Final patients’ rights bill depends on House-Senate compromise

In July, when the Senate passed The Bipartisan Patient Protection Act of 2001, sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.), it looked to many Washington observers as though a final patients’ bill of rights might be in the offing. But, after nearly five years of Congressional debate, the battle was just beginning. On Aug. 2, the House of Representatives passed a competing bill sponsored by Reps. Greg Ganske (R-Iowa), John Dingell (D-Mich.) and Charlie Norwood (R-Ga.). At press time, Congress was set to appoint a conference committee to attempt a compromise between the two bills.

While the bills are similar in much of their content and provide significant improvements in patients’ rights, the House bill offers patients a more limited right to sue health plans in state courts, the result of a last-minute amendment negotiated between Norwood and President Bush. For example, the Senate bill does not limit monetary damages in state courts, whereas the House bill limits such damages to $1.5 million and applies other restrictions. In addition, under the House bill, self-funded health plans for employees would be exempt from lawsuits in state courts.

Supporters of the House bill say it provides adequate patient protection while discouraging frivolous litigation, which would drive up health care premiums. Opponents argue that the House bill does not provide enough protection in state courts and, in some cases, weakens existing state laws.

Coding errors common, due to complex guidelines, says study

Family physicians overcoded new-patient evaluation and management (E/M) visits 8 out of 10 times in a study published in the May/June issue of the Journal of the American Board of Family Practice. The study, which was based on 205 Illinois family physicians coding hypothetical examples, also found that the physicians undercoded established-patient visits in 33 percent of the cases.

The authors of the study concluded that the complexity of the CPT guidelines and physicians’ limited coding training accounted for the substantial rate of coding errors.

Health care utilization constant over 40 years, still concentrated in primary care

More women, men and children receive medical care in the offices of primary care physicians than in any other professional setting, according to research published in the June 28 New England Journal of Medicine.

The new study updates a 1961 study by White, Williams and Greenberg [The ecology of medical care. N Engl J Med. 1961;265:885–892] and shows that, despite substantial changes in the organization and financing of health care, utilization has remained remarkably consistent over the last 40 years.

E/M guidelines on hold

The revised, revised documentation guidelines for evaluation and management services are currently at a standstill, according to the July 23 Part B News. After 39 physician organizations expressed concerns about the latest draft guidelines, which are based on clinical examples rather than the bulleted lists used in the 1997 version, Health and Human Services Secretary Tommy Thompson announced that work on the guidelines’ clinical examples has stopped so that the Centers for Medicare and Medicaid Services can “reassess and retune” its efforts.

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Patients were interrupted by their doctors within 12 seconds of speaking in a recent study of family practice and internal medicine residents published in the July/August 2001 issue of Family Medicine. The study also found that patients spoke for about four minutes in an 11-minute visit, female patients were more likely to be interrupted than male patients and male residents were more likely to interrupt patients than female residents. Despite the interruptions, 77 percent of the patients said they were satisfied with the amount of time they spoke.

No free lunch

The Queen City Physicians group in Cincinnati is saying no to free lunches, doughnuts and gizmos from pharmaceutical representatives. Tired of watching drug reps jockey with patients for face time with doctors, the 50-member group is now charging them $65 for 10-minute appointments with doctors, according to Reuters Health, July 27.

Breaking up isn’t hard to do

Is the only thing standing between you and a new practice situation that pesky little non-compete agreement with your current employer? Never fear. Log on to www.breakyournoncompete.com, where, for only $49, a corporate lawyer will provide you with a 51-page outline of 16 strategies for breaking non-compete clauses. Sorry, there’s no money-back guarantee, but the site does offer several free samples of arguments used by those who have successfully broken their non-competes.

Error in the IOM errors report?

By now, everyone knows the statistic from the 1999 Institute of Medicine (IOM) study on medical errors: between 44,000 and 98,000 patients are killed by medical mistakes in hospitals annually. However, authors of a recent retrospective review of medical errors at seven VA hospitals believe that number is much lower. “Many deaths reportedly due to medical errors occur at the end of life or in critically ill patients in whom death was the most likely outcome … regardless of the care received,” wrote the researchers in the July 25 Journal of the American Medical Association. Authors of the IOM report are standing by their data.

Fight or flight

When faced with the challenge of adapting their practices to environments with high HMO penetration, many physicians are choosing to retire, according to a study of U.S. physicians over the age of 55, published in the December 2000 issue of Health Services Research. “Generalist physician” retirement rates were 13 percent higher in highly penetrated markets than in low-level markets.

“Understanding Your Managed Care Plan,” an FPM Patient Handout

This downloadable handout is the first of a series of patient handouts you’ll find in Family Practice Management over the next several issues. They’re designed to help your patients navigate the health care system. At the same time, they’re designed to help you deal with questions your patients may ask and with problems that arise from your patients’ misunderstandings of their insurance benefits and their unrealistic expectations of you.

This handout was written by James Bare, policy analyst for the AAFP. It explains in simple terms the common restrictions patients agreed to when they signed up for a managed care plan. Future handouts will deal with such topics as prescriptions, referrals and medical bills.

If you have an idea for a patient handout you’d like us to develop, send an e-mail message to fpmedit@aafp.org.