- Email: [email protected]
AMA declares war on managed contracts
L ICYAN D PEOP LE PO
Round-the-clock that Ininfluential the budget
registered
disregard political climate, an advisory committee is recommending that Congress mandates 24 h registered-nurse (RN) coverage in all US nursing homes by a move
seems to
and
year 2000 at
an
annual
cost
of about
US$338 million. States and the federal government spent$40 billion on nursing-home care in 1995. Public programmes (including Medicare but largely Medicaid) account for nearly 63% of nursing home spending in the USA. The Institute of Medicine panel recommends that the added cost of a 24 h RN should be added to the federal tab. Critics counter that such a suggestion flies in the face of the philosophy of this Congress, which has disavowed mandates. Republicans have been advocating sharp cuts
AMA declares
war on
American Medical Assohas opened a new front in its undeclared war on certain forms of managed care, calling on managed-care plans to eliminate from their contracts with physicians "gag" clauses that forbid doctors from informing patients about treatments or physicians not covered by their insurance. Although the AMA has long since recognised that managed care is likely to represent the future of medicine in the USA, this action is part of a stepped-up effort to attack what AMA President Dr Lonnie R Bristow refers to as "managed profiteering" rather than managed care-the rise of for-profit plans, "where the allegiance is clearly to the stockholder who’s invested in the company", rather than to the
patient. In this most recent action, on Jan the organisation’s Council on Affairs Ethical and Judicial 17
declared unethical "gag" or "confidentiality" clauses in managedcare contracts that seek to prevent physicians from telling patients anything that would cause the patient to mistrust the plan, even if that means withholding information about potential treatment options. The council also called on physicians not to abide by such contractual restrictions. "Patients cannot be subject to making decisions with inadequate information.
for US
nursing
homes recommended
in Medicaid spending and recently forced to retreat from seeking to relax a landmark 1987 nursing home law (spawned by another IOM report) to improve staffing and patient quality standards. Recent data show a slight increase in RNs in nursing homes. In 1992, 7% of RNs worked in homes, up from 6-6% in 1989. One reason for the slight rise is the layoffs of RNs from hospitals, which like nursing homes, are in a fiscal squeeze. Joyce Clifford, an RN and vice president for nursing at a Boston-based hospital, says the proposal to increase RN presence on all shifts in homes "was not made lightly, and was not made without recognition of the financial burden that it might incur". Clifford and her IOM committee members say that greater RN presence will were
managed
The ciation
318
nurses
contracts
That would be an absolute violation of the informed consent requirements", said the council in a The AMA said it would "stand behind any physician who believes he or she is prevented from fulfilling the ethical duties due to a gag clause or similar policy" and urged physicians and managed-care plans to submit contract language to the organisation for a free legal review. In a separate interview, Bristow said the organisation was not
for-profit managed only if it met certain criteria, most importantly "providing the kind of information patients needed to make intelligent choices" and assuring that "physicians who can their retain participate traditional role of being patient advocates". In terms of patient information, Bristow said, "we mean that they should be told, in understandable language, what services are covered, and what services are not. They should be care,
to
but
told what the incentives are, or inducements there may be for caregivers to withhold services". Finally, said Bristow, utilisation review requirements must be based on sound scientific criteria, "not
somebody saying, ’you know, can
to
dissenter. He recommends that RNs be available on an "on call" basis. For larger nursing homes, he says, a staff RN may be appropriate and feasible round the clock but for smaller
facilities, a "sharing arrangement" might work better. Blumstein says he cannot support the proposal because it calls for a mandate and is not based on hard evidence about the costs involved or about the value of the benefit Janet Firshein
Sticking points in EU diagnostics and devices directives abilities of doctors
statement.
opposed
higher rates of patient survival, improved ability of residents to function independently, fewer hospital admissions, and earlier discharge from nursing homes. James Blumstein, a law professor from Vanderbilt University in Tennessee, was the panel’s lone lead
save$2 million if
we
we
just do
The linguistic and other health
professionals point in negotiations over a draft in-vitro diagnostics (IVD) directive. Many members of the European Parliament and some are
proving
member states, want to see all IVDs labelled in the language of the country or region where they are sold, whereas the European Commission proposal requires the local language only for home-test kits used by nonprofessionals. There is also disagreement on what to include in the list of products that would be subject to a stricter approval process than most IVDs. A majority of member states and many MEPs are further opposed to the draft directive’s attempt to update the EU’s 1993 medical device directive that came into effect on Jan 1 last year so that it covers devices made from or incorporating human tissues. Opponents of the move say that human tissue products need strong ethical controls and should be regulated under transplant or other medical laws. The Commission and industry claim that the tissues are rendered non-viable so are no different from any other material used in devices.
