"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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One health plan has come to a conclusion that many physicians already have reached: The financial benefits of office-based electronic medical records systems are not worth the cost to doctors.

Relying on information from past studies, including an American Medical Association estimate that doctors see only 11 cents of every dollar saved through the use of information technology, BlueCross BlueShield of Massachusetts recently announced that it has decided not to require physicians to install an EMR to participate in its bonus program.

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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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A California appeals court dealt another blow to health plans over their policy cancellation tactics.

The 4th District Court of Appeal unanimously said insurers have a responsibility to make sure patients’ policy applications are complete and accurate before issuing coverage — not after expensive claims come in the door. Judges said plans cannot revoke patients’ policies unless they fully investigate pre-enrollment forms up front or insurers show patients intentionally misled them.

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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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A California appeals court ruling may bode well for physicians and patients in their fight against alleged illegal policy cancellations by health insurance companies.

A three-judge panel of the 2nd District Court of Appeal unanimously ruled that the practice of reviewing individuals’ applications after they have submitted claims and then pulling the coverage based on alleged errors “is flatly prohibited” under state insurance laws. The Dec. 4, 2007, decision gave the green light to a patient’s class-action lawsuit alleging that Blue Shield of California tried to dodge claims by looking for supposed misstatements or omissions on patients’ policy forms after approving treatment.

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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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Washington — The rapid consolidation of the insurance industry in recent years has made the health system less efficient and has harmed patients and physicians, medical organizations told lawmakers at an Oct. 24 hearing.

The American Medical Association asked the House Small Business Committee for help in convincing the Dept. of Justice to disapprove a proposed merger that it believes would add to these problems.

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