From pottsbri@yahoo.com  Wed Jan  1 18:44:39 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 1 Jan 2003 10:44:39 -0800 (PST)
Subject: Study: Widespread smallpox inoculations too dangerous
Message-ID: <20030101184439.17359.qmail@web20708.mail.yahoo.com>

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===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Friday, December 20, 2002

3) Study: Widespread smallpox inoculations too dangerous

Widespread smallpox vaccination is too dangerous to justify unless the likelihood of a major biological attack on the U.S. is substantial, says a new study by the nonprofit RAND Center for Domestic and International Health Security. The study, appearing on the Web site of the New England Journal of Medicine (<http://www.nejm.org>), adds, however, that it is prudent to vaccinate health care workers now against the disease. RAND researchers estimate that if 60% of the U.S. population were immunized, there would be about 500 deaths -- a price they say is too high to pay if there is little chance of a widespread attack against America. Researchers also found that if nearly all 10 million health care workers in the U.S. were vaccinated against smallpox, an estimated 25 people would die. The study said the risk is justified, though, because health care workers could come in close contact with the sick before the disease is recognized.

==================================

Copyright 2002 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>===================================</P>
<P>AHA NEWS NOW</P>
<P>The Daily Report for Health Care Executives</P>
<P></FONT><A href="http://us.f207.mail.yahoo.com/ym/www.ahanews.com"><U><FONT color=#0000ff size=2>www.ahanews.com</U></FONT></A></P><FONT size=2>
<P>===================================</P>
<P>Friday, December 20, 2002</P>
<P>3) Study: Widespread smallpox inoculations too dangerous</P>
<P>Widespread smallpox vaccination is too dangerous to justify unless the likelihood of a major biological attack on the U.S. is substantial, says a new study by the nonprofit RAND Center for Domestic and International Health Security. The study, appearing on the Web site of the New England Journal of Medicine (&lt;</FONT><A href="http://www.nejm.org/"><U><FONT color=#0000ff size=2>http://www.nejm.org</U></FONT></A><FONT size=2>&gt;), adds, however, that it is prudent to vaccinate health care workers now against the disease. RAND researchers estimate that if 60% of the U.S. population were immunized, there would be about 500 deaths -- a price they say is too high to pay if there is little chance of a widespread attack against America. Researchers also found that if nearly all 10 million health care workers in the U.S. were vaccinated against smallpox, an estimated 25 people would die. The study said the risk is justified, though, because health care workers could come in clo!
se contact with the sick before the disease is recognized.</P>
<P>==================================</P>
<P>Copyright 2002 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Sat Jan  4 02:57:02 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Fri, 3 Jan 2003 18:57:02 -0800 (PST)
Subject: 'Nickel a Drink' Legislation Would Fund Trauma and Emergency System
Message-ID: <20030104025702.1987.qmail@web20703.mail.yahoo.com>

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-----Original Message-----

Subject: CMA Alert: December 19, 2002

4. 'Nickel a Drink' Legislation Would Fund Trauma and Emergency System



State Senator Gloria Romero (D-Los Angeles) reintroduced legislation to help save California's beleaguered trauma centers and emergency rooms. The CMA-sponsored bill is expected to generate $500 million annually by assessing a 5¢-a-drink fee. The fee would be levied at the wholesale level and targets liquor vendors rather than consumers. The bill guarantees that all of the money will be used to defray the rising costs of operating emergency rooms, trauma centers, and first-response teams.

"In light of our $21 billion budget deficit, California taxpayers cannot continue to bear the financial burden for an industry's product that is responsible for substantial health care costs to the public and the state," Senator Romero said during a press conference at White Memorial Medical Center in Los Angeles. "The alcohol industry must assume greater responsibility for a product that, by its design, debilitates an individual's physical and mental capacities."

The legislation comes on the heels of Governor Davis's announcement that he has rescinded a one-time appropriation of $25 million to assist struggling trauma centers in California and has rolled back Medi-Cal reimbursement to 1985 levels. The governor's $2 billion in proposed cuts from health care programs and services are going to have a devastating impact on California's already struggling emergency rooms and trauma centers, Senator Romero said, adding that counties will be hard-pressed to find the funding necessary to help keep California's health care delivery system afloat.

Prepared by the CMA Communication Center

Katherine Gallia, Editor, 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<P>-----Original Message-----</P>
<P>Subject: CMA Alert: December 19, 2002</P>
<P>4. 'Nickel a Drink' Legislation Would Fund Trauma and Emergency System</P>
<P></P>
<P>State Senator Gloria Romero (D-Los Angeles) reintroduced legislation to help save California's beleaguered trauma centers and emergency rooms. The CMA-sponsored bill is expected to generate $500 million annually by assessing a 5¢-a-drink fee. The fee would be levied at the wholesale level and targets liquor vendors rather than consumers. The bill guarantees that all of the money will be used to defray the rising costs of operating emergency rooms, trauma centers, and first-response teams.</P>
<P>"In light of our $21 billion budget deficit, California taxpayers cannot continue to bear the financial burden for an industry's product that is responsible for substantial health care costs to the public and the state," Senator Romero said during a press conference at White Memorial Medical Center in Los Angeles. "The alcohol industry must assume greater responsibility for a product that, by its design, debilitates an individual's physical and mental capacities."</P>
<P>The legislation comes on the heels of Governor Davis's announcement that he has rescinded a one-time appropriation of $25 million to assist struggling trauma centers in California and has rolled back Medi-Cal reimbursement to 1985 levels. The governor's $2 billion in proposed cuts from health care programs and services are going to have a devastating impact on California's already struggling emergency rooms and trauma centers, Senator Romero said, adding that counties will be hard-pressed to find the funding necessary to help keep California's health care delivery system afloat.</P>
<P>Prepared by the CMA Communication Center</P>
<P>Katherine Gallia, Editor, </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Sun Jan  5 04:40:38 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Sat, 4 Jan 2003 20:40:38 -0800 (PST)
Subject: GOP Plans To Push Caps on Medical Malpractice Awards in Next Legislative Session
Message-ID: <20030105044038.62185.qmail@web20708.mail.yahoo.com>

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-----Original Message-----

From: California Healthline

To: CALIFORNIAHEALTHLINEHTML@MAILINGS.ADVISORY.COM

GOP Plans To Push Caps on Medical Malpractice Awards in Next Legislative Session 

01/02/2003 





The Washington Post on Dec. 29 examined congressional Republicans' plans for tort reform, including caps on awards in medical malpractice cases. According to Sen. Trent Lott (R-Miss.), in the next congressional session, Republicans will use a strategy of passing liability caps in "small pieces" for "serious problems like medical liability and outlandish class-action lawsuits." He said that such "piecemeal measures" will garner enough support from pro-business Democrats to pass the Senate and avoid the "unwinnable fight" over one "big tort reform bill," the Post reports. Republicans and President Bush already have had success in using such a strategy, including enacting liability limits for drug makers. In the next session, Republicans plan to advocate legislation proposed by President Bush that would "dramatically limit" the liability of doctors sued for medical malpractice, the Post reports. Under the plan, awards for pain and suffering in medical malpractice cases would be!
 capped at $250,000; however, there would be no federal limits on economic damages. Republicans also are considering legislation that would provide new liability protections for asbestos manufacturers and HMOs, the Post reports (VandeHei, Washington Post, 12/29/02). In related news, the New York Times on Dec. 29 looked at the outcome of tort reform in Texas, most of which was enacted by Bush when he was governor (Oppel, New York Times, 12/29/02). 



Wall Street Journal Editorial 

The malpractice crisis has led some patients to be denied medical treatment "because of an out-of-control tort system," a Wall Street Journal editorial states, adding, "Juries willing to award sky-high payouts to plaintiffs poison the well for patients everywhere." The editorial continues, "The House passes medical malpractice reform every two years, but it always dies in the Senate." It concludes, "This sounds like a job for" incoming Senate Majority Leader Bill Frist (R-Tenn.) (Wall Street Journal, 1/2). 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: California Healthline</P>
<P>To: CALIFORNIAHEALTHLINEHTML@MAILINGS.ADVISORY.COM</P>
<P>GOP Plans To Push Caps on Medical Malpractice Awards in Next Legislative Session </P>
<P>01/02/2003 </P>
<P></P>
<P></P>
<P>The Washington Post on Dec. 29 examined congressional Republicans' plans for tort reform, including caps on awards in medical malpractice cases. According to Sen. Trent Lott (R-Miss.), in the next congressional session, Republicans will use a strategy of passing liability caps in "small pieces" for "serious problems like medical liability and outlandish class-action lawsuits." He said that such "piecemeal measures" will garner enough support from pro-business Democrats to pass the Senate and avoid the "unwinnable fight" over one "big tort reform bill," the Post reports. Republicans and President Bush already have had success in using such a strategy, including enacting liability limits for drug makers. In the next session, Republicans plan to advocate legislation proposed by President Bush that would "dramatically limit" the liability of doctors sued for medical malpractice, the Post reports. Under the plan, awards for pain and suffering in medical malpractice cases would!
 be capped at $250,000; however, there would be no federal limits on economic damages. Republicans also are considering legislation that would provide new liability protections for asbestos manufacturers and HMOs, the Post reports (VandeHei, Washington Post, 12/29/02). In related news, the New York Times on Dec. 29 looked at the outcome of tort reform in Texas, most of which was enacted by Bush when he was governor (Oppel, New York Times, 12/29/02). </P>
<P></P>
<P>Wall Street Journal Editorial </P>
<P>The malpractice crisis has led some patients to be denied medical treatment "because of an out-of-control tort system," a Wall Street Journal editorial states, adding, "Juries willing to award sky-high payouts to plaintiffs poison the well for patients everywhere." The editorial continues, "The House passes medical malpractice reform every two years, but it always dies in the Senate." It concludes, "This sounds like a job for" incoming Senate Majority Leader Bill Frist (R-Tenn.) (Wall Street Journal, 1/2). </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Wed Jan  8 16:19:05 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 8 Jan 2003 08:19:05 -0800 (PST)
Subject: West Virginia Officials Urge Doctors to End Their Walkout
Message-ID: <20030108161905.17000.qmail@web20707.mail.yahoo.com>

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-----Original Message-----

From: Paul Windham

To: Kazzi, A. Antoine



The New York Times

January 3, 2003

West Virginia Officials Urge Doctors to End Their Walkout

By THE ASSOCIATED PRESS



CHARLESTON, W.Va., Jan. 2 (AP) - State officials called on two dozen surgeons in the Northern Panhandle today to end a job action over malpractice costs as four hospitals cut staff hours and transferred more patients.

So far, five patients have had to be sent elsewhere because of the dispute. Two were sent by the Weirton Medical Center today to a hospital in Ohio and two from Wheeling Hospital were taken to Pittsburgh hospitals on Wednesday. One patient who needed emergency surgery was taken 90 miles from Wheeling to Morgantown.

The surgeons in Wheeling and Weirton began 30-day leaves of absence on Wednesday or planned to begin leaves in the next few days. They say the state has ignored calls to help lower soaring malpractice insurance premiums, a complaint also voiced by doctors in other states. 

Gov. Bob Wise, a Democrat, will unveil proposed malpractice legislation next week, the state's health and human resources secretary, Paul L. Nusbaum, said today. The proposal has been months in the making.

"Six days before our announcement is not the time to go," Mr. Nusbaum said. "I urge the physicians to give us time to fix this."

Health officials assured residents that state emergency medical personnel were on alert to help transfer patients, and they announced a toll-free number for patients needing help with doctor referrals.

All four affected hospitals are keeping emergency rooms open, but except for plastic surgeons they have almost no emergency surgeons available.

The hospitals also began reducing shifts of operating room nurses and other surgical support staff.

"It's definitely generating worries within our staff, both about their own financial needs and about the health of the community," said Howard Gamble, a spokesman for Ohio Valley Medical Center in Wheeling.

Dr. William Ramsey, director of the West Virginia Office of Emergency Medical Services, said no additional ambulances, helicopters or crews had been needed.

The surgeons want the state to make it harder to file malpractice lawsuits, which they say would eventually lower their premiums. They also want the state to seek help from insurance companies and other third parties to pay more of their costs.

Doctors in the Parkersburg area will consider suspending work in a meeting of the state medical association next week, said Dr. David Avery, a Parkersburg family practitioner and former association president.

"I'm afraid this is just the first bit," Dr. Avery said.

Copyright 2003 The<http://www.nytimes.com/ref/membercenter/help/copyright.html> New York Times Company | Permissions<http://www.nytimes.com/ref/membercenter/help/permission.html> | Privacy Policy <http://www.nytimes.com/ref/membercenter/help/privacy.html> 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: Paul Windham</P>
<P>To: Kazzi, A. Antoine</P>
<P></P>
<P>The New York Times</P>
<P>January 3, 2003</P>
<P>West Virginia Officials Urge Doctors to End Their Walkout</P>
<P>By THE ASSOCIATED PRESS</P>
<P></P>
<P>C</FONT><FONT size=2>HARLESTON, W.Va., Jan. 2 (AP) - State officials called on two dozen surgeons in the Northern Panhandle today to end a job action over malpractice costs as four hospitals cut staff hours and transferred more patients.</P>
<P>So far, five patients have had to be sent elsewhere because of the dispute. Two were sent by the Weirton Medical Center today to a hospital in Ohio and two from Wheeling Hospital were taken to Pittsburgh hospitals on Wednesday. One patient who needed emergency surgery was taken 90 miles from Wheeling to Morgantown.</P>
<P>The surgeons in Wheeling and Weirton began 30-day leaves of absence on Wednesday or planned to begin leaves in the next few days. They say the state has ignored calls to help lower soaring malpractice insurance premiums, a complaint also voiced by doctors in other states. </P>
<P>Gov. Bob Wise, a Democrat, will unveil proposed malpractice legislation next week, the state's health and human resources secretary, Paul L. Nusbaum, said today. The proposal has been months in the making.</P>
<P>"Six days before our announcement is not the time to go," Mr. Nusbaum said. "I urge the physicians to give us time to fix this."</P>
<P>Health officials assured residents that state emergency medical personnel were on alert to help transfer patients, and they announced a toll-free number for patients needing help with doctor referrals.</P>
<P>All four affected hospitals are keeping emergency rooms open, but except for plastic surgeons they have almost no emergency surgeons available.</P>
<P>The hospitals also began reducing shifts of operating room nurses and other surgical support staff.</P>
<P>"It's definitely generating worries within our staff, both about their own financial needs and about the health of the community," said Howard Gamble, a spokesman for Ohio Valley Medical Center in Wheeling.</P>
<P>Dr. William Ramsey, director of the West Virginia Office of Emergency Medical Services, said no additional ambulances, helicopters or crews had been needed.</P>
<P>The surgeons want the state to make it harder to file malpractice lawsuits, which they say would eventually lower their premiums. They also want the state to seek help from insurance companies and other third parties to pay more of their costs.</P>
<P>Doctors in the Parkersburg area will consider suspending work in a meeting of the state medical association next week, said Dr. David Avery, a Parkersburg family practitioner and former association president.</P>
<P>"I'm afraid this is just the first bit," Dr. Avery said.</P>
<P>Copyright 2003 The&lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/copyright.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/copyright.html</U></FONT></A><FONT size=2>&gt; New York Times Company | Permissions&lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/permission.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/permission.html</U></FONT></A><FONT size=2>&gt; | Privacy Policy &lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/privacy.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/privacy.html</U></FONT></A><FONT size=2>&gt; </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Thu Jan  9 03:40:01 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 8 Jan 2003 19:40:01 -0800 (PST)
Subject: Lower-Income California Residents Wait Longer for Emergency Room Care, Study Finds
Message-ID: <20030109034001.36754.qmail@web20707.mail.yahoo.com>

--0-891063365-1042083601=:36681
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From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Lower-Income California Residents Wait Longer for Emergency Room Care, Study Finds 

01/06/2003 

California residents who seek emergency room care wait an average of 56 minutes, and 42% wait longer than 60 minutes to visit a physician or nurse, according to a study published last week in the http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=home&id=em Annals of Emergency Medicine, the Los Angeles Daily News reports. In the study, titled "Waiting Times in California's Emergency Departments," researchers observed 1,798 patients at 30 California hospitals between Dec. 15, 2000, and May 15, 2001. The study, commissioned by the <http://www.chcf.org/> California HealthCare Foundation and conducted by the University of California-Los Angeles and the Veterans Administration Greater Los Angeles Healthcare System, found that lower-income patients often must wait longer for care (Bartholomew, Los Angeles Daily News, 1/3). The study found that for each $10,000 decrease in per capita income within a zip code, patients waited 10 minutes longer, regard!
less of whether they visited public or private hospitals. Researchers said that lower-income communities "may have a disproportionate number of uninsured patients with more complex medical problems." Dr. Susan Lambe, lead author of the study, said, "We hope policy makers will use this information to begin addressing this supply and demand problem, which has become particularly pressing, considering the nation's emergency departments are vulnerable to threats ranging from bioterrorism to the current economic downturn" ( <http://www.acep.org/> American College of Emergency Physicians release, 1/2). The study is available online  http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=amem032&nav=abs


