"Health & Medical News"

Many of the country’s largest health plans have agreed on a set of standards to be used nationwide as the basis for physician pay-for-performance initiatives and tiered networks. Underlying the effort is insurers’ fears that states could develop 50 different sets of regulations to govern these programs — a concern sparked by last year’s crackdown by New York’s attorney general.

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It only takes a year to start draining empathy from future physicians, according to a study of medical students in the March issue of Academic Medicine. But empathy is a key quality medical schools should promote, experts said, because it makes for better physicians.

“We know as a medical community that really good communication skills with patients help the patients to comply with the instructions of the physician,” said lead study author Bruce W. Newton, PhD. “It puts them more at ease with the physician, a bond of trust is established, and if something unfortunately goes wrong, if you have this bond and communications skills, you are much less likely to be sued.”

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Health plans are facing even more legal, regulatory and legislative challenges to their practice of canceling enrollees’ coverage after approving treatment. In reaction to the mounting pressure, some insurers are changing their rescission policies.

Last month, Health Net became the latest target in California. A state arbitrator on Feb. 21 levied a $9 million award, largely in punitive damages, against the insurer for canceling a breast cancer patient’s policy after authorizing $129,000 in medical care. The plan dropped the woman for supposedly misrepresenting her weight and a heart condition on a pre-enrollment form.

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Some California physicians say a recent settlement between a Ventura hospital and the Dept. of Justice underscores the importance of a self-governing medical staff.

Community Memorial Hospital in December 2007 agreed to pay $1.5 million to settle allegations that the facility gave improper gifts, loans and payments to some doctors in exchange for Medicare patient referrals. No doctors were named in the agreement, and the hospital did not admit any wrongdoing. Community Memorial administrators voluntarily disclosed the financial relationships, which took place under the hospital’s former leadership.

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“Not happy” wrote to complain about the 90-minute wait to be seen at a dermatologist’s office. “Disgusted” said that a certain doctor “refuses to communicate with patients.” But “CarolaBen” responded to “Disgusted” that this doctor returned every call placed by her regarding her husband’s liver duct problem.

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When Health Net held a conference call to discuss its third-quarter earnings, investment analysts pointed out one particular growth industry — covering mental health services for military members and their families.

Health Net President and CEO Jay Gellert agreed. He called the demand, fueled by the large number of Iraq and Afghanistan war veterans, a “positive surprise, which I think we anticipate to be ongoing.”

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