August 1999 Bulletin


HCFA proposes changes in Medicare fee schedule

The Health Care Financing Administration published its Notice of Proposed Rule Making (NPRM) on the 2000 Medicare Fee Schedule in the July 22, 1999 Federal Register. The Proposed Rule includes the agency's proposal for development of resource-based malpractice relative value units. Currently, the malpractice RVUs are based on a charge system, while the other two components of the Medicare relative value system (physician work and practice expenses) are resource-based. In addition, the NPRM proposes further refinements to the practice expense relative value units, clarifies the level of physician supervision required for diagnostic tests, establishes parameters for use of an operating microscope, establishes qualifications for nurse practitioners, eliminates X-ray as a prerequisite for chiropractic manipulation, and excludes payments for assisted suicide. Comments to HCFA on the Proposed Rule are due September 20, 1999.

Academy supports reclassification of four medical devices

The Academy has informed Jane E. Henney, MD, Food and Drug Administration commission, that it is supporting the reclassification of four preamendment Class III orthopaedic devices to Class II-elbow joint metal/polymer constrained cemented prosthesis, knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis, shoulder joint metal/polymer nonconstrained cemented prosthesis, and shoulder joint metal/polymer semi-constrained cemented prosthesis.

Fellows urge senator to sponsor bill on collective negotiations

At the request of the American Association of Orthopaedic Surgeons, James W. Turner, MD, and Albert A. Coates, MD, both of Cedar Rapids, Iowa, met with Sen. Charles Grassley (R-Iowa) in Washington, D.C. on July 15 to encourage him to sponsor the Senate version of H.R. 1304, the Quality Health Care Coalition Act. This legislation would provide an antitrust exemption to allow physicians to engage in collective negotiations without violating the antitrust laws. The Association also is maintaining a toll free public service phone line-(800) 812-8824-to help AAOS members and their patients contact members of the U.S. House of Representatives and urge them to cosponsor H.R. 1304. (See page 25.)

Public skeptical of MCO's medical, cost-saving benefits

A new survey of public opinion finds that while Americans say that managed care has increased access to preventative health services such as immunizations and physical exams, 63 percent believe managed care has decreased access to specialists and 61 percent said managed care has decreased the time doctors spend with patients. Fifty percent said managed care had decreased quality of care for the sick. The Public Opinion Update of the Kaiser Family Foundation/Harvard School of Public Health said one in two Americans believe that managed care has not produced significant health care savings. Fifty-eight percent of Americans worry that if they become sick, their health plan will be more concerned about savings money than providing the best treatment.

AMA survey finds physicians reduce time with patients

The AMA Socioeconomic Monitoring Survey of 2,450 physicians found 63 percent reported they had reduced the length of time spent with patients during visits, referred more difficult cases to other physicians or substituted videos for face-to-face patient counseling and education. Thirty-one percent said they had cut staff costs by trimming the number of staff, curtailing salary increases or reducing fringe benefits; 36 percent reported reducing their own salaries and fringe benefits. Thirty percent of the physicians surveyed plan to retire early; 25 percent are augmenting their practices by selling pharmaceuticals or eyeglasses or expanding in-office testing; and 24 percent are pursuing other activities, both professional and nonmedical.

Orthopaedics Overseas programs available for volunteers

Orthopaedics Overseas is seeking volunteers for its international programs. The programs and chairmen are: Bhutan, Robert Stein, MD, (615) 329-6633; Ethiopia, Robert Feddis, MD, (301) 724-7146; Indonesia, John Dormans, MD, (215) 590-1534 and Morris Schultz, MD, (301) 774-0484; Kenya, George Rapp, MD, (317) 253-3204; Malawi, Richard Kemme, MD, (970) 352-0250; Peru, James Bennett, MD, (713) 799-2300; St. Lucia, Darrell Fisher, MD, (515) 422-6630; South Africa, David Francisco, MD, (913) 642-7676; Tanzania, W.W. Schaefer, MD, (920) 458-9274; Uganda, David Denzel, MD, (716) 434-2697; and Vietnam, Lewis Zirkle, MD, (509) 946-1654, volunteers should write him at 875 Swift Blvd., Richland, Wash. 99352. For more information, contact the program department at Health Volunteers Overseas (202) 296-0928.

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