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Lower-Income California Residents Wait Longer for Emergency Room Care, Study Finds </P>
<P>01/06/2003 </P>
<P>California residents who seek emergency room care wait an average of 56 minutes, and 42% wait longer than 60 minutes to visit a physician or nurse, according to a study published last week in the </FONT><A href="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;"><U><FONT color=#0000ff size=2><A href="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;searchDBfor=home&amp;id=em">http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;</U></FONT></A><FONT size=2>searchDBfor=home&amp;id=em</A> Annals of Emergency Medicine, the Los Angeles Daily News reports. In the study, titled "Waiting Times in California's Emergency Departments," researchers observed 1,798 patients at 30 California hospitals between Dec. 15, 2000, and May 15, 2001. The study, commissioned by the &lt;</FONT><A href="http://www.chcf.org/"><U><FONT color=#0000ff size=2>http://www.chcf.org/</U></FONT></A><FONT size=2>&gt; California HealthCa!
re Foundation and conducted by the University of California-Los Angeles and the Veterans Administration Greater Los Angeles Healthcare System, found that lower-income patients often must wait longer for care (Bartholomew, Los Angeles Daily News, 1/3). The study found that for each $10,000 decrease in per capita income within a zip code, patients waited 10 minutes longer, regardless of whether they visited public or private hospitals. Researchers said that lower-income communities "may have a disproportionate number of uninsured patients with more complex medical problems." Dr. Susan Lambe, lead author of the study, said, "We hope policy makers will use this information to begin addressing this supply and demand problem, which has become particularly pressing, considering the nation's emergency departments are vulnerable to threats ranging from bioterrorism to the current economic downturn" ( &lt;</FONT><A href="http://www.acep.org/"><U><FONT color=#0000ff size=2>http://www.a!
cep.org/</U></FONT></A><FONT size=2>&gt; American College of Emergency Physicians release, 1/2). The study is available&nbsp;online &nbsp;</FONT><A href="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;"><U><FONT color=#0000ff size=2><A href="http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;searchDBfor=art&amp;artType=abs&amp;id=amem032&amp;nav=abs">http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&amp;</U></FONT></A><FONT size=2>searchDBfor=art&amp;artType=abs&amp;id=amem032&amp;nav=abs</A></P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Fri Jan 10 02:47:01 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Thu, 9 Jan 2003 18:47:01 -0800 (PST)
Subject: Fwd: Reuters Health Information (2003-01-08) US health spending shows record rise
Message-ID: <20030110024701.63848.qmail@web20707.mail.yahoo.com>

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 "William Durkin jr." <wtdjmd@pol.net> wrote:Date: Wed, 8 Jan 2003 23:27:25 -0500 (EST)
From: "William Durkin jr." 
To: pottsbri@yahoo.com
Subject: Fwd: Reuters Health Information (2003-01-08) US health spending A Medical News Service 
on Physicians' Online 

---------------------------------

US health spending shows record rise 

Last Updated: 2003-01-08 3:00:29 -0400 (Reuters Health)

By Todd Zwillich

WASHINGTON (Reuters Health) - The country's spending on healthcare reached an all time record and grew at the fastest rate in a decade in 2001, in a trend that analysts said threatens the nation's ability to finance medical care.

Spending on healthcare was up 8.7% from the year before, an upsurge not seen since 1990. Overall, Americans spent an unprecedented $1.42 trillion on healthcare in 2001, which averages out to $5,035 per person, according to a federal report released Wednesday. 

Economists have seen rises in healthcare costs every year since 1970. But recent trends have analysts worried that costs may now be increasing too quickly for the sagging US economy to cover.

They warned that rising costs could foreshadow deep cuts to the Medicaid program and to drastic pullbacks in the amount of medical coverage employers are willing to finance for their workers.

The report noted that health spending accounted for 14.1% of the US gross domestic product in 2001, a 0.8% rise from the year before. The sharp rise comes after eight years in which healthcare's share of the economy was slowly declining or flat.

Analysts had not seen such a large "spike" in health spending since 1990, when similarly increasing costs led to the rapid rise of HMO's and a rationing of medical care in the US, said Katherine Levit, director of the National Health Statistics Group at the Centers for Medicare and Medicaid Services, the agency responsible for administering federal healthcare programs. 

"We probably should be on the lookout for some policy changes or some private sector initiatives that puts the brakes on spending growth," she said.

Some of the changes have already begun to materialize. With states facing a total of $50 billion in budget deficits and faltering tax revenues this year, several governors have already announced that they will pare benefits or restrict enrollment in Medicaid and other state-run health programs for the poor.

"We're on the verge of losing the access that Medicaid enrollees already have," said Alan Weil, director of the Assessing New Federalism Project at the Urban Institute, a Washington think tank.

Many large employers have also forecast moves to cut the amount of health coverage they provide for current and former workers. More than one in five companies surveyed by the Henry J. Kaiser Family Foundation in December 2002 indicated they would soon bar current workers from future retiree health benefits. 

Those companies also said that they had raised retirees' insurance premiums by an average of 20% last year to help cover rising costs. Most firms also forecast plans to shift more healthcare costs to workers and retirees, raising their insurance deductibles, copayments, and other out-of-pocket costs.

Analysts said that they expected the latest figures to add to enthusiasm in the US Congress for reforms to publicly funded health programs. Lawmakers are expected to soon continue debate on how to add a prescription drug benefit to the Medicare program and to consider ways to stem rapidly rising costs among Medicare and Medicaid beneficiaries.

Spending on drugs rose 16% in 2001, making it the fastest growing part of healthcare expenses. 

Congress is also likely to debate proposals that would allow the federal government to pay the prescription costs for elderly and disabled persons who are eligible for both Medicare and Medicaid. State officials have said that they are desperate for the transfer since patients who are eligible for both programs comprise on average a third of all Medicaid enrollees.

"The federal government needs to take back some of these responsibilities," said Ray Scheppach, the executive director of the National Governors Association.

House Democrats announced an economic stimulus plan on Monday that included $10 billion designed to help cash-strapped states cover current Medicaid costs.

A stimulus plan unveiled by President Bush on Tuesday contained no new Medicaid money, but did include $3.6 billion in payments to help states pay for extended unemployment benefits. 

Sen. Charles E. Grassley (R-IA), who chairs the Finance Committee, said Monday that he favors offering some short-term payments to help states cover their Medicaid programs.

Meanwhile, Republican congressional aides said that lawmakers would likely go beyond short-term Medicaid payments to states and consider ways to make the program more efficient.

According to one GOP aide, Republicans will move this year to enact laws that help states control their spending on prescription drugs and on long-term care for elderly and disabled Medicaid patients.

"It's not sufficient to say that we simply need to throw money at Medicaid to fix its problems," the aide said.


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<P>&nbsp;<B><I>"William Durkin jr." &lt;wtdjmd@pol.net&gt;</I></B> wrote:
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">Date: Wed, 8 Jan 2003 23:27:25 -0500 (EST)<BR>From: "William Durkin jr." <WTDJMD@POL.NET><BR>To: pottsbri@yahoo.com<BR>Subject: Fwd: Reuters Health Information (2003-01-08) US health spending <FONT face=Verdana>A Medical News Service <BR>on Physicians' Online</FONT> <BR clear=all>
<HR>

<P class=headline><STRONG>US health spending shows record rise </STRONG></P>
<P class=datestamp><SMALL><EM><FONT face=Verdana>Last Updated: 2003-01-08 3:00:29 -0400 (Reuters Health)</FONT></EM></SMALL></P>
<P class=byline>By Todd Zwillich</P>
<P class=lead>WASHINGTON (Reuters Health) - The country's spending on healthcare reached an all time record and grew at the fastest rate in a decade in 2001, in a trend that analysts said threatens the nation's ability to finance medical care.</P>
<P>Spending on healthcare was up 8.7% from the year before, an upsurge not seen since 1990. Overall, Americans spent an unprecedented $1.42 trillion on healthcare in 2001, which averages out to $5,035 per person, according to a federal report released Wednesday. </P>
<P>Economists have seen rises in healthcare costs every year since 1970. But recent trends have analysts worried that costs may now be increasing too quickly for the sagging US economy to cover.</P>
<P>They warned that rising costs could foreshadow deep cuts to the Medicaid program and to drastic pullbacks in the amount of medical coverage employers are willing to finance for their workers.</P>
<P>The report noted that health spending accounted for 14.1% of the US gross domestic product in 2001, a 0.8% rise from the year before. The sharp rise comes after eight years in which healthcare's share of the economy was slowly declining or flat.</P>
<P>Analysts had not seen such a large "spike" in health spending since 1990, when similarly increasing costs led to the rapid rise of HMO's and a rationing of medical care in the US, said Katherine Levit, director of the National Health Statistics Group at the Centers for Medicare and Medicaid Services, the agency responsible for administering federal healthcare programs. </P>
<P>"We probably should be on the lookout for some policy changes or some private sector initiatives that puts the brakes on spending growth," she said.</P>
<P>Some of the changes have already begun to materialize. With states facing a total of $50 billion in budget deficits and faltering tax revenues this year, several governors have already announced that they will pare benefits or restrict enrollment in Medicaid and other state-run health programs for the poor.</P>
<P>"We're on the verge of losing the access that Medicaid enrollees already have," said Alan Weil, director of the Assessing New Federalism Project at the Urban Institute, a Washington think tank.</P>
<P>Many large employers have also forecast moves to cut the amount of health coverage they provide for current and former workers. More than one in five companies surveyed by the Henry J. Kaiser Family Foundation in December 2002 indicated they would soon bar current workers from future retiree health benefits. </P>
<P>Those companies also said that they had raised retirees' insurance premiums by an average of 20% last year to help cover rising costs. Most firms also forecast plans to shift more healthcare costs to workers and retirees, raising their insurance deductibles, copayments, and other out-of-pocket costs.</P>
<P>Analysts said that they expected the latest figures to add to enthusiasm in the US Congress for reforms to publicly funded health programs. Lawmakers are expected to soon continue debate on how to add a prescription drug benefit to the Medicare program and to consider ways to stem rapidly rising costs among Medicare and Medicaid beneficiaries.</P>
<P>Spending on drugs rose 16% in 2001, making it the fastest growing part of healthcare expenses. </P>
<P>Congress is also likely to debate proposals that would allow the federal government to pay the prescription costs for elderly and disabled persons who are eligible for both Medicare and Medicaid. State officials have said that they are desperate for the transfer since patients who are eligible for both programs comprise on average a third of all Medicaid enrollees.</P>
<P>"The federal government needs to take back some of these responsibilities," said Ray Scheppach, the executive director of the National Governors Association.</P>
<P>House Democrats announced an economic stimulus plan on Monday that included $10 billion designed to help cash-strapped states cover current Medicaid costs.</P>
<P>A stimulus plan unveiled by President Bush on Tuesday contained no new Medicaid money, but did include $3.6 billion in payments to help states pay for extended unemployment benefits. </P>
<P>Sen. Charles E. Grassley (R-IA), who chairs the Finance Committee, said Monday that he favors offering some short-term payments to help states cover their Medicaid programs.</P>
<P>Meanwhile, Republican congressional aides said that lawmakers would likely go beyond short-term Medicaid payments to states and consider ways to make the program more efficient.</P>
<P>According to one GOP aide, Republicans will move this year to enact laws that help states control their spending on prescription drugs and on long-term care for elderly and disabled Medicaid patients.</P>
<P>"It's not sufficient to say that we simply need to throw money at Medicaid to fix its problems," the aide said.</P></BLOCKQUOTE><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Fri Jan 10 19:59:22 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Fri, 10 Jan 2003 11:59:22 -0800 (PST)
Subject: Wall Street Journal Looks at California Budget Crisis, Health Care Impact
Message-ID: <20030110195923.89134.qmail@web20701.mail.yahoo.com>

--0-187413458-1042228762=:88727
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-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Wall Street Journal Looks at California Budget Crisis, Health Care Impact 

01/10/2003 

The Wall Street Journal today looks at California's $35 billion budget gap over the next 18 months, a financial crisis that indicates "painful cuts in spending for education, health care and the poor are almost certainly on the way." In the first round of cuts, proposed by Gov. Gray Davis (D) in December 2002, eligibility rules for Medi-Cal, the state's Medicaid program, would become more stringent (Thurm/Rundle, Wall Street Journal, 1/10). Under the plan, the state would reduce income eligibility limits for families enrolled in Medi-Cal to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the plan would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The plan also would reduce Medi-Cal reimbursement to physicians and other providers by 10% ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47447&collection!
id=3&program=1 California Healthline, 12/9/02). The <http://www.cbpp.org/> Center on Budget and Policy Priorities, a think tank in Washington, D.C., projects that the changes would eliminate some 500,000 "mostly low-income working parents" from the Medi-Cal rolls. The Journal notes that much of today's budget crisis stems from the massive tax cuts and spending increases that took place during the "stock-market and technology boom of the 1990s." B. Timothy Gage, Davis' finance director, said that "simply reversing boom-era largess" will not be "enough" to repair the state's budget deficit, but the governor will try to "minimize damage to the most vital programs." Davis is set to announce his spending plan for the next fiscal year, beginning July 1, today (Wall Street Journal, 1/10). 

States Seek Help 

In related news, Democratic governors yesterday submitted their $157 billion economic stimulus proposal, "castigating President Bush's new economic plan as a blow to state governments reeling from their worst fiscal crises in 50 years," the <http://www.washingtonpost.com/wp-dyn/articles/A35155-2003Jan9.html> Washington Post reports (Weisman, Washington Post, 1/10). Medicaid and other health care costs account for 30% of states' spending, and those expenses rose 13% last year, the largest increase in a decade ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47358&collectionid=3&program=1 California Healthline, 11/26/02). The governors' plan calls for $75 billion in tax cuts, $13 billion for schools, roads and homeland security, $19 billion for unemployed workers and low-income senior benefits, and $50 billion in "direct aid" for the states. States faced a combined $60 billion to $70 billion in budget deficits for the next fiscal year, and by law most mu!
st close the deficits through spending cuts and tax increases, according to Iris Lav, an economist at the Center on Budget and Policy Priorities. At the same time, Bush's plan could cost states $4 billion this year and $45 billion to $50 billion over the next decade by cutting taxation of investment dividends, according to Harley Duncan, executive director of the <http://www.taxadmin.org/> Federation of Tax Administrators. Lav said that "even a modest hit to state coffers" could lead to cuts in health care, as well as education and other state programs, according to the Post (Washington Post, 1/10). 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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<FONT size=2>
<P></P>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Wall Street Journal Looks at California Budget Crisis, Health Care Impact </P>
<P>01/10/2003 </P>
<P>The Wall Street Journal today looks at California's $35 billion budget gap over the next 18 months, a financial crisis that indicates "painful cuts in spending for education, health care and the poor are almost certainly on the way." In the first round of cuts, proposed by Gov. Gray Davis (D) in December 2002, eligibility rules for Medi-Cal, the state's Medicaid program, would become more stringent (Thurm/Rundle, Wall Street Journal, 1/10). Under the plan, the state would reduce income eligibility limits for families enrolled in Medi-Cal to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the plan would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The plan also would reduce Medi-Cal reimbursement to physicians and other providers by 10% ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?content!
id=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47447&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7447&amp;collectionid=3&amp;program=1</A> California Healthline, 12/9/02). The &lt;</FONT><A href="http://www.cbpp.org/"><U><FONT color=#0000ff size=2>http://www.cbpp.org/</U></FONT></A><FONT size=2>&gt; Center on Budget and Policy Priorities, a think tank in Washington, D.C., projects that the changes would eliminate some 500,000 "mostly low-income working parents" from the Medi-Cal rolls. The Journal notes that much of today's budget crisis stems from the massive tax cuts and spending increases that took place during the "stock-market and technology boom of the 1990s." B. Timothy Gage, Davis' finance director, said that "simply reversing boom-era largess" will not be "enough" to repair the state's budget deficit, but the go!
vernor will try to "minimize damage to the most vital programs." Davis is set to announce his spending plan for the next fiscal year, beginning July 1, today (Wall Street Journal, 1/10). </P>
<P>States Seek Help </P>
<P>In related news, Democratic governors yesterday submitted their $157 billion economic stimulus proposal, "castigating President Bush's new economic plan as a blow to state governments reeling from their worst fiscal crises in 50 years," the &lt;</FONT><A href="http://www.washingtonpost.com/wp-dyn/articles/A35155-2003Jan9.html"><U><FONT color=#0000ff size=2>http://www.washingtonpost.com/wp-dyn/articles/A35155-2003Jan9.html</U></FONT></A><FONT size=2>&gt; Washington Post reports (Weisman, Washington Post, 1/10). Medicaid and other health care costs account for 30% of states' spending, and those expenses rose 13% last year, the largest increase in a decade ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47358&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></!
A><FONT size=2>7358&amp;collectionid=3&amp;program=1</A> California Healthline, 11/26/02). The governors' plan calls for $75 billion in tax cuts, $13 billion for schools, roads and homeland security, $19 billion for unemployed workers and low-income senior benefits, and $50 billion in "direct aid" for the states. States faced a combined $60 billion to $70 billion in budget deficits for the next fiscal year, and by law most must close the deficits through spending cuts and tax increases, according to Iris Lav, an economist at the Center on Budget and Policy Priorities. At the same time, Bush's plan could cost states $4 billion this year and $45 billion to $50 billion over the next decade by cutting taxation of investment dividends, according to Harley Duncan, executive director of the &lt;</FONT><A href="http://www.taxadmin.org/"><U><FONT color=#0000ff size=2>http://www.taxadmin.org/</U></FONT></A><FONT size=2>&gt; Federation of Tax Administrators. Lav said that "even a modes!
t hit to state coffers" could lead to cuts in health care, as well as education and other state programs, according to the Post (Washington Post, 1/10). </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Sat Jan 11 19:20:24 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Sat, 11 Jan 2003 11:20:24 -0800 (PST)
Subject: AAEM & Hotel Cutoff Date January 19
Message-ID: <20030111192024.12174.qmail@web20705.mail.yahoo.com>

--0-1428448340-1042312824=:11351
Content-Type: text/plain; charset=us-ascii


--Original Message-----

From: AAEM [mailto:info@aaem.org] 



Subject: AAEM & Hotel Cutoff Date January 19

Join AAEM in New Orleans for the 9th Annual Scientific Assembly February 21-23, 2003. Pre-conferences courses on Ultrasound, Airway Management, CT, and Physician Wellness will be held on February 19 and 20. Some spaces are still available.

