Collective bargaining advances in Texas, Illinois

Efforts to bring collective bargaining power to physicians and medical groups are gaining momentum in Texas and Illinois.

The Texas Senate has passed a measure that would allow competing physicians to join together when negotiating contracts with health care plans and let allied doctors share information during negotiations, reports the May 17 Ft. Worth Star-Telegram. The bill also would limit the size of negotiating groups to no more than 10 percent of the licensed physicians in a particular market. If the measure is approved by the state House and signed by the governor, Texas would become the first state to allow physicians jointly to negotiate fees with managed care companies, says the Star-Telegram. (House action on the bill was pending at press time.)

In April, the Illinois State Medical Society's House of Delegates voted to work toward establishing collective bargaining units in the state. The vote was intended to send a message to the AMA, which will debate the issue at its annual meeting this month in Chicago, reports the April 26 Chicago Tribune.

The AAFP recently announced its support of a bill before the U.S. Congress that would allow physicians to bargain collectively with health plans. The Quality Health Care Coalition Act also is endorsed by 30 other medical groups.

Public confidence in medicine continues to rise

The percentage of Americans professing high confidence in the institution of medicine stands at 39 percent, the highest rate since 1988, according to a recent Harris Poll measuring public confidence in various sectors of society. The 1999 percentage, though the highest of the decade, is a far cry from the support revealed by Harris' first public-confidence survey, taken in 1966. At that time, 73 percent of those surveyed reported high confidence in medicine. The lowest level of confidence, 22 percent, came in 1993.

Source: The Harris Poll (No. 9). New York: Louis Harris & Associates; 1999.

Seniors not receiving covered preventive services

A large proportion of senior citizens are not receiving recommended preventive care, according to a recent report from the Dartmouth Atlas of Health Care. Even though Medicare pays for services such as screenings for breast or colorectal cancer, compliance with widely known recommendations is inconsistent.

Only 28 percent of women ages 65 to 69 received at least one mammogram during 1995 and 1996, yet women in this age group should have a mammogram every other year. On average, only 12 percent of Medicare enrollees received either a fecal occult blood test or colonoscopy in those years. Annual colorectal cancer screening is recommended.

The report also found that rates of recommended pneumonia immunizations among Medicare beneficiaries varied from 9 percent to 38 percent, depending on the geographic region. Similarly, the percentage of beneficiaries with diabetes who received recommended eye exams ranged from 25 percent to 60 percent.

“The underuse of these services and the haphazard nature of compliance with recommended guidelines indicate there is substantial opportunity to improve the quality of care,” says John E. Wennberg, MD, MPH, director of the Center for the Evaluative Clinical Sciences at Dartmouth Medical School and the Atlas' principal investigator. “The cure appears to be better management of resources rather than more spending.”

Opposition to use of hospitalists grows

Insurers trying to mandate the use of hospitalists are meeting strong resistance from some physicians and consumer groups, many of whom see the move as a breach of the physician-patient relationship.

The Florida Medical Association has sought approval of a legislative amendment that would prohibit HMOs from restricting a “physician's ability to provide and manage inpatient hospital services.” In Texas, a coalition of physician groups has proposed a similar bill, which is now awaiting action by the full House.

No insurer in either state currently has a mandatory hospitalist program. But the April 14 Florida edition of the Wall Street Journal reports that under Prudential HealthCare's new hospitalist program in Tampa and southern Florida, fewer than 25 percent of participating physicians are eligible to care for their hospitalized patients because they don't meet the company's benchmark criteria for hospital care efficiency.

HMO industry experts say they expect more health plans to mandate hospitalist programs in the future.

MedPartners continues exit from PPM business

MedPartners Inc. is continuing to shed its physician practice management (PPM) business, having announced last fall it would focus instead on its pharmacy benefits management (PBM) division, Caremark. The company's decision was the result of financial troubles, discontented doctors and a failed merger with fellow PPM company Phycor Inc.

While MedPartners has had some success in finding buyers for its medical practices, exiting the PPM market has been complicated. In March, fearing disruption of care for patients within MedPartners Provider Network (a subsidiary of the parent company), the California Department of Corporations seized control of the network and filed for bankruptcy on its behalf. MedPartners protested the takeover, calling it unwarranted, and at press time was negotiating to regain control of its network by agreeing to pay its California debts as it phases out its operations, according to the May 5 Los Angeles Times.

In the Feb. 25 Wall Street Journal, MedPartners was rated the worst three-year performer on the newspaper's Shareholder Scoreboard; its stock dropped 76.5 percent in 1998 alone. Last month, MedPartners reported a first-quarter net income of $10.8 million, with a 1.4 percent profit margin, due largely to its PBM division.

FDA seeks to reduce accidental drug deaths

In an attempt to decrease the number of deaths due to adverse drug reactions, an FDA task force has proposed several changes in the drug-approval process, reports the May 10 Los Angeles Times. The changes being considered include these:

• Revising drug information for physicians so that it identifies precautions more clearly;

• Increasing the FDA's use of computers to compare proposed drug names, in order to avoid medication errors caused by confusion with similarly named agents;

• Upgrading the FDA's system for logging pharmaceutical companies' reports of unexpected reactions to recently approved drugs;

• Applying easy-to-understand warnings for consumers to up to 10 new agents annually (those the FDA feels have the riskiest side effects).

The Times notes that faster FDA approval of pharmaceuticals, spurred by patient demand and political pressure, increases the risk of adverse reactions. However, the FDA report says shorter FDA review time during the 1990s has resulted in a rate of market withdrawals for safety reasons “relatively unchanged” from previous decades. The report, “Managing the Risks From Medical Product Use: Creating a Risk Management Framework,” is available at www.fda.gov/oc/tfrm/Tableofcontents.htm.