Doctors And Hospitals

AMERICANS haven't even begun to think seriously about reforming Medicare. At current spending rates, the trust fund runs dry in 2008.President Clinton proposed using part of the future budget surplus to shore up the system until 2020.But that's far from certain and wouldn't address the continuing medical needs of the giant boomer generation.To find out what kind of reforms the public might accept, the League of Women Voters, together with the Henry J. Kaiser Family Foundation, sponsored 321 community talkathons: 11 focus groups, 300 small discussion circles and 10 large public meetings.

University of Maryland Medicine and Doctors Health System, the state's largest independent physician group, said yesterday they will join forces to offer insurers a broad array of health services.The affiliation -- not a merger or acquisition but a series of agreements to collaborate in a number of areas -- brings together one of the state's two academic medical centers (a medical school and teaching hospital) with a physician "mega-group" with more than 300 primary care doctors in Maryland and Northern Virginia.

Principal Health Care of the Mid-Atlantic, a Bethesda-based HMO, said yesterday that it was selling its Washington-area business to Inova Health System, a Virginia-based network of hospitals, nursing homes and other health services.Terms of the transaction were not disclosed.About 14,000 members whose employers are in Montgomery and Prince George's counties, the District of Columbia and Virginia are expected to become Inova HMO subscribers after the deal is completed.Principal's 12,000 members who have employers in the rest of Maryland will remain with the company.

After a successful shakedown cruise, the Johns Hopkins Health System is seeking higher visibility for a plan in which it offers managed-care services directly to self-insured employers -- skipping over insurance companies and health maintenance organizations.The program, called Employee Health Plans (EHP), makes Hopkins the only hospital in Maryland contracting directly with employers, although other hospitals and doctors' groups have assembled care networks to contract with managed-care insurers.

WASHINGTON -- The government will report tomorrow that the Medicare and Social Security trust funds will each run out of money a year earlier than expected, officials said yesterday.The Medicare trust fund, which pays the hospital bills of the elderly, will go bankrupt in 2001 if steps are not taken to shore it up, the trustees are to report."Hospital usage is way up," reflecting the needs of the fast-growing 85-and-over population, one official said. Last year's report predicted that the fund would be exhausted in 2002.

C When Dr. Lawrence Gordon opens his family medical practice next month in Mount Airy, he plans to spend most of his time with patients instead of struggling to keep up with insurance paperwork and billing.He'll leave most of the business of medicine to Carroll County General Hospital.The hospital owns Dr. Gordon's practice and will pay his salary, take care of billing, hire staff and handle other administrative tasks.Dr. Gordon comes to Mount Airy after five years of running a solo practice in Collinsville, Va."

Without warning, the Serbian grenades rained down on Tomislav Tomic in a field near the town of Bihac in Bosnia's northwestern corner.There was a burst of light, deafening explosions, gunfire. A fiery bolt of pain tore up his legs. He nearly fainted as a fog rolled across his eyes; he went numb below the waist."The whole ground was afire," the 21-year-old Croatian recalled of the attack that killed 60 men, including four friends. "It was hell."His legs badly mangled, Mr. Tomic spent a year in a Zagreb hospital.

Going for the gold can be a costly undertaking for youngathletes -- just ask 28-year-old Harford Countian Max Skelley. He'd like to be the first American to compete in one of the Olympics' newest events, the Laser single-handed boat competition. Max began sailing Lasers about nine years ago and is one of the top Laser sailors in North America.Here's how he got this far: After each Olympics, the U.S. Sailing Committee and the Olympic Committee form a team and schedule competitions in which the team members vie for points.

BLUE BELL, Pa. -- For months, Americans nervously watched Washington try to overhaul the nation's health care system. They should have been looking to Blue Bell instead.This southeast Pennsylvania town is the home of U.S. Healthcare, a leader in a revolution that is shattering the traditional relationship between doctor and patient.If you don't belong to U.S. Healthcare or another health maintenance organization, odds are that you will someday. Already, more than 45 million Americans, including 1.4 million Marylanders, get their health care through HMOs.

WASHINGTON -- Health maintenance organizations, which now serve 45 million Americans, proposed uniform federal standards yesterday for the operation and financing of health plans across the country.The HMOs, concerned about the possibility of 50 different sets of state regulations, would go much further than President Clinton's health care plan in trying to establish uniform national standards.Under Mr. Clinton's proposal, no health plan could do business unless it was first certified by one or more states.