Hotel rooms ARE still available, but the cutoff date is January 19, so book your room now. Be sure to let the hotel know you are attending the AAEM Scientific Assembly when making your reservation. Phone the Marriott (555 Canal Street) at 800-654-3990 or 504-581-1000 to reserve your room today. 

AAEM

611 East Wells Street

Milwaukee, WI 53202

800-884-2235

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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<SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT size=2>
<P><FONT face=Arial>--Original Message-----</FONT></P>
<P><FONT face=Arial>From: AAEM [</FONT></FONT><A href="mailto:info@aaem.org"><U><FONT color=#0000ff size=2><FONT face=Arial>mailto:info@aaem.org</FONT></U></FONT></A><FONT size=2><FONT face=Arial>] </FONT></P>
<P>
<P><FONT face=Arial></FONT></P><FONT face=Arial>Subject: AAEM &amp; Hotel Cutoff Date January 19</FONT></P>
<P><FONT face=Arial>Join AAEM in New Orleans for the 9th Annual Scientific Assembly February 21-23, 2003. Pre-conferences courses on Ultrasound, Airway Management, CT, and Physician Wellness will be held on February 19 and 20. Some spaces are still available.</FONT></P>
<P><FONT face=Arial>Hotel rooms ARE still available, but the cutoff date is January 19, so book your room now. Be sure to let the hotel know you are attending the AAEM Scientific Assembly when making your reservation. Phone the Marriott (555 Canal Street) at 800-654-3990 or 504-581-1000 to reserve your room today. </FONT></P>
<P><FONT face=Arial>AAEM</FONT></P>
<P><FONT face=Arial>611 East Wells Street</FONT></P>
<P><FONT face=Arial>Milwaukee, WI 53202</FONT></P>
<P><FONT face=Arial>800-884-2235</FONT></P>
<P><FONT face=Arial>Fax: 414-276-3349</FONT></P>
<P><FONT face=Arial>E-mail: info@aaem.org</FONT></P>
<P><FONT face=Arial>Website: </FONT></FONT><A href="http://us.f207.mail.yahoo.com/ym/www.aaem.org"><U><FONT color=#0000ff size=2><FONT face=Arial>www.aaem.org</FONT></U></FONT></A></SPAN></P><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Mon Jan 13 09:46:33 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Mon, 13 Jan 2003 01:46:33 -0800 (PST)
Subject: CMS: Health care spending grew 8.7% in 2001, -and- American Lung Association Report Finds States Using Settlement Money for Budget Deficits
Message-ID: <20030113094633.49078.qmail@web20709.mail.yahoo.com>

--0-471455915-1042451193=:48963
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===================================

AHA NEWS NOW

The Daily Report for Health Care Executives

www.ahanews.com

===================================

Wednesday, January 8, 2003

2) CMS: Health care spending grew 8.7% in 2001

The Centers for Medicare & Medicaid Services says health care spending in the U.S. increased 8.7% to $1.4 trillion in 2001, the 5th consecutive year of an accelerating rate. The growth was 7.4% in 2000 and 6.1% in 1999, CMS said in a report released Jan. 7. While hospital spending increased 8.3% in 2001 and accounted for 30% of the total growth, CMS was quick to point out that much of that was due to utilization increases. "While a slowdown in medical price growth curbed overall spending during the mid-1990s," the agency said in the report, "a rise in the quantity and intensity of services consumed, along with slow and steady price increases, caused aggregate spending to accelerate in 2001." The report also showed that spending for prescription drugs grew faster -- at 15.7% -- than any other category in 2001, and spending for physician services increased by 8.6% in 2001.

---------------------------------------------------------

Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.

===============================================

----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 





American Lung Association Report Finds States Using Settlement Money for Budget Deficits 

01/07/2003 

Most states are using their tobacco settlement money to fund "only a fraction" of what federal officials recommend for tobacco prevention and cessation programs and instead are using the settlement to cover budget deficits, according to a new report from the <http://www.lungusa.org/> American Lung Association, the <http://www.arizonarepublic.com/news/articles/0107tobacco07.html> AP/Arizona Republic reports. Under the settlement, tobacco companies agreed to pay $206 billion over 25 years to 46 states to settle lawsuits; four states later settled on their own for a total of $40 billion (McClam, AP/Arizona Republic, 1/7). Although the settlement allows states to use the money as they see fit, anti-smoking advocates had hoped states would use the money to reduce smoking rates ( http://www.californiahealthline.org/members/basecontent.asp?contentid=46848&collectionid=3&program=1 California Healthline, 10/3/02). In the first annual "American Lung Association State of Tobacco Contro!
l 2002" report, the group gave 32 states and the District of Columbia a grade of "F" for spending on anti-tobacco programs. Forty-three states and the District of Columbia received an "F" in smoke-free air laws, 17 received "Fs" for tobacco taxes and 28 received "F"s for laws intended to limit youth access to tobacco. Four states -- California, Maine, New York and Rhode Island -- scored "A" grades in two categories (American Lung Association <http://www.lungusa.org/press/tobacco/tobacco_010703.html> release, 1/7). Only six states earned "A" grades overall (AP/Arizona Republic, 1/7). 

Reaction 

John Kirkwood, the association's chief executive, said states "are raiding tobacco funds to cover budget shortfalls and denying themselves a sound investment in their citizens' health." However, Joan Henneberry, director of health policy for the <http://www.nga.org/> National Governors Association, said, "States are in such a bad financial position now, if they don't tap into other sources, they're going to have to cut benefits and eligibility in Medicaid. That doesn't help with anti-smoking efforts either" (AP/Arizona Republic, 1/7). The report is available <http://lungaction.org/reports/tobacco-control.html> online. 

 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>===================================</P>
<P>AHA NEWS NOW</P>
<P>The Daily Report for Health Care Executives</P>
<P></FONT><A href="http://us.f207.mail.yahoo.com/ym/www.ahanews.com"><U><FONT color=#0000ff size=2>www.ahanews.com</U></FONT></A></P><FONT size=2>
<P>===================================</P>
<P>Wednesday, January 8, 2003</P>
<P>2) CMS: Health care spending grew 8.7% in 2001</P>
<P>The Centers for Medicare &amp; Medicaid Services says health care spending in the U.S. increased 8.7% to $1.4 trillion in 2001, the 5th consecutive year of an accelerating rate. The growth was 7.4% in 2000 and 6.1% in 1999, CMS said in a report released Jan. 7. While hospital spending increased 8.3% in 2001 and accounted for 30% of the total growth, CMS was quick to point out that much of that was due to utilization increases. "While a slowdown in medical price growth curbed overall spending during the mid-1990s," the agency said in the report, "a rise in the quantity and intensity of services consumed, along with slow and steady price increases, caused aggregate spending to accelerate in 2001." The report also showed that spending for prescription drugs grew faster -- at 15.7% -- than any other category in 2001, and spending for physician services increased by 8.6% in 2001.</P>
<P>---------------------------------------------------------</P>
<P>Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.</P>
<P>===============================================</P><FONT size=2>
<P>----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P></P>
<P></P>
<P>American Lung Association Report Finds States Using Settlement Money for Budget Deficits </P>
<P>01/07/2003 </P>
<P>Most states are using their tobacco settlement money to fund "only a fraction" of what federal officials recommend for tobacco prevention and cessation programs and instead are using the settlement to cover budget deficits, according to a new report from the &lt;</FONT><A href="http://www.lungusa.org/"><U><FONT color=#0000ff size=2>http://www.lungusa.org/</U></FONT></A><FONT size=2>&gt; American Lung Association, the &lt;</FONT><A href="http://www.arizonarepublic.com/news/articles/0107tobacco07.html"><U><FONT color=#0000ff size=2>http://www.arizonarepublic.com/news/articles/0107tobacco07.html</U></FONT></A><FONT size=2>&gt; AP/Arizona Republic reports. Under the settlement, tobacco companies agreed to pay $206 billion over 25 years to 46 states to settle lawsuits; four states later settled on their own for a total of $40 billion (McClam, AP/Arizona Republic, 1/7). Although the settlement allows states to use the money as they see fit, anti-smoking advocates had hoped stat!
es would use the money to reduce smoking rates ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=46848&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>6848&amp;collectionid=3&amp;program=1</A> California Healthline, 10/3/02). In the first annual "American Lung Association State of Tobacco Control 2002" report, the group gave 32 states and the District of Columbia a grade of "F" for spending on anti-tobacco programs. Forty-three states and the District of Columbia received an "F" in smoke-free air laws, 17 received "Fs" for tobacco taxes and 28 received "F"s for laws intended to limit youth access to tobacco. Four states -- California, Maine, New York and Rhode Island -- scored "A" grades in two categories (American Lung Association &lt;</FONT><!
A href="http://www.lungusa.org/press/tobacco/tobacco_010703.html"><U><FONT color=#0000ff size=2>http://www.lungusa.org/press/tobacco/tobacco_010703.html</U></FONT></A><FONT size=2>&gt; release, 1/7). Only six states earned "A" grades overall (AP/Arizona Republic, 1/7). </P>
<P>Reaction </P>
<P>John Kirkwood, the association's chief executive, said states "are raiding tobacco funds to cover budget shortfalls and denying themselves a sound investment in their citizens' health." However, Joan Henneberry, director of health policy for the &lt;</FONT><A href="http://www.nga.org/"><U><FONT color=#0000ff size=2>http://www.nga.org/</U></FONT></A><FONT size=2>&gt; National Governors Association, said, "States are in such a bad financial position now, if they don't tap into other sources, they're going to have to cut benefits and eligibility in Medicaid. That doesn't help with anti-smoking efforts either" (AP/Arizona Republic, 1/7). The report is available &lt;</FONT><A href="http://lungaction.org/reports/tobacco-control.html"><U><FONT color=#0000ff size=2>http://lungaction.org/reports/tobacco-control.html</U></FONT></A><FONT size=2>&gt; online. </FONT></P>
<P><FONT size=2>&nbsp;</P></FONT></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Tue Jan 14 06:29:30 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Mon, 13 Jan 2003 22:29:30 -0800 (PST)
Subject: Davis Budget Proposal Likely To Include Tax Increases, Reductions in Medi-Cal Reimbursements, -and- Health Care Lobbyists Propose Plans in Preparation for Davis Budget Proposal
Message-ID: <20030114062930.34114.qmail@web20707.mail.yahoo.com>

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news re: analysis about the Davis plan to be sent tomorrow........

===============

"This would reduce Medi-Cal reimbursements to providers by $1.5 billion, which would include a 5% reduction in reimbursements for physicians, pharmacists and other providers in addition to a 10% reduction proposed last month"



A 15% total... so far. Time to support your EMPAC more than ever to put up a strong fight.



Antoine Kazzi



-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Davis Budget Proposal Likely To Include Tax Increases, Reductions in Medi-Cal Reimbursements 

01/10/2003 

Gov. Gray Davis (D) will likely include $8.3 billion per year in tax increases and reductions in funds for a number of state programs, such as Medi-Cal, as part of his fiscal year 2003-2004 budget proposal to cover the state's estimated $34.8 billion deficit over the next 18 months, the http://www.latimes.com/news/local/la-me-budget10jan10,0,3165183.story?coll=la%2Dhome%2Dheadlines Los Angeles Times reports. The budget proposal, which Davis plans to release today at noon, would reduce Medi-Cal reimbursements to providers by $1.5 billion, which would include a 5% reduction in reimbursements for physicians, pharmacists and other providers in addition to a 10% reduction proposed last month, sources familiar with the proposal said. The reductions would not affect hospitals and some rural health centers, the Times reports. In addition, the budget proposal would transfer some state services, such as mental health and substance abuse programs, to local governments, a move that woul!
d save the state more than $300 million; the proposal also would shift responsibility to counties for home health care workers, a $1.4 billion expense, and nursing home care, a $1.4 billion expense, the Times reports. According to the Times, the budget proposal would increase the state's cigarette tax by $1.10 per pack (Jones/Morain, Los Angeles Times, 1/10). Under the proposal, California would have the highest tobacco tax in the nation (Howard, http://www2.ocregister.com/ocrweb/ocr/article.do?id=19995§ion=NEWS&year=2003&month=1&day=10 Orange County Register, 1/10). According to a Davis administration official, the cigarette tax increase would raise an additional $1 billion in annual revenue for the state (LaMar, <http://www.bayarea.com/mld/cctimes/4916337.htm> Contra Costa Times, 1/10). 

Reaction 

The Times reports that Davis faces a "tough political fight" to win legislative approval of his budget proposal. At least two Republicans in the Senate and six in the Assembly must support the proposal to meet the two-thirds vote required to pass the budget. Republicans have said that they will not support tax increases (Los Angeles Times, 1/10). County officials also raised concerns about provisions in the budget proposal that would shift responsibility for state programs to counties. Pat Leary, legislative representative for the California State Association of Counties, said, "Are we going to set rates for nursing homes? If we're going to have a share of the costs, we also ought to have a share of the control" (Hill, <http://www.sacbee.com/content/politics/ca/story/5848621p-6814385c.html> Sacramento Bee, 1/10). In addition, advocates for low-income residents have said that the proposal would not address the state's budget problems and would limit future expenditures to lev!
els that "jeopardize essential services," the Times reports. Davis also faces "resistance" from Democrats over provisions in the proposal that would make large reductions in funds for state programs, such as health care, the Times reports (Los Angeles Times, 1/10). 

State Deficits on 'NOW with Bill Moyers' 

PBS' " <http://www.pbs.org/now/> NOW with Bill Moyers" tonight will include a segment on "skyrocketing" state budget deficits nationwide and reductions in government services, such as health care. The program focuses on the situation in California to "see what may be ahead for other states." The segment includes comments from Dr. Susan Fleischman of UCLA Medical Center. The program's Web site includes an <http://www.pbs.org/now/politics/statebudgets.html> overview of the issue, a list of related Web <http://www.pbs.org/now/resources/politics.html> resources and a <http://www.pbs.org/now/politics/budgetmap.html> map of state budget resources. Check local listings for show times (Moyers, "NOW with Bill Moyers," PBS, 1/10). 

