Nation responds to medical needs in wake of attacks

On Sept. 11, for the first time in the nation’s history, the Department of Health and Human Services (HHS) activated all 80 of the nation’s Disaster Medical Assistance Teams, putting them on call to assist in relief efforts following terrorist attacks on the United States. Only a fraction of the some 7,000 private-sector health care personnel serving on the teams were actually dispatched, due to the relatively low number of survivors at the disaster sites, but many in the health care community were eager to help out as needed.

According to HHS, more than 1,000 physicians across the county called to volunteer their services following the attacks. Drug and medical supply companies donated literally tons of medications and supplies. And blood drives organized across the United States were so successful that many locations were forced to close temporarily because no more blood could be stored.

Resources. To assist doctors in helping their patients and families cope with these traumatic events, several resources have been made available:

• The HHS’s Substance Abuse and Mental Health Services Administration has set up a hotline at 800–789–2647 offering counseling services to those in need.

• The American Academy of Family Physicians and the National Institute of Mental Health have both posted a variety of resources related to post-traumatic stress disorder, depression and anxiety on their Web sites: www.aafp.org/resources and www.nimh.nih.gov/outline/responseterrorism.cfm.

• The National Mental Health Association offers tips for primary care physicians talking to patients traumatized by the terrorist attacks at www.nmha.org/reassurance/primarycare.cfm.

Legislative agenda. Meanwhile, both houses of Congress have essentially halted all health care legislation that was being debated, such as a patients’ bill of rights and Medicare reform, due to more pressing issues of national security. A House committee aide, quoted in the Sept. 13 Congress Daily/AM, said, “Positions haven’t changed, but the world has.”

HMOs doing a better job, not good enough

Although less “managed” systems of health care, such as PPOs, are currently more popular among U.S. employees, according to the October 2001 Consumer Reports, people enrolled in HMOs are just as satisfied as those in PPOs. The magazine surveyed more than 83,000 readers and found that 57 percent of PPO members were highly satisfied with the care they received, compared with 55 percent of those in HMOs.

Meanwhile, a report from the National Committee on Quality Assurance (NCQA) shows that HMOs are indeed improving their performance. The greatest gains occurred in diabetes management and in control of high blood pressure and cholesterol rates. In 2000, 77 percent of patients with diabetes were screened for LDL cholesterol, compared with 69 percent in 1999; 74 percent of heart attack patients received cholesterol screening, up from 69 percent the previous year; and 52 percent of patients with high blood pressure received treatment, up from 39 percent in 1999.

Yet, despite HMOs’ marked improvement in clinical care, enrollment rates continue to decline. According to a national survey of employers conducted by the Kaiser Family Foundation and the Health Research and Educational Trust, health care enrollment in HMOs dropped from 31 percent of workers in 1996 to 23 percent in 2001.

PRACTICE PEARLS from here and there

How to appeal denied claims

It has been estimated that roughly half of denied Medicare claims that are appealed are eventually paid by carriers. Here are three ways to improve your chances of a successful appeal.

1. Keep track of denied claims. If your billing software doesn’t do this automatically, set up a spreadsheet of denied claims to help you determine which ones should be re-filed, which should be written off and which should be appealed. Sort denials by date of service, CPT code, ICD-9 codes and the reason for the denial. If you don’t know why a claim was denied or you don’t know what the denial code means, call your carrier for an explanation.

2. File the appeal correctly. Make sure you include a copy of the claim, a copy of the remittance notice (or EOB) with the denial in question highlighted, a copy of the progress note, a written explanation as to why the claim should not have been denied and any other information that may support your appeal.

3. Do some homework to bolster your appeal. Search the Web (e.g., www.lmrp.net) for other carriers’ policies that would support payment for the claim in question. Also contact your state medical society, AAFP chapter or local academic medical center to see whether other physicians have experienced similar denials and how they have handled it.

— Ingram M. Try these strategies to boost your success when you appeal denied claims. Part B News. July 30, 2001:1–4.

Doctor’s orders

When it comes to phone calls and postcards encouraging patients to follow through with their treatment plans, more isn’t necessarily better, according to research published in the June 2001 issue of Clinical Therapeutics. Study participants who received multiple reminders to comply with pravastatin therapy for coronary artery disease were no more likely to follow their doctors’ orders than patients who received just two reminders over the six-month study period. The author suggests that the only effective way to improve patient compliance is to “enhance the physician-patient relationship and/or patient involvement in care.”

Bright lights, big city

None of the medical residents responding to a recent study by Merritt, Hawkins & Associates, a Dallas-based health care recruiting firm, expressed any interest in practicing in rural communities of 10,000 people or less. The study of 300 residents (half of whom were in primary care specialties) found that the most important criteria for selecting a practice were geographic location and lifestyle. Almost 80 percent of respondents indicated a preference for communities of 51,000 people or more.

Meanwhile …

Due in part to poorer access to care, rural communities have higher smoking rates, lower exercise rates and higher death rates for children and young adults than do suburban and urban communities, according to the CDC’s 25th annual report on the nation’s health. The report will aid the Department of Health and Human Services in its efforts to improve Americans’ health in rural and underserved areas.

Medicare updates

In an effort to help physicians better understand and comply with Medicare regulations and instructions, the Centers for Medicare & Medicaid Services (CMS) plans to begin issuing quarterly compendia of all Medicare changes that affect providers. A prototype compendium will be posted on the CMS Web site (www.hcfa.gov) this month to allow providers a chance to view and comment on the format before regular publication begins.

Compensation and RVUs

From 1999 to 2000, compensation increased significantly for many medical and surgical specialties, such as urology (8.5 percent) and anesthesiology (7.4 percent), while the median compensation for primary care specialties increased significantly less, according to the American Medical Group Association’s 2001 Medical Group Compensation and Productivity Survey. Family practice increased only 1.9 percent and internists reported a 0.5 percent increase. To measure productivity, the survey evaluated median RVUs by specialty and found that cardiology increased by 11 percent, dermatology increased by 7.7 percent and family practice decreased by 2 percent.

Charity care strong but slipping

The percentage of physicians providing charity care has dropped four percent despite the addition of 16,000 practicing physicians to the work force between 1997 and 1999, according to a recent study by the Center for Studying Health System Change. The existence of fewer physician-owned clinics, declining reimbursement and lack of time may have contributed to the drop, the study says. Meanwhile, the demand for charity care, an important part of the safety net for poor and uninsured individuals, is expected to increase.

Clinical preparedness

A majority of graduating family practice residents feel “prepared” or “very prepared” to care for ambulatory and hospitalized patients and to diagnose and treat conditions such as diabetes, hypertension and depression, according to research published in the Sept. 5 Journal of the American Medical Association. However, over 25 percent reported feeling unprepared to practice in a managed care environment or to care for patients with critical conditions or substance abuse problems. More than 50 percent reported feeling unprepared to care for patients with HIV/AIDS.

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