Health Care Providers

Proper DoubtsEditor: If Rudolph Almaraz kept silent about having AIDS because he doubted the ability of the news media, Johns Hopkins and the public, including his own patients, to react without hysteria, he was certainly justified. The sensationalism with which this story has been approached only confirms the validity of that decision.The Sun acts irresponsibly by legitimizing reactions of panic, in view of the extreme unlikelihood of the doctor having transmitted the disease to his patients.

WASHINGTON -- A well-meaning effort to root out Medicare fraud and abuse appears to have backfired, threatening thousands of elderly homebound patients with the loss of health care visits.The federal Health Care Financing Administration (HCFA), aiming to crack down on cheaters and fly-by-night operators, devised anti-fraud rules last month that the home health care industry says could shut down many independent providers.That, the industry claims, could leave countless patients who are currently treated at home in the lurch and, ironically, make them candidates for more expensive programs such as Medicaid, the health care program for the poor.

United Payors & United Providers Inc., a Rockville-based financial services company supporting the health care industry, said yesterday that it acquired ProAmerica, an operating subsidiary of UnitedHealth Group, for an undisclosed sum.ProAmerica, an Arlington, Texas-based network of health care providers, is expected to record revenue of about $13 million in 1998.The combined operations of UP&UP and ProAmerica are expected to exceed $100 million in revenue in 1999, said Ed Civera, UP&UP president and chief operating officer.

United Payors & United Providers Inc., a Rockville company that provides health insurers a national network of health care providers, said yesterday that it will buy America's Health Plan Inc. for $14.75 million.Publicly held UP&UP said AHP, which operates a network of health care providers nationwide, should significantly improve its earnings in 1998.UP&UP, which employs about 400, posted a net profit of $10.6 million on $35.2 million in revenue in 1996.Ed Civera, president and chief operating officer of the fast-growing company, which expects to post revenue of about $60 million this year, said the deal is part of UP&UP's plan to selectively acquire preferred provider organizations and other health care outfits as part of a growth strategy.

Blue Cross and Blue Shield of Maryland yesterday won the right to set the rates it pays doctors and other health care providers.The state Senate unanimously passed a bill, already approved by the House of Delegates, that frees Blue Cross from oversight from the state insurance commissioner over provider rates.Some providers had opposed the legislation, but the insurance commissioner, Dwight K. Bartlett III, told legislators that reviews of fees by his office -- a regulatory mechanism dating from the 1930s -- are no longer needed in the current health marketplace.

Creating a better model for health careI am writing in response to the column titled, "A better model for health care," that appeared in The Sun on Sept. 24. In his commentary, L. David Taylor addressed the rise of managed care and the dissatisfaction of health care providers with the current system.Physicians said that treatment restrictions sometimes conflict with the trained physician's professional judgement.Concerned that patients are not always receiving appropriate care, some physicians are attempting to form new organizations called physician organizations (POs)

HOME SHOULD be a haven, but in too many families home is a dangerous place. According to the American Medical Association, the annual toll of domestic violence in this country includes physical abuse to at least 2 million children, up to 4 million women and 1 1/2 million older adults. A 1993 Commonwealth Fund study found that abuse by husbands or boyfriends is the single largest cause of physical injury to women in America, more common than burglary, muggings and other physical crimes combined.

The Baltimore City Council gave preliminary approval last night to a bill that would require health maintenance organizations contracting with the city to have minority doctors and dentists as participants.The bill, which still faces a final vote, does not specify numbers of minority health care providers that would be required, but an HMO that bids on a city contract would have to demonstrate to a city panel that it has a diverse group of doctors or dentists."Anyone who bids on a contract with the city to provide health care services will have to prequalify," said Lawrence A. Bell III, the bill's sponsor.

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."

WASHINGTON -- Hospitals and other health care providers who responded to demands for more rural health clinics, hospices and health care in the home for Medicare patients say they are stymied in offering these services because they cannot get approval from federal regulators.Because of budget cuts, federal and state officials say, they have a huge, growing backlog of health care providers awaiting certification to participate in Medicare.Matters will only worsen, they say, as Republicans in Congress cut the budget for such regulatory activity, while encouraging doctors and hospitals to form new health plans to serve Medicare patients.