============================================



-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Health Care Lobbyists Propose Plans in Preparation for Davis Budget Proposal 

01/06/2003 



Gov. Gray Davis (D) plans to release his proposed fiscal year 2003-2004 budget on Friday, and lobbyists in a number of industries, such as health care, have proposed plans to help cover the state's estimated $34.8 billion budget deficit and avoid reductions for their organizations, the <http://www.latimes.com/news/local/la-me-cuts3jan03.story> Los Angeles Times reports. The plans "all share a common theme: They point the finger at someone else," according to the Times. For example, pharmacy owners, who have raised concerns that Davis may propose reductions in their Medi-Cal reimbursements, have recommended that state lawmakers target pharmaceutical companies to address the budget deficit. The National Association of Chain Drug <http://www.nacds.org/> Stores has released a position paper that alleges that pharmaceutical companies overcharge consumers and recommends that state lawmakers require Medi-Cal beneficiaries to use generic treatments, rather than decrease reimbursemen!
ts to pharmacies, to reduce program costs. The paper said that pharmaceutical companies should "bear their fair share" of increased Medi-Cal costs "because they are driving up drug use" (Halper, Los Angeles Times, 1/3). In addition, the California Medical Association <http://www.cmanet.org/> plans to partner with union and business leaders to reform health care in the state. "We might be at a point ... to finally get universal health coverage and stop wasting billions on health care," CMA Executive Officer Jack Lewin said (Rojas/Korber, <http://www.sacbee.com/content/politics/story/5812507p-6780642c.html> Sacramento Bee, 1/6). The CMA also supports a bill http://www.californiahealthline.org/members/basecontent.asp?contentid=47505&collectionid=3&program=1 , sponsored by Sen. Gloria Romero (D-Los Angeles), to fund hospital trauma centers through a five-cent tax on alcoholic beverages (Los Angeles Times, 1/3).


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>news re: analysis about the Davis plan to be sent tomorrow........</P>
<P>===============</P>
<P>"This would reduce Medi-Cal reimbursements to providers by $1.5 billion, which would include a 5% reduction in reimbursements for physicians, pharmacists and other providers in addition to a 10% reduction proposed last month"</P>
<P></P>
<P>A 15% total... so far. Time to support your EMPAC more than ever to put up a strong fight.</P>
<P></P>
<P>Antoine Kazzi</P>
<P></P>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Davis Budget Proposal Likely To Include Tax Increases, Reductions in Medi-Cal Reimbursements </P>
<P>01/10/2003 </P>
<P>Gov. Gray Davis (D) will likely include $8.3 billion per year in tax increases and reductions in funds for a number of state programs, such as Medi-Cal, as part of his fiscal year 2003-2004 budget proposal to cover the state's estimated $34.8 billion deficit over the next 18 months, the </FONT><A href="http://www.latimes.com/news/local/la-me-budget10jan10,0,3165183.story?c"><U><FONT color=#0000ff size=2><A href="http://www.latimes.com/news/local/la-me-budget10jan10,0,3165183.story?coll=la%2Dhome%2Dheadlines">http://www.latimes.com/news/local/la-me-budget10jan10,0,3165183.story?c</U></FONT></A><FONT size=2>oll=la%2Dhome%2Dheadlines</A> Los Angeles Times reports. The budget proposal, which Davis plans to release today at noon, would reduce Medi-Cal reimbursements to providers by $1.5 billion, which would include a 5% reduction in reimbursements for physicians, pharmacists and other providers in addition to a 10% reduction proposed last month, sources familiar with the propo!
sal said. The reductions would not affect hospitals and some rural health centers, the Times reports. In addition, the budget proposal would transfer some state services, such as mental health and substance abuse programs, to local governments, a move that would save the state more than $300 million; the proposal also would shift responsibility to counties for home health care workers, a $1.4 billion expense, and nursing home care, a $1.4 billion expense, the Times reports. According to the Times, the budget proposal would increase the state's cigarette tax by $1.10 per pack (Jones/Morain, Los Angeles Times, 1/10). Under the proposal, California would have the highest tobacco tax in the nation (Howard, </FONT><A href="http://www2.ocregister.com/ocrweb/ocr/article.do?id=19995§ion=NEWS&amp;year"><U><FONT color=#0000ff size=2><A href="http://www2.ocregister.com/ocrweb/ocr/article.do?id=19995§ion=NEWS&amp;year=2003&amp;month=1&amp;day=10">http://www2.ocregister.com/ocrweb/ocr/ar!
ticle.do?id=19995§ion=NEWS&amp;year</U></FONT></A><FONT size=2>=2003&amp;month=1&amp;day=10</A> Orange County Register, 1/10). According to a Davis administration official, the cigarette tax increase would raise an additional $1 billion in annual revenue for the state (LaMar, &lt;</FONT><A href="http://www.bayarea.com/mld/cctimes/4916337.htm"><U><FONT color=#0000ff size=2>http://www.bayarea.com/mld/cctimes/4916337.htm</U></FONT></A><FONT size=2>&gt; Contra Costa Times, 1/10). </P>
<P>Reaction </P>
<P>The Times reports that Davis faces a "tough political fight" to win legislative approval of his budget proposal. At least two Republicans in the Senate and six in the Assembly must support the proposal to meet the two-thirds vote required to pass the budget. Republicans have said that they will not support tax increases (Los Angeles Times, 1/10). County officials also raised concerns about provisions in the budget proposal that would shift responsibility for state programs to counties. Pat Leary, legislative representative for the California State Association of Counties, said, "Are we going to set rates for nursing homes? If we're going to have a share of the costs, we also ought to have a share of the control" (Hill, &lt;</FONT><A href="http://www.sacbee.com/content/politics/ca/story/5848621p-6814385c.html"><U><FONT color=#0000ff size=2>http://www.sacbee.com/content/politics/ca/story/5848621p-6814385c.html</U></FONT></A><FONT size=2>&gt; Sacramento Bee, 1/10). In additi!
on, advocates for low-income residents have said that the proposal would not address the state's budget problems and would limit future expenditures to levels that "jeopardize essential services," the Times reports. Davis also faces "resistance" from Democrats over provisions in the proposal that would make large reductions in funds for state programs, such as health care, the Times reports (Los Angeles Times, 1/10). </P>
<P>State Deficits on 'NOW with Bill Moyers' </P>
<P>PBS' " &lt;</FONT><A href="http://www.pbs.org/now/"><U><FONT color=#0000ff size=2>http://www.pbs.org/now/</U></FONT></A><FONT size=2>&gt; NOW with Bill Moyers" tonight will include a segment on "skyrocketing" state budget deficits nationwide and reductions in government services, such as health care. The program focuses on the situation in California to "see what may be ahead for other states." The segment includes comments from Dr. Susan Fleischman of UCLA Medical Center. The program's Web site includes an &lt;</FONT><A href="http://www.pbs.org/now/politics/statebudgets.html"><U><FONT color=#0000ff size=2>http://www.pbs.org/now/politics/statebudgets.html</U></FONT></A><FONT size=2>&gt; overview of the issue, a list of related Web &lt;</FONT><A href="http://www.pbs.org/now/resources/politics.html"><U><FONT color=#0000ff size=2>http://www.pbs.org/now/resources/politics.html</U></FONT></A><FONT size=2>&gt; resources and a &lt;</FONT><A href="http://www.pbs.org/now/politics/!
budgetmap.html"><U><FONT color=#0000ff size=2>http://www.pbs.org/now/politics/budgetmap.html</U></FONT></A><FONT size=2>&gt; map of state budget resources. Check local listings for show times (Moyers, "NOW with Bill Moyers," PBS, 1/10). </FONT></P>
<P><FONT size=2>============================================</FONT></P><FONT size=2><FONT size=2>
<P></P>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Health Care Lobbyists Propose Plans in Preparation for Davis Budget Proposal </P>
<P>01/06/2003 </P>
<P></P>
<P>Gov. Gray Davis (D) plans to release his proposed fiscal year 2003-2004 budget on Friday, and lobbyists in a number of industries, such as health care, have proposed plans to help cover the state's estimated $34.8 billion budget deficit and avoid reductions for their organizations, the &lt;</FONT><A href="http://www.latimes.com/news/local/la-me-cuts3jan03.story"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/local/la-me-cuts3jan03.story</U></FONT></A><FONT size=2>&gt; Los Angeles Times reports. The plans "all share a common theme: They point the finger at someone else," according to the Times. For example, pharmacy owners, who have raised concerns that Davis may propose reductions in their Medi-Cal reimbursements, have recommended that state lawmakers target pharmaceutical companies to address the budget deficit. The National Association of Chain Drug &lt;</FONT><A href="http://www.nacds.org/"><U><FONT color=#0000ff size=2>http://www.nacds.org/</U></FONT></A><F!
ONT size=2>&gt; Stores has released a position paper that alleges that pharmaceutical companies overcharge consumers and recommends that state lawmakers require Medi-Cal beneficiaries to use generic treatments, rather than decrease reimbursements to pharmacies, to reduce program costs. The paper said that pharmaceutical companies should "bear their fair share" of increased Medi-Cal costs "because they are driving up drug use" (Halper, Los Angeles Times, 1/3). In addition, the California Medical Association &lt;</FONT><A href="http://www.cmanet.org/"><U><FONT color=#0000ff size=2>http://www.cmanet.org/</U></FONT></A><FONT size=2>&gt; plans to partner with union and business leaders to reform health care in the state. "We might be at a point ... to finally get universal health coverage and stop wasting billions on health care," CMA Executive Officer Jack Lewin said (Rojas/Korber, &lt;</FONT><A href="http://www.sacbee.com/content/politics/story/5812507p-6780642c.html"><U><FONT !
color=#0000ff size=2>http://www.sacbee.com/content/politics/story/5812507p-6780642c.html</U></FONT></A><FONT size=2>&gt; Sacramento Bee, 1/6). The CMA also supports a bill </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47505&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7505&amp;collectionid=3&amp;program=1</A> , sponsored by Sen. Gloria Romero (D-Los Angeles), to fund hospital trauma centers through a five-cent tax on alcoholic beverages (Los Angeles Times, 1/3).</P></FONT></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Wed Jan 15 05:33:31 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Tue, 14 Jan 2003 21:33:31 -0800 (PST)
Subject: Californians Hear Grim News on Budget
Message-ID: <20030115053331.76611.qmail@web20706.mail.yahoo.com>

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-----Original Message-----

From: Paul Windham [mailto:pcwindham@elite.net] 

 

The New York Times

January 11, 2003

Californians Hear Grim News on Budget

By JOHN M. BRODER

SACRAMENTO, Jan. 10 - Gov. Gray Davis offered a grim $62.8 billion budget today that would bring pain to virtually every Californian through tax increases and cuts in almost every state program.

Faced with a $35 billion budget gap, Mr. Davis is seeking $8.3 billion in tax increases and more than $20 billion in spending cuts for the fiscal year beginning July 1. 

"All the choices before me were hard, but they had to be made," Mr. Davis, a Democrat, said at a news briefing. "We are facing the problem head on."

The plan, which by law must pass the Legislature by a two-thirds margin, calls for a higher state sales tax, and increases in income and tobacco taxes. It seeks cuts in virtually every state program. It defers payments to state pension plans and eliminates the jobs of at least 1,500 state workers. Public school financing would be cut by more than $4 billion and tuition would rise at community colleges and public universities.

Republicans quickly vowed to resist the $8.3 billion in tax increases that are a central feature of Mr. Davis's budget. They said that the proposed one-cent increase in the sales tax and the tax increase on high-income families would throttle consumer spending and darken the already gloomy state economy.

"The governor is continuing down the same rigid ideological path that has nearly bankrupted California over the past three years," said James L. Brulte, the Senate Republican leader. "Raising taxes in a sluggish economy is like doctors 200 years ago putting leeches on a sick patient. It's not only unhealthy, it's counterproductive."

Under the governor's proposal, the state budget next year would fall to $62.8 billion from the current year's $75.5 billion, marking the third straight year of declining state spending. It is the first time since World War II that the budget has seen such a decline.

Much of the reduction is the result of shifting billions of dollars of costs now borne by the state to county and municipal governments. Programs covered by the shift include child welfare, adoption, mental health, substance abuse, day care, nursing homes and in-home care of the elderly and disabled. All the new tax revenue would be dedicated to these programs and sent directly to the local agencies that administer them.

Steven Szalay, executive director of the California State Association of Counties, welcomed the proposal to provide more money to counties to run these social service programs. "We're ready to talk about anything that gives us more authority and flexibility."

But he noted that some of the programs - particularly long-term care for the elderly and disabled - were among the fastest-growing health-care costs. He expressed concern that the reimbursements from the state would not keep pace with these costs as the number of older Californians grows.

Mr. Davis said this so-called realignment of spending was a cornerstone of his plan to restructure state finances so that California no longer experiences the feast-or-famine cycles it has suffered over the last 20 years. 

"I want to stress, we're not shortchanging the counties," he said. "We're sending them sufficient money to maintain the programs at their current levels.

In the late 1990's, California's treasury was awash in tax receipts from Internet millionaires until the high-technology bubble burst in 2000. Now the state is deep in debt.

California went through a similar cycle a decade ago when the end of the cold war brought a deep recession to the state's aerospace and military industries. Pete Wilson, the governor then, enacted a similar shift of spending to local government.

State laws and ballot initiatives complicated Mr. Davis's task and required more imaginative solutions than simply raising taxes and cutting programs. Proposition 13, passed in 1978, limited local property taxes, forcing the state to raise sales and income taxes to finance many programs. A decade later, voters approved Proposition 98, which requires the state to spend 40 percent of all tax revenues on education. To protect other programs, Mr. Davis had to return all the new tax revenues to the counties or else pour almost half of it into schools.

The one-cent increase in the state sales tax is projected to yield $4.6 billion a year, or roughly $250 per family. Sales taxes in the state are already high, ranging from 7.25 to 8.25 cents on the dollar. 

Mr. Davis also proposed new tax brackets for individuals earning more than $130,000 a year and couples making more than $260,000. Their tax would rise by 1 percent or 2 percent, producing revenue of $2.6 billion.

His plan also calls for a $1.10-a-pack increase in the state cigarette tax, which is now $1 on each pack. That is projected to raise $1.17 billion. State budget analysts said that would discourage smoking and produce a declining revenue stream as consumption continues to drop.

The governor's budget also calls for $1.5 billion in new fees assessed on Indian casinos, which now pay virtually no state taxes. The compacts under which tribes operate gambling halls are up for renegotiation this spring, and state officials are considering the $5 billion-a-year industry as a potential source of significant new revenue. 

The budget plan includes money to provide health-care coverage to 500,000 children, but cuts other parts of the state's Medi-Cal program. An estimated 200,000 people who were enrolled in the program during the boom years would be dropped, and reimbursements to doctors and hospitals would fall by 15 percent. Optometry, physical therapy, hearing aids and hospice care would no longer be covered.

Analysts gave Mr. Davis some credit for proposing tax increases that are certain to be unpopular in the Legislature and among the public. Democrats endorsed the new taxes on the well off, but said that adding to the state's already high sales tax would disproportionately hurt the poor. Republicans complained that the added tax burden would discourage companies from expanding or moving to California.

The battle is just beginning, and, to a large degree, Mr. Davis's legacy hangs in the balance. The outcome will mark either the beginning of his comeback or the final chapter of his 30-year career in electoral politics.

His reputation was tarnished by his handling of the energy crisis of 2000-2001 and by the relentless fund-raising that seemed at times to occupy more of his time than governing. He won re-election two months ago to his second and final term by a narrow margin over an inexperienced and underfinanced challenger, which many took as a sign that any national political ambitions were a fantasy.

"The last election was a real wake-up call for him," said Bruce Cain, director of the Institute for Governmental Studies of the University of California. "He was shocked to see how little affection there is for him in this state."

Mr. Cain said that how Mr. Davis attacks the budget crisis is as important as whether he is successful. He said that Mr. Davis's tendency to blame others and his unfriendly relations with leaders in the State Senate and Assembly will be a severe handicap in coming months.

Mr. Davis has already said he will not seek the presidency in 2004 and he is not considered a likely candidate for vice president. California should be a safely Democratic state and Mr. Davis, at this point, appears to be damaged goods. And even if he manages to balance the state's budget through luck or adroit politics, Mr. Cain said, "It's possible the damage is irreparable."