VERO BEACH, Fla. -With his stethoscope decorated with three tiny koalas, Dennis Saver looks every bit the family doctor as he steps into the examining room of his small practice on Florida's Treasure Coast. When Saver begins to examine his patient, however, he does something that four out of five doctors in America do not do: He pulls out a computer. The little black Toshiba, its edges worn to the bare metal, now gets more use than the stethoscope and has become key to the care Saver gives his patients.

For two decades, electronic health records have been the Next Big Thing in health care: a way to simultaneously improve care and reduce waste in a system clogged with paper and manila folders. In 1994, President Bill Clinton announced that all doctors would use computerized records within 10 years. In his 2004 State of the Union, President Bush called for universal use of digital health records. The result of all these grand declarations: 90 percent of U.S. doctors and more than two-thirds of U.S. hospitals still use paper for patient records.

By now you surely know the U.S. health care system is massively messed up. But the question is why. A few years ago, health journalist Shannon Brownlee was going through some global health statistics. She noticed that even as U.S. health care costs were rising steadily, Americans were not getting healthier. How to explain this apparent paradox? Brownlee became fascinated and began to collect data in search of answers. The result is Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, her analysis of how American health care has failed.

What if medical care came with a 90-day warranty? That is what a hospital group in central Pennsylvania is trying to learn in an experiment that some experts say is a radically new way to encourage hospitals and doctors to provide high-quality care that can avoid costly mistakes. The group, Geisinger Health System, has overhauled its approach to surgery. And taking a cue from the makers of television sets, washing machines and other consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment.

WASHINGTON - In a victory for patients and their doctors, the Supreme Court ruled yesterday that health maintenance organizations can be forced by state law to open their networks to outside doctors and hospitals. The decision upholds so-called "any willing provider" laws in half the states. These pro-consumer laws permit patients enrolled in an HMO to see a favorite doctor or specialist, even if the physician is not part of the network. So long as the medical provider abides by the network's rules, the HMO may not "discriminate against" the doctor or hospital.

The economy has health insurers worried - fewer employed people means fewer members for the insurance plans. For those who provide health care, however, the impact of the economic slowdown is more indirect. "It's true that physicians and other health care providers are generally recession-proof," said T. Michael Preston, executive director of the state medical society, the Medical and Chirurgical Faculty of Maryland. However, "any downturn plays out over the longer term in the availability of insurance."

Doctors and hospitals scrambled yesterday to treat more than 2,000 burned, broken and crushed patients taken from the wreckage of the World Trade Center. Medical officials set up makeshift emergency rooms, appealed for volunteer staff and set up triage centers, including one at a New Jersey waterfront park where hundreds were ferried throughout the day. Meanwhile, patients injured when an airliner slammed into the Pentagon were taken by ambulance and helicopter to hospitals in Virginia and Washington.

When it comes to TV reporting on medicine in this city, you almost can't tell the players without a spreadsheet. To aid its new morning show, WBFF recently entered pacts with two local medical centers ensuring their doctors will appear regularly as experts. The three-hour news show on Fox 45, from 6 a.m. to 9 a.m. on weekdays, creates added appetite for locally produced content on the channel. And viewers have demonstrated strong interest in health-related news. But some say the station also derives its inspiration from another source: the bottom line.

WASHINGTON - The Clinton administration will soon issue sweeping new rules to protect the privacy of medical records. But under pressure from the health care industry, officials say, they are backing off a proposal to give patients a broad new right to sue and recover damages for the improper disclosure of confidential information. Chris Jennings, the health policy coordinator at the White House, said President Clinton would issue the final rules, with the force of law, in the next few weeks.

Administrative problems in the state's Medicaid program are limiting access to care, according to a report to be released today by Advocates for Children and Youth. Among the problems, the report says, are that there are too few doctors, causing long waits for some services - including one child who, although his condition was not life-threatening, waited six months for an appointment to have a bullet removed from his chest. Also, the report says, children have been assigned to doctors other than their usual pediatrician, and parents have had problems getting care for newborns because the baby does not yet have a membership number for one of the HMOs that provides insurance under HealthChoice, the state's Medicaid program for low-income people, mostly mothers and their children.