such and such.’" Julie Rovner
a moot
Sara Lewis
Round-the-clock that Ininfluential the budget
registered
disregard political climate, an advisory committee is recommending that Congress mandates 24 h registered-nurse (RN) coverage in all US nursing homes by a move
seems to
and
year 2000 at
an
annual
cost
of about
US$338 million. States and the federal government spent$40 billion on nursing-home care in 1995. Public programmes (including Medicare but largely Medicaid) account for nearly 63% of nursing home spending in the USA. The Institute of Medicine panel recommends that the added cost of a 24 h RN should be added to the federal tab. Critics counter that such a suggestion flies in the face of the philosophy of this Congress, which has disavowed mandates. Republicans have been advocating sharp cuts
AMA declares
war on
American Medical Assohas opened a new front in its undeclared war on certain forms of managed care, calling on managed-care plans to eliminate from their contracts with physicians "gag" clauses that forbid doctors from informing patients about treatments or physicians not covered by their insurance. Although the AMA has long since recognised that managed care is likely to represent the future of medicine in the USA, this action is part of a stepped-up effort to attack what AMA President Dr Lonnie R Bristow refers to as "managed profiteering" rather than managed care-the rise of for-profit plans, "where the allegiance is clearly to the stockholder who’s invested in the company", rather than to the
patient. In this most recent action, on Jan the organisation’s Council on Affairs Ethical and Judicial 17
declared unethical "gag" or "confidentiality" clauses in managedcare contracts that seek to prevent physicians from telling patients anything that would cause the patient to mistrust the plan, even if that means withholding information about potential treatment options. The council also called on physicians not to abide by such contractual restrictions. "Patients cannot be subject to making decisions with inadequate information.
for US
nursing
homes recommended
in Medicaid spending and recently forced to retreat from seeking to relax a landmark 1987 nursing home law (spawned by another IOM report) to improve staffing and patient quality standards. Recent data show a slight increase in RNs in nursing homes. In 1992, 7% of RNs worked in homes, up from 6-6% in 1989. One reason for the slight rise is the layoffs of RNs from hospitals, which like nursing homes, are in a fiscal squeeze. Joyce Clifford, an RN and vice president for nursing at a Boston-based hospital, says the proposal to increase RN presence on all shifts in homes "was not made lightly, and was not made without recognition of the financial burden that it might incur". Clifford and her IOM committee members say that greater RN presence will were
managed
The ciation
318
nurses
contracts
That would be an absolute violation of the informed consent requirements", said the council in a The AMA said it would "stand behind any physician who believes he or she is prevented from fulfilling the ethical duties due to a gag clause or similar policy" and urged physicians and managed-care plans to submit contract language to the organisation for a free legal review. In a separate interview, Bristow said the organisation was not
for-profit managed only if it met certain criteria, most importantly "providing the kind of information patients needed to make intelligent choices" and assuring that "physicians who can their retain participate traditional role of being patient advocates". In terms of patient information, Bristow said, "we mean that they should be told, in understandable language, what services are covered, and what services are not. They should be care,
to
but
told what the incentives are, or inducements there may be for caregivers to withhold services". Finally, said Bristow, utilisation review requirements must be based on sound scientific criteria, "not
somebody saying, ’you know, can
to
dissenter. He recommends that RNs be available on an "on call" basis. For larger nursing homes, he says, a staff RN may be appropriate and feasible round the clock but for smaller
facilities, a "sharing arrangement" might work better. Blumstein says he cannot support the proposal because it calls for a mandate and is not based on hard evidence about the costs involved or about the value of the benefit Janet Firshein
Sticking points in EU diagnostics and devices directives abilities of doctors
statement.
opposed
higher rates of patient survival, improved ability of residents to function independently, fewer hospital admissions, and earlier discharge from nursing homes. James Blumstein, a law professor from Vanderbilt University in Tennessee, was the panel’s lone lead
save$2 million if
we
we
just do
The linguistic and other health
professionals point in negotiations over a draft in-vitro diagnostics (IVD) directive. Many members of the European Parliament and some are
proving
member states, want to see all IVDs labelled in the language of the country or region where they are sold, whereas the European Commission proposal requires the local language only for home-test kits used by nonprofessionals. There is also disagreement on what to include in the list of products that would be subject to a stricter approval process than most IVDs. A majority of member states and many MEPs are further opposed to the draft directive’s attempt to update the EU’s 1993 medical device directive that came into effect on Jan 1 last year so that it covers devices made from or incorporating human tissues. Opponents of the move say that human tissue products need strong ethical controls and should be regulated under transplant or other medical laws. The Commission and industry claim that the tissues are rendered non-viable so are no different from any other material used in devices.
such and such.’" Julie Rovner
a moot
Sara Lewis