<http://www.nytimes.com/ref/membercenter/help/copyright.html> Copyright 2003 The New York Times Company | Permissions <http://www.nytimes.com/ref/membercenter/help/permission.html> | Privacy Policy <http://www.nytimes.com/ref/membercenter/help/privacy.html> 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: Paul Windham [</FONT><A href="mailto:pcwindham@elite.net"><U><FONT color=#0000ff size=2>mailto:pcwindham@elite.net</U></FONT></A><FONT size=2>] </FONT></P>
<P><FONT size=2>&nbsp;</P>
<P>The New York Times</FONT><FONT size=2></P>
<P>January 11, 2003</P>
<P>Californians Hear Grim News on Budget</P>
<P>By JOHN M. BRODER</P>
<P>SACRAMENTO, Jan. 10 - Gov. Gray Davis offered a grim $62.8 billion budget today that would bring pain to virtually every Californian through tax increases and cuts in almost every state program.</P>
<P>Faced with a $35 billion budget gap, Mr. Davis is seeking $8.3 billion in tax increases and more than $20 billion in spending cuts for the fiscal year beginning July 1. </P>
<P>"All the choices before me were hard, but they had to be made," Mr. Davis, a Democrat, said at a news briefing. "We are facing the problem head on."</P>
<P>The plan, which by law must pass the Legislature by a two-thirds margin, calls for a higher state sales tax, and increases in income and tobacco taxes. It seeks cuts in virtually every state program. It defers payments to state pension plans and eliminates the jobs of at least 1,500 state workers. Public school financing would be cut by more than $4 billion and tuition would rise at community colleges and public universities.</P>
<P>Republicans quickly vowed to resist the $8.3 billion in tax increases that are a central feature of Mr. Davis's budget. They said that the proposed one-cent increase in the sales tax and the tax increase on high-income families would throttle consumer spending and darken the already gloomy state economy.</P>
<P>"The governor is continuing down the same rigid ideological path that has nearly bankrupted California over the past three years," said James L. Brulte, the Senate Republican leader. "Raising taxes in a sluggish economy is like doctors 200 years ago putting leeches on a sick patient. It's not only unhealthy, it's counterproductive."</P>
<P>Under the governor's proposal, the state budget next year would fall to $62.8 billion from the current year's $75.5 billion, marking the third straight year of declining state spending. It is the first time since World War II that the budget has seen such a decline.</P>
<P>Much of the reduction is the result of shifting billions of dollars of costs now borne by the state to county and municipal governments. Programs covered by the shift include child welfare, adoption, mental health, substance abuse, day care, nursing homes and in-home care of the elderly and disabled. All the new tax revenue would be dedicated to these programs and sent directly to the local agencies that administer them.</P>
<P>Steven Szalay, executive director of the California State Association of Counties, welcomed the proposal to provide more money to counties to run these social service programs. "We're ready to talk about anything that gives us more authority and flexibility."</P>
<P>But he noted that some of the programs - particularly long-term care for the elderly and disabled - were among the fastest-growing health-care costs. He expressed concern that the reimbursements from the state would not keep pace with these costs as the number of older Californians grows.</P>
<P>Mr. Davis said this so-called realignment of spending was a cornerstone of his plan to restructure state finances so that California no longer experiences the feast-or-famine cycles it has suffered over the last 20 years. </P>
<P>"I want to stress, we're not shortchanging the counties," he said. "We're sending them sufficient money to maintain the programs at their current levels.</P>
<P>In the late 1990's, California's treasury was awash in tax receipts from Internet millionaires until the high-technology bubble burst in 2000. Now the state is deep in debt.</P>
<P>California went through a similar cycle a decade ago when the end of the cold war brought a deep recession to the state's aerospace and military industries. Pete Wilson, the governor then, enacted a similar shift of spending to local government.</P>
<P>State laws and ballot initiatives complicated Mr. Davis's task and required more imaginative solutions than simply raising taxes and cutting programs. Proposition 13, passed in 1978, limited local property taxes, forcing the state to raise sales and income taxes to finance many programs. A decade later, voters approved Proposition 98, which requires the state to spend 40 percent of all tax revenues on education. To protect other programs, Mr. Davis had to return all the new tax revenues to the counties or else pour almost half of it into schools.</P>
<P>The one-cent increase in the state sales tax is projected to yield $4.6 billion a year, or roughly $250 per family. Sales taxes in the state are already high, ranging from 7.25 to 8.25 cents on the dollar. </P>
<P>Mr. Davis also proposed new tax brackets for individuals earning more than $130,000 a year and couples making more than $260,000. Their tax would rise by 1 percent or 2 percent, producing revenue of $2.6 billion.</P>
<P>His plan also calls for a $1.10-a-pack increase in the state cigarette tax, which is now $1 on each pack. That is projected to raise $1.17 billion. State budget analysts said that would discourage smoking and produce a declining revenue stream as consumption continues to drop.</P>
<P>The governor's budget also calls for $1.5 billion in new fees assessed on Indian casinos, which now pay virtually no state taxes. The compacts under which tribes operate gambling halls are up for renegotiation this spring, and state officials are considering the $5 billion-a-year industry as a potential source of significant new revenue. </P>
<P>The budget plan includes money to provide health-care coverage to 500,000 children, but cuts other parts of the state's Medi-Cal program. An estimated 200,000 people who were enrolled in the program during the boom years would be dropped, and reimbursements to doctors and hospitals would fall by 15 percent. Optometry, physical therapy, hearing aids and hospice care would no longer be covered.</P>
<P>Analysts gave Mr. Davis some credit for proposing tax increases that are certain to be unpopular in the Legislature and among the public. Democrats endorsed the new taxes on the well off, but said that adding to the state's already high sales tax would disproportionately hurt the poor. Republicans complained that the added tax burden would discourage companies from expanding or moving to California.</P>
<P>The battle is just beginning, and, to a large degree, Mr. Davis's legacy hangs in the balance. The outcome will mark either the beginning of his comeback or the final chapter of his 30-year career in electoral politics.</P>
<P>His reputation was tarnished by his handling of the energy crisis of 2000-2001 and by the relentless fund-raising that seemed at times to occupy more of his time than governing. He won re-election two months ago to his second and final term by a narrow margin over an inexperienced and underfinanced challenger, which many took as a sign that any national political ambitions were a fantasy.</P>
<P>"The last election was a real wake-up call for him," said Bruce Cain, director of the Institute for Governmental Studies of the University of California. "He was shocked to see how little affection there is for him in this state."</P>
<P>Mr. Cain said that how Mr. Davis attacks the budget crisis is as important as whether he is successful. He said that Mr. Davis's tendency to blame others and his unfriendly relations with leaders in the State Senate and Assembly will be a severe handicap in coming months.</P>
<P>Mr. Davis has already said he will not seek the presidency in 2004 and he is not considered a likely candidate for vice president. California should be a safely Democratic state and Mr. Davis, at this point, appears to be damaged goods. And even if he manages to balance the state's budget through luck or adroit politics, Mr. Cain said, "It's possible the damage is irreparable."</P>
<P></P>
<P>&lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/copyright.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/copyright.html</U></FONT></A><FONT size=2>&gt; Copyright 2003 The New York Times Company | Permissions &lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/permission.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/permission.html</U></FONT></A><FONT size=2>&gt; | Privacy Policy &lt;</FONT><A href="http://www.nytimes.com/ref/membercenter/help/privacy.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/ref/membercenter/help/privacy.html</U></FONT></A><FONT size=2>&gt; </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Wed Jan 15 17:11:43 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 15 Jan 2003 09:11:43 -0800 (PST)
Subject: Davis Unveils Budget Proposal, Calls for Tax Increases, Large Reductions for Health Care Programs
Message-ID: <20030115171143.85781.qmail@web20705.mail.yahoo.com>

--0-2037623-1042650703=:85321
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-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Davis Unveils Budget Proposal, Calls for Tax Increases, Large Reductions for Health Care Programs 

01/13/2003 

Gov. Gray Davis (D) on Friday released his fiscal year 2003-2004 budget proposal, which calls for "deep cuts" in funds for state programs, such as health care, and $8.3 billion in tax increases to help cover an estimated $34.8 billion budget deficit, the AP/Philadelphia Inquirer reports. The proposal would eliminate $20.7 billion in state expenditures over the next two years (Bluth, AP/Philadelphia Inquirer, 1/12). In addition, the proposal would transfer some state services, such as mental health and substance abuse programs, to local governments, a move that would save the state more than $300 million. The proposal also would shift responsibility to counties for home health care workers, a $1.4 billion expense, and nursing home care, a $1.4 billion expense ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47664&collectionid=3&contentarea=20754 California Healthline, 1/10). Under the proposal, the state would use revenue raised from tax increases to co!
ver the cost of the programs. Summaries of some of the health care-related provisions in the proposal appear below (AP/Philadelphia Inquirer, 1/12). 

* Medi-Cal: The state would decrease Medi-Cal expenditures by $3.6 billion to $24.7 billion. Under the proposal, the state would revise Medi-Cal eligibility requirements, a move that would reduce enrollment in the program by about 570,000. Medi-Cal also would no longer provide coverage for many optional benefits, such as artificial limbs, optometry, hearing aids, physical therapy and hospice care. In December, Davis proposed the elimination of Medical coverage for dentistry, medical supplies and podiatry (Rabin/Ornstein, <http://www.latimes.com/news/local/la-me-cuts11jan11.story> Los Angeles Times, 1/11). The proposal also would reduce Medi-Cal reimbursements for physicians, pharmacists and other providers by 5%, in addition to a 10% reduction that Davis proposed last month (White, Los Angeles Times, 1/11).

* Disability benefits: The state would reduce SSI-SSP benefits for low-income elderly, blind and disabled residents (Hill, <Sacramento">http://www.sacbee.com/content/politics/story/5857983p-6823553c.html>Sacramento Bee, 1/11).

* Tobacco tax: The state would increase the cigarette tax by $1 to $2.10 per pack, a move that would raise an estimated $1.17 billion in additional revenue (Broder, New York Times, 1/11).

* Cancer research: The state would eliminate funds for cancer research (Martin, San Francisco Chronicle, 1/13).

* HIV/AIDS: The state would require AIDS drugs assistance program members to pay higher copayments for their treatments (LaMar/Kleffman, Contra Costa Times, 1/11).

The proposal includes budget reductions for most state programs but would "spare" Healthy Families, the Los Angeles Times reports (Rabin/Ornstein, Los Angeles Times, 1/11). Davis said, "All of the choices before me were hard, but they had to be made" (Sanchez, Washington Post, 1/11). 

Providers, Advocates Respond 

Advocates for health care and social services criticized the budget proposal and said that taxes should be a "bigger part of the solution," the Bee reports. Casey McKeever, an attorney in the Sacramento office of the Western Center on Law and Poverty, said, "I still have hope that the Legislature will search for ways to avoid the hardship that would be caused to the most vulnerable." (Sacramento Bee, 1/11). Advocates also said the provisions in the proposal that would shift responsibility for state programs to local governments would "discourage" Medi-Cal enrollment, the Contra Costa Times reports. Beth Capell, a spokesperson for Health Access, also said the tax revenue the state would provide to local governments to fund the programs may not "keep up with their costs over the long haul" (Contra Costa Times, 1/11). In addition, providers who treat a large number of Medi-Cal beneficiaries said that the proposed reductions in reimbursements would force them to reconsider their!
 participation in the program (White, Los Angeles Times, 1/11). State Republican lawmakers also criticized the proposal (Washington Post, 1/11). 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Davis Unveils Budget Proposal, Calls for Tax Increases, Large Reductions for Health Care Programs </P>
<P>01/13/2003 </P>
<P>Gov. Gray Davis (D) on Friday released his fiscal year 2003-2004 budget proposal, which calls for "deep cuts" in funds for state programs, such as health care, and $8.3 billion in tax increases to help cover an estimated $34.8 billion budget deficit, the AP/Philadelphia Inquirer reports. The proposal would eliminate $20.7 billion in state expenditures over the next two years (Bluth, AP/Philadelphia Inquirer, 1/12). In addition, the proposal would transfer some state services, such as mental health and substance abuse programs, to local governments, a move that would save the state more than $300 million. The proposal also would shift responsibility to counties for home health care workers, a $1.4 billion expense, and nursing home care, a $1.4 billion expense ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47664&amp;collect!
ionid=3&amp;contentarea=20754">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7664&amp;collectionid=3&amp;contentarea=20754</A> California Healthline, 1/10). Under the proposal, the state would use revenue raised from tax increases to cover the cost of the programs. Summaries of some of the health care-related provisions in the proposal appear below (AP/Philadelphia Inquirer, 1/12). </P>
<P>* Medi-Cal: The state would decrease Medi-Cal expenditures by $3.6 billion to $24.7 billion. Under the proposal, the state would revise Medi-Cal eligibility requirements, a move that would reduce enrollment in the program by about 570,000. Medi-Cal also would no longer provide coverage for many optional benefits, such as artificial limbs, optometry, hearing aids, physical therapy and hospice care. In December, Davis proposed the elimination of Medical coverage for dentistry, medical supplies and podiatry (Rabin/Ornstein, &lt;</FONT><A href="http://www.latimes.com/news/local/la-me-cuts11jan11.story"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/local/la-me-cuts11jan11.story</U></FONT></A><FONT size=2>&gt; Los Angeles Times, 1/11). The proposal also would reduce Medi-Cal reimbursements for physicians, pharmacists and other providers by 5%, in addition to a 10% reduction that Davis proposed last month (White, Los Angeles Times, 1/11).</P>
<P>* Disability benefits: The state would reduce SSI-SSP benefits for low-income elderly, blind and disabled residents (Hill, &lt;</FONT><A href="http://www.sacbee.com/content/politics/story/5857983p-6823553c.html"><U><FONT color=#0000ff size=2><A href="http://www.sacbee.com/content/politics/story/5857983p-6823553c.html>Sacramento">http://www.sacbee.com/content/politics/story/5857983p-6823553c.html</U></FONT></A><FONT size=2>&gt;Sacramento</A> Bee, 1/11).</P>
<P>* Tobacco tax: The state would increase the cigarette tax by $1 to $2.10 per pack, a move that would raise an estimated $1.17 billion in additional revenue (Broder, New York Times, 1/11).</P>
<P>* Cancer research: The state would eliminate funds for cancer research (Martin, San Francisco Chronicle, 1/13).</P>
<P>* HIV/AIDS: The state would require AIDS drugs assistance program members to pay higher copayments for their treatments (LaMar/Kleffman, Contra Costa Times, 1/11).</P>
<P>The proposal includes budget reductions for most state programs but would "spare" Healthy Families, the Los Angeles Times reports (Rabin/Ornstein, Los Angeles Times, 1/11). Davis said, "All of the choices before me were hard, but they had to be made" (Sanchez, Washington Post, 1/11). </P>
<P>Providers, Advocates Respond </P>
<P>Advocates for health care and social services criticized the budget proposal and said that taxes should be a "bigger part of the solution," the Bee reports. Casey McKeever, an attorney in the Sacramento office of the Western Center on Law and Poverty, said, "I still have hope that the Legislature will search for ways to avoid the hardship that would be caused to the most vulnerable." (Sacramento Bee, 1/11). Advocates also said the provisions in the proposal that would shift responsibility for state programs to local governments would "discourage" Medi-Cal enrollment, the Contra Costa Times reports. Beth Capell, a spokesperson for Health Access, also said the tax revenue the state would provide to local governments to fund the programs may not "keep up with their costs over the long haul" (Contra Costa Times, 1/11). In addition, providers who treat a large number of Medi-Cal beneficiaries said that the proposed reductions in reimbursements would force them to reconsider th!
eir participation in the program (White, Los Angeles Times, 1/11). State Republican lawmakers also criticized the proposal (Washington Post, 1/11). </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Fri Jan 17 01:25:17 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Thu, 16 Jan 2003 17:25:17 -0800 (PST)
Subject: Bush To Propose Limit on Medical Malpractice Lawsuit Awards
Message-ID: <20030117012517.40041.qmail@web20706.mail.yahoo.com>

--0-324481728-1042766717=:39800
Content-Type: text/plain; charset=us-ascii


-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Bush To Propose Limit on Medical Malpractice Lawsuit Awards 

01/16/2003 

President Bush today plans to announce a proposal to reduce medical malpractice insurance premiums for physicians by limiting the amount of damages that juries can award in malpractice cases, the <http://www.philly.com/mld/philly/news/4956883.htm> Philadelphia Inquirer reports. Bush hopes that the proposal, which he plans to unveil in a policy address at a hospital in Scranton, Pa., will help address the nationwide problem of physician work stoppages (Stark, Philadelphia Inquirer, 1/16). More than 18 general, orthopedic and heart surgeons in northern West Virginia earlier this month began to take leaves of absence to protest the state's high malpractice insurance rates (AP/Pittsburgh Post-Gazette <http://www.postgazette.com/localnews/20030102surgeonsr4.asp> , 1/6). In Pennsylvania, state officials averted a strike by hundreds of physicians and surgeons scheduled for Jan. 1 after they promised to work to reduce malpractice insurance costs for physicians ( <http://www.nytimes.!
com/2003/01/01/national/01DOCS.html> New York Times, 1/1). According to the http://www.latimes.com/news/nationworld/nation/la-na-medmal16jan16.story Los Angeles Times, Bush today will likely make comments similar to those made in an address in North Carolina last year, when he said that "strict limits" on jury awards would save "tens of billions of dollars" and reduce malpractice insurance premiums. In the North Carolina address, Bush expressed support for a bill sponsored by Rep. James Greenwood (R-Pa.) that would have restricted the number of years a plaintiff has to file a malpractice lawsuit; determined damages in part based on the "degree of culpability" of the defendant; established a $250,000 cap on jury awards for pain and suffering; and limited punitive damages to $250,000 or twice the amount of economic damages, whichever is greater (Gerstenzang, Los Angeles Times, 1/16). In addition, the legislation would have allowed states to reduce, but not raise, the $250,000 !
cap on pain and suffering awards. The bill passed the House last year, 217-203 (Kornblut, http://www.boston.com/dailyglobe2/016/nation/Bush_wants_cap_on_malpractice_awards+.shtml Boston Globe, 1/16). However, the Senate did not pass similar legislation. Greenwood plans to reintroduce the bill later this month, the Los Angeles Times reports (Los Angeles Times, 1/16). 