Almost any doctor will readily offer up horror stories of trying to find and pay for medical malpractice insurance. Such policies are cost-prohibitive and increasingly scarce, and require many to practice "defensive medicine" - ordering extra precautionary tests and procedures that contribute mightily to the rise in health costs. A growing number of policymakers are calling for a cap on medical malpractice awards as a partial solution to the national health care debate. Rooting out frivolous lawsuits is a laudable goal, but limiting damage awards for patients who have been wronged is akin to fixing a broken leg with a band-aid.

Maryland is poised to jump ahead of the rest of the nation in health information technology on Tuesday when Gov. Martin O'Malley signs a bill intended to coax doctors into using electronic medical records. The computerized files are seen as the foundation of a national health information network that proponents say will improve care, advance medical knowledge and save the country tens of billions of dollars annually. But with the startup costs to individual doctors in the tens of thousands of dollars, many smaller practices have been slow to move from clipboard to computer screen.

Health fraud bill deserved defeat The Baltimore Sun's editorial "The defrauders win" (March 27) unfairly criticized state Sens. Nathaniel J. McFadden, Catherine E. Pugh and Nathaniel Exum along with the majority of members of the Maryland Senate who rightly voted to reject legislation that would have increased the number of lawsuits against Maryland health care providers. The so-called False Health Claims Act would not have rooted out Medicaid fraud or provided a windfall of revenue to the state treasury.

BOSTON -- State health officials across New England are on alert after dozens of cases of mumps have been confirmed or suspected in Maine. Fifteen cases have been confirmed in Maine since September, and 57 more are suspected, said Geoff Beckett, the assistant state epidemiologist. While no cases have been confirmed in other New England states since September, officials fear the disease could spread quickly, particularly because of the region's abundance of college students, who are thought to be at particular risk.

WASHINGTON --The Bush administration has no clear strategy to protect the privacy of patients as it promotes the use of electronic medical records throughout the nation's health care system, federal investigators say in a new report. In the report, the Government Accountability Office, an investigative arm of Congress, said the administration had a jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers.

WASHINGTON -- The White House is clashing with governors of both parties over a plan to cut Medicaid payments to hospitals and nursing homes that care for millions of low-income people. The White House says the changes are needed to ensure the "fiscal integrity" of Medicaid and to curb "excessive payments" to health care providers. But the plan faces growing opposition. The National Governors Association said it "would impose a huge financial burden on states," already struggling with explosive growth in health costs.

For years, doctors have been warning that our health care delivery system is being damaged by health insurers' strategy of cutting payments to physicians and other health care providers to control costs. The evidence is becoming clear that the damage is real and its consequences affect everyone who needs medical care. Whether you're talking about a nonprofit hospital or a for-profit physician practice, a simple maxim prevails - no margin, no mission. Payment cuts by health insurers and Medicare have produced far more than a reduction in health care providers' profit margins; they have cut deeply into the ability of our delivery system to meet the needs of our communities.

During the Katrina disaster, Robbie Prepas, a certified nurse midwife from California, delivered five babies in the New Orleans Airport and twins in an ambulance en route to Baton Rouge. She triaged several hundred pregnant moms by listening to their fetal heartbeats, providing antenatal and postpartum care. "I have worked in disaster situations all over the world, and Hurricane Katrina was the worst I have ever been involved in," said Ms. Prepas, a member of the White Ribbon Alliance for Safe Motherhood.

Attending to the health needs of prisoners presents an array of occupational and professional challenges. Hazards, some might say. Inmates aren't the most fit or healthy members of the population. An overwhelming majority have been involved in the drug trade, which puts them at significant risk for HIV/AIDS and other complications. A recent Johns Hopkins public health study found that asthma, high blood pressure and diabetes were common among women at the state-run jail in Baltimore. Prison inmates are entitled to decent medical care, and incarceration shouldn't be an impediment to their getting it. But in recent years, that too often has been the case for Maryland inmates, as documented by this newspaper and, most recently, a city grand jury.

WASHINGTON - House and Senate negotiators have tucked a potentially far-reaching anti-abortion provision into a $388 billion must-pass spending bill, complicating plans for Congress to end its business and adjourn for the year. The provision may be an early indication of the growing political muscle of social conservatives who provided crucial support for Republican candidates, including President Bush, in the election. It expands to all hospitals, clinics and doctors a provision that currently applies to Catholic hospitals, which do not have to comply with a federal law that requires health care providers who receive taxpayer dollars to discuss the option of abortion with women if they inquire about it. The language also allows hospitals and health care providers to opt out of state and local laws that require them to provide abortions, abortion counseling or referrals.