"Health & Medical News"

Physicians say a Missouri Supreme Court ruling, though narrow, recognizes the significance of medical staff bylaws and offers doctors some recourse in the face of unfair discipline.

Breaking with a 43-year-old precedent, a unanimous high court opened the door for medical staff members to sue hospitals over privileging disputes if the facilities fail to follow staff bylaws. Justices departed from a long-held principle that hospital privileging decisions were not subject to judicial review, noting that was the “nationwide majority rule” at the time of the high court’s 1965 decision.

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An investigation into how a UnitedHealth Group subsidiary determined reimbursement for out-of-network physicians across multiple insurers alleges to show a pattern of underpricing services to shift the payment burden from insurers to patients.

New York Attorney General Andrew Cuomo on Feb. 13 announced his intent to sue United, after a six-month investigation focusing on its Ingenix subsidiary. Ingenix operates a database used by most insurers to determine the so-called usual, customary and reasonable rates for physician services.

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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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Imagine being allowed to practice medicine but not being allowed to drive. That’s what some Michigan physicians are facing.

Under a new state law that took effect Jan. 22, doctors in Michigan on a visa cannot get a new driver’s license. That’s because a law intended to prevent illegal immigrants from obtaining a driver’s license also prevents legal residents on student or work visas, including physicians, from getting a license.

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Health plans often declare that they want to have good relationships with their physicians. But UnitedHealth Group has at least 315,000 reasons to make extra nice.

That number represents the 2007 slide that the insurer experienced in employer-sponsored and individual memberships. The company attributes the loss, in part, to frayed relations with patients and physicians. At a Dec. 4, 2007, investors’ meeting in New York, United pledged that improvements were on the way.

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The movement to align patient safety and payment seems to be picking up a full head of steam. Hospitals and payers are coalescing around the idea that no one should get paid for so-called never events — serious reportable events, such as wrong-site surgery, that kill or maim patients.

Perhaps most significantly, the BlueCross BlueShield Assn. announced in November 2007 that its plans will work toward ending payment for never events. The change will be phased in over several years as the Blues alters its coding and claims processes. A spokesman said adoption will vary among the 39 Blues plans, which insure more than 100 million people, because the change requires renegotiating contracts and securing agreements from local physicians and hospitals.

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With Rocky Vista University College of Osteopathic Medicine in Parker, Colo., one step closer to becoming the only for-profit, accredited medical school in the United States, it is generating controversy in the medical community.

In August, the Commission on Osteopathic College Accreditation awarded the school provisional accreditation. Once fully accredited, it will join the ranks of 149 public and private medical schools in the U.S. All those institutions are nonprofits.

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