Democratic Position 

Several Democratic lawmakers yesterday said that Bush's proposal would "benefit the insurance industry at the expense of patients," <http://www.nandotimes.com/politics/story/719749p-5279762c.html> McClatchy Newspapers/Nando Times reports. A letter to Bush signed by Sens. John Edwards (D-N.C.), Edward Kennedy (D-Mass.), Patrick Leahy (D-Vt.) and Richard Durbin (D-Ill.) said, "The best answer to unreasonably high medical malpractice premiums is tougher regulation of insurance companies." According to McClatchy/Nando Times, the senators maintain that malpractice insurers have raised premiums to help recoup stock market losses. The letter continued, "When insurance companies lose money on their investments, they should not be able to recover those losses from the doctors they insure." Bush administration spokesperson Jeanie Mamo said that Bush "would be undeterred" by the letter. Mamo added, "The president hopes that Democrats in the Senate will put partisanship aside and focus !
on what's best for patients" (Wagner, McClatchy Newspapers/Nando Times, 1/15). Meanwhile, CongressDaily/AM reports that Senate Republicans are "developing a strategy" to move legislation through the Senate that would cap damages awarded in malpractice lawsuits. Senate Republicans may address the issue through a committee, such as the Health, Education, Labor and Pensions Committee, whose next chair, Sen. Judd Gregg (R-N.H.), considers malpractice reform a "top issue," CongressDaily/AM reports. Senate Republicans also may seek help from Democrats from states with large insurance companies (Fulton, CongressDaily/AM, 1/16). 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Bush To Propose Limit on Medical Malpractice Lawsuit Awards </P>
<P>01/16/2003 </P>
<P>President Bush today plans to announce a proposal to reduce medical malpractice insurance premiums for physicians by limiting the amount of damages that juries can award in malpractice cases, the &lt;</FONT><A href="http://www.philly.com/mld/philly/news/4956883.htm"><U><FONT color=#0000ff size=2>http://www.philly.com/mld/philly/news/4956883.htm</U></FONT></A><FONT size=2>&gt; Philadelphia Inquirer reports. Bush hopes that the proposal, which he plans to unveil in a policy address at a hospital in Scranton, Pa., will help address the nationwide problem of physician work stoppages (Stark, Philadelphia Inquirer, 1/16). More than 18 general, orthopedic and heart surgeons in northern West Virginia earlier this month began to take leaves of absence to protest the state's high malpractice insurance rates (AP/Pittsburgh Post-Gazette &lt;</FONT><A href="http://www.postgazette.com/localnews/20030102surgeonsr4.asp"><U><FONT color=#0000ff size=2>http://www.postgazette.com/localnews/2!
0030102surgeonsr4.asp</U></FONT></A><FONT size=2>&gt; , 1/6). In Pennsylvania, state officials averted a strike by hundreds of physicians and surgeons scheduled for Jan. 1 after they promised to work to reduce malpractice insurance costs for physicians ( &lt;</FONT><A href="http://www.nytimes.com/2003/01/01/national/01DOCS.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/2003/01/01/national/01DOCS.html</U></FONT></A><FONT size=2>&gt; New York Times, 1/1). According to the </FONT><A href="http://www.latimes.com/news/nationworld/nation/la-na-medmal16jan16.stor"><U><FONT color=#0000ff size=2><A href="http://www.latimes.com/news/nationworld/nation/la-na-medmal16jan16.story">http://www.latimes.com/news/nationworld/nation/la-na-medmal16jan16.stor</U></FONT></A><FONT size=2>y</A> Los Angeles Times, Bush today will likely make comments similar to those made in an address in North Carolina last year, when he said that "strict limits" on jury awards would save "tens of billi!
ons of dollars" and reduce malpractice insurance premiums. In the North Carolina address, Bush expressed support for a bill sponsored by Rep. James Greenwood (R-Pa.) that would have restricted the number of years a plaintiff has to file a malpractice lawsuit; determined damages in part based on the "degree of culpability" of the defendant; established a $250,000 cap on jury awards for pain and suffering; and limited punitive damages to $250,000 or twice the amount of economic damages, whichever is greater (Gerstenzang, Los Angeles Times, 1/16). In addition, the legislation would have allowed states to reduce, but not raise, the $250,000 cap on pain and suffering awards. The bill passed the House last year, 217-203 (Kornblut, </FONT><A href="http://www.boston.com/dailyglobe2/016/nation/Bush_wants_cap_on_malpract"><U><FONT color=#0000ff size=2><A href="http://www.boston.com/dailyglobe2/016/nation/Bush_wants_cap_on_malpractice_awards+.shtml">http://www.boston.com/dailyglobe2/01!
6/nation/Bush_wants_cap_on_malpract</U></FONT></A><FONT size=2>ice_awards+.shtml</A> Boston Globe, 1/16). However, the Senate did not pass similar legislation. Greenwood plans to reintroduce the bill later this month, the Los Angeles Times reports (Los Angeles Times, 1/16). </P>
<P>Democratic Position </P>
<P>Several Democratic lawmakers yesterday said that Bush's proposal would "benefit the insurance industry at the expense of patients," &lt;</FONT><A href="http://www.nandotimes.com/politics/story/719749p-5279762c.html"><U><FONT color=#0000ff size=2>http://www.nandotimes.com/politics/story/719749p-5279762c.html</U></FONT></A><FONT size=2>&gt; McClatchy Newspapers/Nando Times reports. A letter to Bush signed by Sens. John Edwards (D-N.C.), Edward Kennedy (D-Mass.), Patrick Leahy (D-Vt.) and Richard Durbin (D-Ill.) said, "The best answer to unreasonably high medical malpractice premiums is tougher regulation of insurance companies." According to McClatchy/Nando Times, the senators maintain that malpractice insurers have raised premiums to help recoup stock market losses. The letter continued, "When insurance companies lose money on their investments, they should not be able to recover those losses from the doctors they insure." Bush administration spokesperson Jeanie Mamo said !
that Bush "would be undeterred" by the letter. Mamo added, "The president hopes that Democrats in the Senate will put partisanship aside and focus on what's best for patients" (Wagner, McClatchy Newspapers/Nando Times, 1/15). Meanwhile, CongressDaily/AM reports that Senate Republicans are "developing a strategy" to move legislation through the Senate that would cap damages awarded in malpractice lawsuits. Senate Republicans may address the issue through a committee, such as the Health, Education, Labor and Pensions Committee, whose next chair, Sen. Judd Gregg (R-N.H.), considers malpractice reform a "top issue," CongressDaily/AM reports. Senate Republicans also may seek help from Democrats from states with large insurance companies (Fulton, CongressDaily/AM, 1/16). </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Sat Jan 18 06:28:27 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Fri, 17 Jan 2003 22:28:27 -0800 (PST)
Subject: HMO Association Chief Leaves After Four Tough Years
Message-ID: <20030118062827.55142.qmail@web41511.mail.yahoo.com>

--0-20837769-1042871307=:54973
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-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 



HMO Association Chief Leaves After Four Tough Years

by Stephen <mailto: sjrobitaille@earthlink.net> Robitaille

January 06, 2003

Walter Zelman, chief executive of the California Association of Health Plans (CAHP), left his post at year's end, calling his decision a personal one that will give him the chance to take a well-deserved rest from the state's punishing managed-care landscape. 

And after a four-year stint at the helm of California's HMO trade association, in an era which included numerous legislative battles, widespread public and provider frustration with managed care, and the establishment of the nation's toughest HMO watchdog agency, Zelman will have plenty of unwinding to do. 

During his tenure, Zelman earned a reputation as somewhat of an enigma. Colleagues and adversaries praised him as a tough negotiator; a skilled advocate, who made effective use of public relations to advance CAHP's agenda; and a thoughtful analyst of public policy, who argued in articulate fashion for greater coverage of the uninsured and improvements in health care quality. 

Yet consumer advocates also voiced a lingering distaste for the fact that Zelman, a former advisor to President Clinton and executive director of California Common Cause, a nonprofit advocacy group that works for campaign finance reform, went to work for the HMO industry at all. 

In a recent interview, the 58-year-old Zelman remained pugnacious and unrepentant over his choices, saying managed care has saved hundreds of billions of dollars nationwide in health care costs-money which has helped provide health insurance coverage to more people and funded other necessary services. 

"It's a personal decision based on the feeling that I need a bit of a change of direction. I need to relax a little bit. I need to be out of the line of fire a bit. And I need to put more time into my family, who is in Southern California," said Zelman. "I never saw this job as going from one side to the other because I believe in managed care. I know it has saved money, and saving money is good because that means money is available for other things-more health care, the environment, cops on the street, education." 

HMO Association Chief Took Over Amid Tumultuous Times

When Zelman came to CAHP from Harvard University, where he had been a professor at the School of Public Health, the HMO industry faced the California equivalent of angry villagers at the castle gates, with pitchforks in hand. Public frustration with the strictures of managed care had prompted state legislators to start crafting competing packages of HMO reform bills-more than 20 in all. 

CAHP fought hard to soften the landmark legislation, the centerpiece of which was the creation of the state Department of Managed Health Care (DMHC), but ended up opposing only one component of the plan, which allowed patients to sue their HMOs. Yet Zelman won kudos from Daniel Zingale, who is chief of the new DMHC, for the persuasiveness of his arguments on the need for cost containment and for his commitment to quality improvement. 

"I have nothing but good things to say about Walter. I hold him in high regard," said Zingale, himself a former AIDS activist. "The history of consumer advocacy always gave us a starting point, but he has always been one of the most thoughtful, knowledgeable people on the scene. He's very patient, and his arguments are always well constructed." 

"I think he has altered the debate on managed care in terms of the importance of cost containment. I think all of us have come to realize that affordability is a critical piece of patient protection," said Zingale. "The rising costs of health insurance have certainly hammered that home. Our first priority as a regulator has been to ensure access to care when HMO's inappropriately deny care, but we also feel it's important to contain costs." 

Accomplishments, Frustrations

Zelman pointed to the end product of the HMO reform process, and CAHP's ability to compromise on a package that in his words "horrified" large portions of the HMO industry in its early incarnations, as one of the highlights of his tenure. 

Another accomplishment for Zelman, also in the realm of cost containment, was passage of a law in the 2002 session that will require a cost-benefit analysis on all proposed legislation that would place coverage or treatment mandates on health plans. 

Despite his reputation as a persuasive advocate, Zelman said one of his most enduring frustrations was his inability to get the message across that HMOs were not the health care bad guys as characterized by consumer groups, physician organizations, and large sectors of the public. Rather, he believes they are brokers of competing demands between patients and those who foot their medical bills. 

"I have had a high level of frustration at being unable to consistently get audiences to understand the fundamental conflicts that run under health care economics," said Zelman. "On the one hand, you have a society that understandably wants all these benefits, options, new technologies, but isn't paying for them out of their own pocket. On the other, you have employers and government wanting to control costs. The health plans are in the middle." 

"The health plan is the arbiter of the demands of the consumer and the needs of the employer and government, who pay for it all. Part of this arbitration is cost control. Someone has to do it, but it is certain to produce ill will from everyone involved. Yet it has to be done, or we will have nine million uninsured in California, not six million," said Zelman. 

Consumer Advocates Still Simmer

What still puzzles some consumer advocates was why someone with Zelman's background felt he had to head up an HMO industry trade group, and defend an industry that has been cited in numerous, high-profile cases of restricting or refusing necessary medical care. 

"I think we'd call it shocking that he went there," said Betsy Imholtz, director of the San Francisco office of Consumers Union, a national advocacy organization. "My hope is now that he'll go on and work with us for universal health care-come back to the advocacy community." 

Zelman countered that the savings from managed care have helped provide health insurance benefits to hundreds of thousands of Californians, who otherwise would have joined the ranks of the uninsured. 

"You look at the last three years-the efforts of consumer advocates have been about giving well-insured people more coverage. It's not an illegitimate goal, but it has not been about making sure that everyone has coverage," said Zelman. "I have had a long-standing concern about the uninsured and affordability of health care. Lots of my liberal consumer-advocate friends are advocating what is in effect upper-middle-class health care." 

Imholtz also criticized CAHP and health care quality supporter Zelman for opposing successful Consumers Union-sponsored legislation in 2002 that mandate public reports on death rates, by hospital and individual surgeon, for a number of common surgical procedures. 

Zelman said that he personally supported the legislation, but that opinion among member HMOs was mixed, which doomed any hope of CAHP support. 

"The association functions on consensus, and while the majority of plans were willing to support it, some plans didn't want it," said Zelman. "While I would've liked to have seen us support that legislation, some plans felt differently."

HMO Industry Battled Physicians, Hospitals

While the HMO industry's battles with consumers have quieted substantially after passage of the legislative reform package, the action has been heated with doctors and hospitals. The California Medical Association (CMA) pushed repeatedly and unsuccessfully for legislation that would've allowed doctors to bargain collectively with HMOs, while hospitals pushed successfully for new prompt payment laws. 

Yet both Jack Lewin, CMA's executive director, and Duane Dauner, president and chief executive of the California Healthcare Association, the state's hospital trade association, praised Zelman's tenacity and acumen. 

For his part, Zelman said he has worked to improve relations between medical groups and health plans. Although attempts to find common ground between plans and hospitals today appear fated to fall prey to disputes over spiraling hospital costs, their impact on rising health insurance premiums, and how to rein them in. 

However, he is also looking forward to viewing that battle from the sidelines. "I'm sorry that we had to play so much defense, that we haven't been able to offer our ideas on how we could improve the system. I think we've made some progress in the relationships between medical groups and health plans," said Zelman. "Both sectors care about the uninsured, [and] Medi-Cal under-funding. Both realize there are improvements to be made in streamlining billing and payment systems, and if we get out of the war zone, we could find more peaceful ground on which to negotiate."

Zelman left CAHP at the end of December and a search is under way for his replacement. 

