Scrushy was hit with an 85-count indictment.
Other firms might qualify as healthcare's Tyco, WorldCom or Global Crossing. Those either caught in the federal wringer or under a cloud in 2003 include:
- Drugmaker AstraZeneca, which admitted to Medicare and Medicaid fraud and settled criminal and civil charges for $355 million. Hundreds of physicians remain under scrutiny.
- Pharmacy benefits manager Medco Health Solutions, sued by the Justice Department, which accused the nation's largest PBM of illegally canceling, destroying and switching prescriptions.
- Healthcare financier DVI, which entered bankruptcy after admitting possible "accounting irregularities."
- Software vendor IDX Systems Corp., which preemptively sued a physician employee whom the company suspects filed a whistleblower case against it. IDX later said it was under federal investigation for possible contracting fraud.
3: Specialty hospitals under the gunThough legislative proposals to ban physician-owned specialty hospitals failed in Congress and legislatures in Arizona, Indiana and Louisiana, the Medicare reform bill, if passed, would include an 18-month moratorium on new construction of specialty hospitals.
The moratorium would end a building spree that has produced about 100 specialty hospitals, according to a GAO count. More than 25 projects now in advanced planning or construction likely would be allowed to go forward, but new projects will have to wait for the moratorium to end.
Planners will have to wait and see whether a study accompanying the moratorium calls for permanent legislation to limit specialty hospitals.
4: Clinical IT dam springs a big spending leakThe 2003 Modern Physician/PricewaterhouseCoopers technology survey published in November showed big gains in physician usage of electronic medical records and other information technology.
Developments throughout the year added credence.
Kaiser Permanente embarked on a $1.8 billion project to automate records for its 11,400 physicians. The American Academy of Family Physicians put out a call for low-cost EMRs in small practices--and got nine takers from IT vendors. National efforts began to set standards for EMRs and continuity of care. Physicians warmed to the idea of clinical decision support.
5: Dean creates own orbitOnce described as an asterisk in the Democratic presidential primary contest, Howard Dean, M.D., might now more aptly be called a political source of gravity. Even the controversy the internist has stirred with his straight-talking, sometimes-gruff stumpside manner hasn't diminished his pull.
He has astonished his rivals by drawing in political and labor endorsements and lots of cash. If this rising star of 2003 has staying power in 2004, national healthcare reform--from a physician's perspective--could receive attention of astronomical intensity.
--Elizabeth Thompson Beckley
6: Class action settlements could reform billingSeparate settlements of medical societies' class action lawsuits this year against Hartford-based Aetna and Philadelphia-based Cigna HealthCare hold the promise of creating standards for claims processing that include transparency, simplicity and physician input. But physicians who negotiated the settlement concede that they will have to wait and see. And other big plans still refuse to settle their lawsuits.
7: Snomed snowballs; LOINC anointedLaying a cornerstone for the proposed National Health Information Infrastructure, the National Library of Medicine struck a deal with the College of American Pathologists to give the public free access to the Snomed CT standardized set of clinical terminology. The $32.4 million, five-year contract removes a barrier to clinical IT interoperability.
In November, the National Committee on Vital and Health Statistics recommended Snomed, the Regenstrief Institute's Logical Observation Identifiers Names and Codes for lab work and three other code sets be used as national standards.
8: Hands off on HIPAAThe twin D-Days of April 14 for privacy and Oct. 16 for electronic transactions and code sets came and went without a single appearance of HIPAA heavies. The HHS Office of Civil Rights soothed nerves by making it clear that it would enforce privacy standards based on complaints rather than compliance audits. Then, CMS decided to permit nonstandard transactions so that thousands of practices and hospitals would not have their reimbursement lifelines cut.
9: Medicare physician fee roller coasterComing out of the steep decline of a 5.4% Medicare payment cut in 2002, physicians were spared a 4.4% cut for 2003 when Congress passed a 1.6% increase instead. Although CMS just announced another 4.5% dip in 2004, lobbyists for doctors are optimistic about an agreement to replace cuts in 2004 and 2005 with a minimum 1.5% increase each year.
To avert future whiplash, Medical societies continue to push Congress for a payment formula that reflects practice costs.
10: The elephant growsThe latest U.S. Census Bureau data shows the ranks of the uninsured grew in 2002 to 15.2% of the population, or 43.6 million people--the highest number in a decade.
The Commonwealth Fund says one-third of large-company workers had no insurance in 2001.
11: Cedars slips on CPOECedars-Sinai Health System in Los Angeles had hoped to achieve 100% computerized physician order entry within 14 weeks of the October 2002 launch by threatening to yank the privileges of any holdout doctor. Then the medical staff revolted against the "big bang" strategy, complaining that the system was too slow and potentially unsafe.
Embarrassed management reverted to paper orders on Jan. 23. As of mid-November, the system remained offline.
12: Mega-plan formedOn Oct. 29, Indianapolis-based Anthem and Thousand Oaks, Calif.-based WellPoint Health Networks announced merger plans that would create the largest U.S. health plan with 26 million enrollees. Coverage areas have minimal overlap, and observers predict antitrust approval.