More on the Web: See Mr. Zelman's <http://www.calhealthplans.com/zelmanbio.htm> biography at the California Association of Health Plans Web site. 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P></P>
<P>HMO Association Chief Leaves After Four Tough Years</P>
<P>by Stephen &lt;</FONT><A href="mailto: sjrobitaille@earthlink.net"><U><FONT color=#0000ff size=2>mailto: sjrobitaille@earthlink.net</U></FONT></A><FONT size=2>&gt; Robitaille</P>
<P>January 06, 2003</P>
<P>Walter Zelman, chief executive of the California Association of Health Plans (CAHP), left his post at year's end, calling his decision a personal one that will give him the chance to take a well-deserved rest from the state's punishing managed-care landscape. </P>
<P>And after a four-year stint at the helm of California's HMO trade association, in an era which included numerous legislative battles, widespread public and provider frustration with managed care, and the establishment of the nation's toughest HMO watchdog agency, Zelman will have plenty of unwinding to do. </P>
<P>During his tenure, Zelman earned a reputation as somewhat of an enigma. Colleagues and adversaries praised him as a tough negotiator; a skilled advocate, who made effective use of public relations to advance CAHP's agenda; and a thoughtful analyst of public policy, who argued in articulate fashion for greater coverage of the uninsured and improvements in health care quality. </P>
<P>Yet consumer advocates also voiced a lingering distaste for the fact that Zelman, a former advisor to President Clinton and executive director of California Common Cause, a nonprofit advocacy group that works for campaign finance reform, went to work for the HMO industry at all. </P>
<P>In a recent interview, the 58-year-old Zelman remained pugnacious and unrepentant over his choices, saying managed care has saved hundreds of billions of dollars nationwide in health care costs-money which has helped provide health insurance coverage to more people and funded other necessary services. </P>
<P>"It's a personal decision based on the feeling that I need a bit of a change of direction. I need to relax a little bit. I need to be out of the line of fire a bit. And I need to put more time into my family, who is in Southern California," said Zelman. "I never saw this job as going from one side to the other because I believe in managed care. I know it has saved money, and saving money is good because that means money is available for other things-more health care, the environment, cops on the street, education." </P>
<P>HMO Association Chief Took Over Amid Tumultuous Times</P>
<P>When Zelman came to CAHP from Harvard University, where he had been a professor at the School of Public Health, the HMO industry faced the California equivalent of angry villagers at the castle gates, with pitchforks in hand. Public frustration with the strictures of managed care had prompted state legislators to start crafting competing packages of HMO reform bills-more than 20 in all. </P>
<P>CAHP fought hard to soften the landmark legislation, the centerpiece of which was the creation of the state Department of Managed Health Care (DMHC), but ended up opposing only one component of the plan, which allowed patients to sue their HMOs. Yet Zelman won kudos from Daniel Zingale, who is chief of the new DMHC, for the persuasiveness of his arguments on the need for cost containment and for his commitment to quality improvement. </P>
<P>"I have nothing but good things to say about Walter. I hold him in high regard," said Zingale, himself a former AIDS activist. "The history of consumer advocacy always gave us a starting point, but he has always been one of the most thoughtful, knowledgeable people on the scene. He's very patient, and his arguments are always well constructed." </P>
<P>"I think he has altered the debate on managed care in terms of the importance of cost containment. I think all of us have come to realize that affordability is a critical piece of patient protection," said Zingale. "The rising costs of health insurance have certainly hammered that home. Our first priority as a regulator has been to ensure access to care when HMO's inappropriately deny care, but we also feel it's important to contain costs." </P>
<P>Accomplishments, Frustrations</P>
<P>Zelman pointed to the end product of the HMO reform process, and CAHP's ability to compromise on a package that in his words "horrified" large portions of the HMO industry in its early incarnations, as one of the highlights of his tenure. </P>
<P>Another accomplishment for Zelman, also in the realm of cost containment, was passage of a law in the 2002 session that will require a cost-benefit analysis on all proposed legislation that would place coverage or treatment mandates on health plans. </P>
<P>Despite his reputation as a persuasive advocate, Zelman said one of his most enduring frustrations was his inability to get the message across that HMOs were not the health care bad guys as characterized by consumer groups, physician organizations, and large sectors of the public. Rather, he believes they are brokers of competing demands between patients and those who foot their medical bills. </P>
<P>"I have had a high level of frustration at being unable to consistently get audiences to understand the fundamental conflicts that run under health care economics," said Zelman. "On the one hand, you have a society that understandably wants all these benefits, options, new technologies, but isn't paying for them out of their own pocket. On the other, you have employers and government wanting to control costs. The health plans are in the middle." </P>
<P>"The health plan is the arbiter of the demands of the consumer and the needs of the employer and government, who pay for it all. Part of this arbitration is cost control. Someone has to do it, but it is certain to produce ill will from everyone involved. Yet it has to be done, or we will have nine million uninsured in California, not six million," said Zelman. </P>
<P>Consumer Advocates Still Simmer</P>
<P>What still puzzles some consumer advocates was why someone with Zelman's background felt he had to head up an HMO industry trade group, and defend an industry that has been cited in numerous, high-profile cases of restricting or refusing necessary medical care. </P>
<P>"I think we'd call it shocking that he went there," said Betsy Imholtz, director of the San Francisco office of Consumers Union, a national advocacy organization. "My hope is now that he'll go on and work with us for universal health care-come back to the advocacy community." </P>
<P>Zelman countered that the savings from managed care have helped provide health insurance benefits to hundreds of thousands of Californians, who otherwise would have joined the ranks of the uninsured. </P>
<P>"You look at the last three years-the efforts of consumer advocates have been about giving well-insured people more coverage. It's not an illegitimate goal, but it has not been about making sure that everyone has coverage," said Zelman. "I have had a long-standing concern about the uninsured and affordability of health care. Lots of my liberal consumer-advocate friends are advocating what is in effect upper-middle-class health care." </P>
<P>Imholtz also criticized CAHP and health care quality supporter Zelman for opposing successful Consumers Union-sponsored legislation in 2002 that mandate public reports on death rates, by hospital and individual surgeon, for a number of common surgical procedures. </P>
<P>Zelman said that he personally supported the legislation, but that opinion among member HMOs was mixed, which doomed any hope of CAHP support. </P>
<P>"The association functions on consensus, and while the majority of plans were willing to support it, some plans didn't want it," said Zelman. "While I would've liked to have seen us support that legislation, some plans felt differently."</P>
<P>HMO Industry Battled Physicians, Hospitals</P>
<P>While the HMO industry's battles with consumers have quieted substantially after passage of the legislative reform package, the action has been heated with doctors and hospitals. The California Medical Association (CMA) pushed repeatedly and unsuccessfully for legislation that would've allowed doctors to bargain collectively with HMOs, while hospitals pushed successfully for new prompt payment laws. </P>
<P>Yet both Jack Lewin, CMA's executive director, and Duane Dauner, president and chief executive of the California Healthcare Association, the state's hospital trade association, praised Zelman's tenacity and acumen. </P>
<P>For his part, Zelman said he has worked to improve relations between medical groups and health plans. Although attempts to find common ground between plans and hospitals today appear fated to fall prey to disputes over spiraling hospital costs, their impact on rising health insurance premiums, and how to rein them in. </P>
<P>However, he is also looking forward to viewing that battle from the sidelines. "I'm sorry that we had to play so much defense, that we haven't been able to offer our ideas on how we could improve the system. I think we've made some progress in the relationships between medical groups and health plans," said Zelman. "Both sectors care about the uninsured, [and] Medi-Cal under-funding. Both realize there are improvements to be made in streamlining billing and payment systems, and if we get out of the war zone, we could find more peaceful ground on which to negotiate."</P>
<P>Zelman left CAHP at the end of December and a search is under way for his replacement. </P>
<P>More on the Web: See Mr. Zelman's &lt;</FONT><A href="http://www.calhealthplans.com/zelmanbio.htm"><U><FONT color=#0000ff size=2>http://www.calhealthplans.com/zelmanbio.htm</U></FONT></A><FONT size=2>&gt; biography at the California Association of Health Plans Web site. </P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Sun Jan 19 03:45:11 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Sat, 18 Jan 2003 19:45:11 -0800 (PST)
Subject: CMS: REPORT DETAILS NATIONAL HEALTH CARE SPENDING INCREASES IN 2001
Message-ID: <20030119034511.10183.qmail@web41511.mail.yahoo.com>

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-----Original Message-----

From: Ulric Wair [mailto:UWair@CMS.GOV] 



MEDICARE NEWS

FOR IMMEDIATE RELEASE

CMS Public Affairs Office

Wednesday, January 8, 2003

REPORT DETAILS NATIONAL HEALTH CARE SPENDING INCREASES IN 2001

Health care spending in the United States rose to $1.4 trillion in 2001, an 8.7 percent increase over the previous year, according to a report by the Centers for Medicare & Medicaid Services (CMS).

The 8.7 percent growth rate for 2001, compared with 7.4 percent in 2000, and 6.1 in 1999, marked the fifth consecutive year in which health spending grew at an accelerating rate. Health spending increased more than three times faster than the 2.6 percent nominal rate of growth in the economy in 2001. Health care spending averaged $5,035 per person in 2001, compared to $4,672 in 2000.

"While still the greatest in the world, our healthcare system is stretched and stressed to the point of nearly breaking," Health and Human Services Secretary Tommy G. Thompson said. "We have launched a series of town hall meeting across America to listen to Americans and develop solutions to rising health costs and other challenges. What will emerge from these meetings will be a series of legislative proposals and pilot projects that can be adopted by states to strengthen our healthcare system."

CMS economists said in the report that the health share of gross domestic product (GDP) increased from 13.3 percent in 2000 to 14.1 percent in 2001. That increase results less from increases in actual health spending than from slower economic growth resulting from the national recession that began in March 2001 and exacerbated by the September 11 terrorist attacks. This was similar to the spike in the health-spending share of GDP leading seen before the 1990-1991 recession.

In the 1990s, managed care restrained health expenditure growth by slowing the rate of price increases to providers, and to a lesser extent by slowing growth in quantity of services per capita. While a slowdown in medical price growth curbed overall spending during the mid-1990s, a rise in the quantity and intensity of services consumed, along with slow and steady price increases, caused aggregate spending to accelerate in 2001, the report says.

An 8.3 percent rise in hospital spending accounted for 30 percent of the health spending increase in 2001. This was the first time since 1992 that hospitals' contribution to the annual rate of increase had been this significant.

Although hospital spending contributed the most in absolute terms to the overall health spending increase in 2001, prescription drug spending grew at the fastest rate of any spending category, although that rate was slowing. In 1999, prescription drug spending grew by 19.7 percent, by 16.4 percent in 2000 and 15.7 percent in 2001.

Spending for physician services accelerated from 6.9 percent in 2000 to 8.6 percent in 2001.

Public spending, accounting for 45 percent of national health expenditures, increased 9.4 percent in 2001. This is the second consecutive year that public spending growth exceeded private spending growth. Important sources for this growth were Medicare payment increases granted providers by the Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), as well as increased Medicaid spending.

Medicare spending growth accelerated 2.8 percentage points in 2001, to 7.8 percent. Medicare payment to hospitals, home health agencies, and nursing homes were particularly affected by changes in public policy, first experiencing moderate reductions in payments through the Balanced Budget Act of 1997 (BBA), then benefiting from BIPA in 2001.

Medicare spending for these providers increased by 3.6 percent in 2000, and 8.6 percent in 2001, following a decline of 1.9 percent in 1999. Legislation added $7.5 billion to total Medicare spending in 2001, with $2.6 billion alone benefiting inpatient hospital spending.

Spending for Medicaid, a shared federal and state government program, increased 10.8 percent in 2001, totaling $224.3 billion. This was the fastest growth rate since 1993. An 8.5 percent rise in Medicaid enrollment contributed to increased spending, with some enrollment growth related to the national recession, and some from separate program expansions for the uninsured. Medicaid spending accelerated in 2001, with double-digit increases for all health services except nursing home care.

"If there ever was an argument for Medicare and Medicaid reform, this report is it," said CMS Administrator Tom Scully.

The recession and rapidly growing Medicaid expenditures, which climbed to an average of 20 percent of state spending, contributed to severe budgetary shortfalls for state governments in fiscal year 2001. Some states also were affected by reductions in the Medicaid Federal Medical Assistance Percentage, which were calculated based on data from periods when economic conditions were stronger.

Private health insurance premium growth accelerated in 2001 for the fourth consecutive year, with benefits growing more slowly than premiums in the last three. Premiums rose 10.5 percent in 2001 to reach $496.1 billion, while benefits grew 10.1 percent.

###


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2>
<P>-----Original Message-----</P>
<P>From: Ulric Wair [</FONT><A href="mailto:UWair@CMS.GOV"><U><FONT color=#0000ff size=2>mailto:UWair@CMS.GOV</U></FONT></A><FONT size=2>] </P>
<P>
<P></FONT><FONT size=2></P>MEDICARE NEWS</P>
<P>FOR IMMEDIATE RELEASE</P>
<P>CMS Public Affairs Office</P>
<P>Wednesday, January 8, 2003</P>
<P>REPORT DETAILS NATIONAL HEALTH CARE SPENDING INCREASES IN 2001</P>
<P>Health care spending in the United States rose to $1.4 trillion in 2001, an 8.7 percent increase over the previous year, according to a report by the Centers for Medicare &amp; Medicaid Services (CMS).</P>
<P>The 8.7 percent growth rate for 2001, compared with 7.4 percent in 2000, and 6.1 in 1999, marked the fifth consecutive year in which health spending grew at an accelerating rate. Health spending increased more than three times faster than the 2.6 percent nominal rate of growth in the economy in 2001. Health care spending averaged $5,035 per person in 2001, compared to $4,672 in 2000.</P>
<P>"While still the greatest in the world, our healthcare system is stretched and stressed to the point of nearly breaking," Health and Human Services Secretary Tommy G. Thompson said. "We have launched a series of town hall meeting across America to listen to Americans and develop solutions to rising health costs and other challenges. What will emerge from these meetings will be a series of legislative proposals and pilot projects that can be adopted by states to strengthen our healthcare system."</P>
<P>CMS economists said in the report that the health share of gross domestic product (GDP) increased from 13.3 percent in 2000 to 14.1 percent in 2001. That increase results less from increases in actual health spending than from slower economic growth resulting from the national recession that began in March 2001 and exacerbated by the September 11 terrorist attacks. This was similar to the spike in the health-spending share of GDP leading seen before the 1990-1991 recession.</P>
<P>In the 1990s, managed care restrained health expenditure growth by slowing the rate of price increases to providers, and to a lesser extent by slowing growth in quantity of services per capita. While a slowdown in medical price growth curbed overall spending during the mid-1990s, a rise in the quantity and intensity of services consumed, along with slow and steady price increases, caused aggregate spending to accelerate in 2001, the report says.</P>
<P>An 8.3 percent rise in hospital spending accounted for 30 percent of the health spending increase in 2001. This was the first time since 1992 that hospitals' contribution to the annual rate of increase had been this significant.</P>
<P>Although hospital spending contributed the most in absolute terms to the overall health spending increase in 2001, prescription drug spending grew at the fastest rate of any spending category, although that rate was slowing. In 1999, prescription drug spending grew by 19.7 percent, by 16.4 percent in 2000 and 15.7 percent in 2001.</P>
<P>Spending for physician services accelerated from 6.9 percent in 2000 to 8.6 percent in 2001.</P>
<P>Public spending, accounting for 45 percent of national health expenditures, increased 9.4 percent in 2001. This is the second consecutive year that public spending growth exceeded private spending growth. Important sources for this growth were Medicare payment increases granted providers by the Balanced Budget Refinement Act of 1999 (BBRA) and the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), as well as increased Medicaid spending.</P>
<P>Medicare spending growth accelerated 2.8 percentage points in 2001, to 7.8 percent. Medicare payment to hospitals, home health agencies, and nursing homes were particularly affected by changes in public policy, first experiencing moderate reductions in payments through the Balanced Budget Act of 1997 (BBA), then benefiting from BIPA in 2001.</P>
<P>Medicare spending for these providers increased by 3.6 percent in 2000, and 8.6 percent in 2001, following a decline of 1.9 percent in 1999. Legislation added $7.5 billion to total Medicare spending in 2001, with $2.6 billion alone benefiting inpatient hospital spending.</P>
<P>Spending for Medicaid, a shared federal and state government program, increased 10.8 percent in 2001, totaling $224.3 billion. This was the fastest growth rate since 1993. An 8.5 percent rise in Medicaid enrollment contributed to increased spending, with some enrollment growth related to the national recession, and some from separate program expansions for the uninsured. Medicaid spending accelerated in 2001, with double-digit increases for all health services except nursing home care.</P>
<P>"If there ever was an argument for Medicare and Medicaid reform, this report is it," said CMS Administrator Tom Scully.</P>
<P>The recession and rapidly growing Medicaid expenditures, which climbed to an average of 20 percent of state spending, contributed to severe budgetary shortfalls for state governments in fiscal year 2001. Some states also were affected by reductions in the Medicaid Federal Medical Assistance Percentage, which were calculated based on data from periods when economic conditions were stronger.</P>
<P>Private health insurance premium growth accelerated in 2001 for the fourth consecutive year, with benefits growing more slowly than premiums in the last three. Premiums rose 10.5 percent in 2001 to reach $496.1 billion, while benefits grew 10.1 percent.</P>
<P>###</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Mon Jan 20 05:11:27 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Sun, 19 Jan 2003 21:11:27 -0800 (PST)
Subject: Bush Administration Says Hospitals Not Liable for Adverse Vaccine Reactions, -and- HHS agrees with AHA on smallpox liability
Message-ID: <20030120051127.63488.qmail@web41501.mail.yahoo.com>

--0-1170967583-1043039487=:62084
Content-Type: text/plain; charset=us-ascii


From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 



Bush Administration Says Hospitals Not Liable for Adverse Vaccine Reactions 

01/15/2003 

Hospitals and health care workers who administer or receive smallpox vaccinations will not face liability for adverse reactions to others, Bush administration officials announced yesterday, the <http://www.washingtonpost.com/wpdyn/articles/A56861-2003Jan14.html> Washington Post reports (Connolly, Washington Post, 1/15). President Bush on Dec. 13, 2002, announced a national smallpox vaccination plan under which about 500,000 military personnel and as many as 10 million emergency and health care workers will receive the vaccine. In late January, the government will begin to vaccinate about 439,000 civilian emergency workers not at high risk for side effects as part of a 30-day voluntary program. In the second phase of the vaccination plan, which will take between 45 and 90 days, federal and state governments will move to vaccinate about 10 million health care workers; government officials estimate that about half of the workers will decide to receive the vaccine. In late sprin!
g or early summer of 2003, the federal government will offer the vaccine to U.S. adults in the general population not at high risk for side effects ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47507&collectionid=3&program=1 California Healthline, 12/16/02). The smallpox vaccine can cause adverse reactions in individuals who receive the inoculation and those with whom they come in contact. The administration announcement yesterday was "good news" for hospitals and health care workers but left "little recourse" for individuals who experience adverse reactions to the smallpox vaccine, "unless negligence is involved, which would be difficult to prove," the <http://www.nandotimes.com/healthscience/story/718133p-5269935c.html> AP/Nando Times reports. Dr. D.A. Henderson, chair of the HHS Council on Public Health Preparedness, said that the liability protections announced yesterday could prompt some individuals not to take the smallpox vaccine, which he sa!
id could become "potentially a very large problem" (Meckler, AP/Nando Times, 1/14). The Bush administration yesterday also rejected a proposal to establish a compensation fund for individuals injured by the smallpox vaccine. Henderson attributed the decision not to establish the fund to the "potentially very large" cost of compensation for those injured by the smallpox vaccine (Washington Post, 1/15). 

ACIP Expands Recommendations 

In related news, the Advisory Committee on Immunization Practices yesterday expanded the group of individuals that they recommend should not receive the smallpox vaccinate, the <http://www.nytimes.com/2003/01/15/health/15SMAL.html> New York Times reports. In draft recommendations released in October, the ACIP recommended that individuals with autoimmune diseases such as lupus or rheumatoid arthritis should receive the smallpox vaccine in the event that they used medications to suppress their immune systems. However, in a conference call yesterday, committee members said that they will recommend that individuals with "severe" autoimmune disorders should not receive the smallpox vaccine, regardless of whether they take medication to treat the disease. The ACIP also upheld an October recommendation that adults who reside with children younger than age one can receive the smallpox vaccine. Several experts had expressed concern that vaccinated adults could infect an infant with v!
accinia, the virus used to make the smallpox vaccine, in the event that the infant came in contact with the inoculation site. The ACIP will present final recommendations to the CDC (Grady, New York Times, 1/15). 

 

===================================

AHA NEWS NOW - www.ahanews.com

===================================

Friday, January 10, 2003

1) HHS agrees with AHA on smallpox liability

Health and Human Services Secretary Tommy Thompson, in a letter delivered late Jan. 9 to AHA President Dick Davidson, said that HHS intends to word Sect. 304 of the Homeland Security Act to include the secretary's determination "that hospitals that designate employees to receive smallpox countermeasures under the state's smallpox vaccination plan are participants in the program and thus are health care entities under whose auspices the countermeasure is administered." Thompson sent the letter in response to AHA's concerns about a narrow interpretation of Sect. 304 by the Centers for Disease Control and Prevention, which would have left hospitals not providing vaccinations, but taking part by urging employees to receive the voluntary vaccinations, unprotected from liability in several cases. "The secretary has taken a decisive step toward clarity on this important issue, and we appreciate his addressing our concerns," Davidson said. "We'll continue to work with him and the ad!
ministration to ensure the success of this important program."

==================================

Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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Content-Type: text/html; charset=us-ascii

<FONT size=2><FONT size=2>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P></P>
<P>Bush Administration Says Hospitals Not Liable for Adverse Vaccine Reactions </P>
<P>01/15/2003 </P>
<P>Hospitals and health care workers who administer or receive smallpox vaccinations will not face liability for adverse reactions to others, Bush administration officials announced yesterday, the &lt;</FONT><A href="http://www.washingtonpost.com/wpdyn/articles/A56861-2003Jan14.html"><U><FONT color=#0000ff size=2>http://www.washingtonpost.com/wpdyn/articles/A56861-2003Jan14.html</U></FONT></A><FONT size=2>&gt; Washington Post reports (Connolly, Washington Post, 1/15). President Bush on Dec. 13, 2002, announced a national smallpox vaccination plan under which about 500,000 military personnel and as many as 10 million emergency and health care workers will receive the vaccine. In late January, the government will begin to vaccinate about 439,000 civilian emergency workers not at high risk for side effects as part of a 30-day voluntary program. In the second phase of the vaccination plan, which will take between 45 and 90 days, federal and state governments will move to vaccina!
te about 10 million health care workers; government officials estimate that about half of the workers will decide to receive the vaccine. In late spring or early summer of 2003, the federal government will offer the vaccine to U.S. adults in the general population not at high risk for side effects ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47507&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7507&amp;collectionid=3&amp;program=1</A> California Healthline, 12/16/02). The smallpox vaccine can cause adverse reactions in individuals who receive the inoculation and those with whom they come in contact. The administration announcement yesterday was "good news" for hospitals and health care workers but left "little recourse" for individuals wh!
o experience adverse reactions to the smallpox vaccine, "unless negligence is involved, which would be difficult to prove," the &lt;</FONT><A href="http://www.nandotimes.com/healthscience/story/718133p-5269935c.html"><U><FONT color=#0000ff size=2>http://www.nandotimes.com/healthscience/story/718133p-5269935c.html</U></FONT></A><FONT size=2>&gt; AP/Nando Times reports. Dr. D.A. Henderson, chair of the HHS Council on Public Health Preparedness, said that the liability protections announced yesterday could prompt some individuals not to take the smallpox vaccine, which he said could become "potentially a very large problem" (Meckler, AP/Nando Times, 1/14). The Bush administration yesterday also rejected a proposal to establish a compensation fund for individuals injured by the smallpox vaccine. Henderson attributed the decision not to establish the fund to the "potentially very large" cost of compensation for those injured by the smallpox vaccine (Washington Post, 1/15). </P>
<P>ACIP Expands Recommendations </P>
<P>In related news, the Advisory Committee on Immunization Practices yesterday expanded the group of individuals that they recommend should not receive the smallpox vaccinate, the &lt;</FONT><A href="http://www.nytimes.com/2003/01/15/health/15SMAL.html"><U><FONT color=#0000ff size=2>http://www.nytimes.com/2003/01/15/health/15SMAL.html</U></FONT></A><FONT size=2>&gt; New York Times reports. In draft recommendations released in October, the ACIP recommended that individuals with autoimmune diseases such as lupus or rheumatoid arthritis should receive the smallpox vaccine in the event that they used medications to suppress their immune systems. However, in a conference call yesterday, committee members said that they will recommend that individuals with "severe" autoimmune disorders should not receive the smallpox vaccine, regardless of whether they take medication to treat the disease. The ACIP also upheld an October recommendation that adults who reside with children younger !
than age one can receive the smallpox vaccine. Several experts had expressed concern that vaccinated adults could infect an infant with vaccinia, the virus used to make the smallpox vaccine, in the event that the infant came in contact with the inoculation site. The ACIP will present final recommendations to the CDC (Grady, New York Times, 1/15). </FONT></P>
<P><FONT size=2>&nbsp;</P>
<P></FONT>===================================</P>
<P>AHA NEWS NOW - </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.ahanews.com"><U><FONT color=#0000ff size=2>www.ahanews.com</U></FONT></A></P><FONT size=2>
<P>===================================</P>
<P>Friday, January 10, 2003</P>
<P>1) HHS agrees with AHA on smallpox liability</P>
<P>Health and Human Services Secretary Tommy Thompson, in a letter delivered late Jan. 9 to AHA President Dick Davidson, said that HHS intends to word Sect. 304 of the Homeland Security Act to include the secretary's determination "that hospitals that designate employees to receive smallpox countermeasures under the state's smallpox vaccination plan are participants in the program and thus are health care entities under whose auspices the countermeasure is administered." Thompson sent the letter in response to AHA's concerns about a narrow interpretation of Sect. 304 by the Centers for Disease Control and Prevention, which would have left hospitals not providing vaccinations, but taking part by urging employees to receive the voluntary vaccinations, unprotected from liability in several cases. "The secretary has taken a decisive step toward clarity on this important issue, and we appreciate his addressing our concerns," Davidson said. "We'll continue to work with him and the!
 administration to ensure the success of this important program."</P>
<P>==================================</P>
<P>Copyright 2003 by the American Hospital Association. All rights reserved. For republication rights, contact Craig Webb. AHA News is a registered trademark of the American Hospital Association. The opinions expressed in AHA News Now are not necessarily those of the American Hospital Association.</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Mon Jan 20 19:48:51 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Mon, 20 Jan 2003 11:48:51 -0800 (PST)
Subject: Have you made your plans for New Orleans yet?
Message-ID: <20030120194851.78454.qmail@web41504.mail.yahoo.com>

--0-164327801-1043092131=:77446
Content-Type: text/plain; charset=us-ascii


 

-----Original Message-----

From: AAEM [mailto:info@aaem.org] 

Have you made your plans for New Orleans yet? 

AAEM would like to organize a pre-conference outing to Oak Alley Plantation for Assembly attendees on Thursday February 20, 2003. Space will be limited to 49 attendees and will cost $85 per person. Participants will leave the hotel at 3:00pm and return by 9:00pm.

Located on the Mississippi River between the historic cities of New Orleans and Baton Rouge, Louisiana, Oak Alley Plantation has been called the "Grande Dame" of the Great River Road. Nowhere else in the South will you find such a spectacular setting! The 1/4 mile canopy of giant live oak trees, believed to be nearly 300 years old, forms an impressive avenue leading to the classic Greek-revival style antebellum home. 

The outing will include transportation to and from the plantation, a tour of the plantation, and a Cajun dinner buffet with open bar following the tour. Dinner will be served in a heated open-air pavilion in the back of the mansion. The cost for interested participants will be $85.00. Those interested should contact AAEM for more details. If you would like more information on Oak Alley you may visit their website at www.oakalleyplantation.com. 

Please register on-line at www.aaem.org or by calling 800-884-2236. *If a minimum of 30 participants do not register, AAEM reserves the right to cancel the tour. Anyone already signed up will be notified one week in advance.

AAEM

611 East Wells Street

Milwaukee, WI 53202

800-884-2236

Fax: 414-276-3349

E-mail: info@aaem.org

Website: www.aaem.org


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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<FONT size=2>
<P>&nbsp;</P>
<P>-----Original Message-----</P>
<P>From: AAEM [</FONT><A href="mailto:info@aaem.org"><U><FONT color=#0000ff size=2>mailto:info@aaem.org</U></FONT></A><FONT size=2>] </P>
<P>Have you made your plans for New Orleans yet? </P>
<P>AAEM would like to organize a pre-conference outing to Oak Alley Plantation for Assembly attendees on Thursday February 20, 2003. Space will be limited to 49 attendees and will cost $85 per person. Participants will leave the hotel at 3:00pm and return by 9:00pm.</P>
<P>Located on the Mississippi River between the historic cities of New Orleans and Baton Rouge, Louisiana, Oak Alley Plantation has been called the "Grande Dame" of the Great River Road. Nowhere else in the South will you find such a spectacular setting! The 1/4 mile canopy of giant live oak trees, believed to be nearly 300 years old, forms an impressive avenue leading to the classic Greek-revival style antebellum home. </P>
<P>The outing will include transportation to and from the plantation, a tour of the plantation, and a Cajun dinner buffet with open bar following the tour. Dinner will be served in a heated open-air pavilion in the back of the mansion. The cost for interested participants will be $85.00. Those interested should contact AAEM for more details. If you would like more information on Oak Alley you may visit their website at </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.oakalleyplantation.com"><U><FONT color=#0000ff size=2>www.oakalleyplantation.com</U></FONT></A><FONT size=2>. </P>
<P>Please register on-line at </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.aaem.org"><U><FONT color=#0000ff size=2>www.aaem.org</U></FONT></A><FONT size=2> or by calling 800-884-2236. *If a minimum of 30 participants do not register, AAEM reserves the right to cancel the tour. Anyone already signed up will be notified one week in advance.</P>
<P>AAEM</P>
<P>611 East Wells Street</P>
<P>Milwaukee, WI 53202</P>
<P>800-884-2236</P>
<P>Fax: 414-276-3349</P>
<P>E-mail: info@aaem.org</P>
<P>Website: </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.aaem.org"><U><FONT color=#0000ff size=2>www.aaem.org</U></FONT></A></P><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Wed Jan 22 03:43:08 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Tue, 21 Jan 2003 19:43:08 -0800 (PST)
Subject: Thomas Introduces Legislation To Halt Physician Payment Reductions, -and- STUDY SHOWS HEALTH CARE FOR MEDICARE BENEFICIARIES IS IMPROVING
Message-ID: <20030122034308.20669.qmail@web41506.mail.yahoo.com>

--0-286705617-1043206988=:17982
Content-Type: text/plain; charset=us-ascii


From: Jonathan Fishburn [mailto:jfishburn@aamc.org] 

AAMC WASHINGTON HEADLINES

Legislative and Regulatory News from the Association of American Medical Colleges

January 10, 2003

Thomas Introduces Legislation To Halt Physician Payment Reductions 



January 10, 2003 - Ways and Means Committee Chairman Bill Thomas (R-Calif.) Jan. 7 introduced legislation (H.J. Res. 3) that would prevent the 4.4 percent reduction to the CY 2003 Medicare conversion factor used to calculate physician payments. The joint resolution would "disapprove under the Congressional Review Act of 1996" the Dec. 31, 2002 final rule [67 FR 79966] that revised the Medicare physician fee schedule for CY 2003. Specifically, it would freeze the Medicare conversion factor for physician payments at the CY 2002 level for one year.

The Congressional Review Act of 1996 permits Congress to disapprove a rule issued by a federal agency. Unless action is taken, the Medicare conversion factor for physician payments will drop 4.4 percent on March 1, 2003. This would represent the second consecutive reduction in physician payments (5.4 percent cut in CY 2002).

In a published statement, Chairman Thomas expressed concern that Medicare beneficiaries' access to physician services "is threatened by the additional reductions included in the rule." In June 2002, the House passed a Medicare package (H.R. 4954) that included annual conversion factor increases of 2 percent for CYs 2003, 2004, and 2005. In his statement, Thomas criticized the previously Democrat-controlled Senate for failing to take up the issue before they adjourned in November.

Congress is expected to devote a great deal of January and February to debating an economic stimulus package, finalizing FY 2003 appropriations bills, and working on FY 2004 budget proposals. Subsequently, the House and Senate might not act on H.J. Res. 3 before the CY 2003 payment update is implemented. However, provisions within the Congressional Review Act could potentially expedite the legislative process and halt the reductions before March. 

Information:

Christiane Mitchell, Senior Legislative Analyst

AAMC Office of Governmental Relations

cmitchell@aamc.org

(202) 828-0526 

==============================================

-----Original Message-----

To: Recipients of HHS_CMS_PRESS digests

MEDICARE NEWS -- FOR IMMEDIATE RELEASE

CMS Public Affairs Office

Tuesday, January 14, 2003

STUDY SHOWS HEALTH CARE FOR MEDICARE BENEFICIARIES IS IMPROVING: Progress Has Been Made, But More Work Needs to Be Done

Medical care for Medicare beneficiaries improved significantly since 1998, according to a study from the Centers for Medicare & Medicaid Services (CMS) that is published today in the Journal of the American Medical Association. Nevertheless, the study reports that more than a quarter of Medicare beneficiaries still do not receive services that could protect them from disease or prolong life.

The study is the first since a baseline of health care quality was established by a CMS survey published in 2000. It compares current quality of care conditions with those measured in the 1998-1999 study and shows improvement across the board.

The original study of 22 health care measures related to primary prevention, secondary prevention, and/or treatment of six medical conditions, found that the typical beneficiary had a 69 percent chance of receiving care that was appropriate on the typical measure; in 2000-2001 that chance had risen to 73 percent. (If all patients received appropriate care, the rate would be 100 percent.)

"This report shows we're making important progress on quality health care delivery," said HHS Secretary Tommy G. Thompson. "Medicare beneficiaries deserve high quality care -- and more. They deserve a stronger Medicare program with high quality, meaningful choice and effective coverage. They deserve prescription drug coverage, and preventive services that are often already available to those under 65. This administration has taken unprecedented steps to improve quality of care, and our efforts are working. We will continue those efforts as we move ahead to modernize and strengthen Medicare."

HHS and CMS launched the National Nursing Home Quality Initiative in November, 2002 to make quality of care information about the nation's nursing homes available and in 2003 will report similar information for in home health agencies. HHS has also joined with hospitals, consumers, the National Quality Forum and others to begin to develop the public reporting of quality measures for hospitals. That project includes a three-state pilot project and a standardized patient experience survey instrument.

"Progress is taking place and we are accelerating that progress through the publication of this article and the launch of these public reporting initiatives," Tom Scully, CMS Administrator.

The study provides data for individual states as well as for the entire United States and shows that in 2000-2001 beneficiaries in some states were consistently more likely than those in other States to receive these vital services. The pattern of differences among states changed little over the 2 years. The article does not, however, report information on individual hospitals or doctors, which is not currently available.

The gap between care delivered and the care that could be delivered is generally much greater than the differences among states. "It's important to look at these findings as pointing to areas for further improvement for all states, because even the best-performing States have large opportunities to improve," said Stephen F. Jencks, M.D., Assistant Surgeon General and the senior author of the study. "The problem is not bad physicians, bad nurses, or bad hospitals; it is a broken health care system that allows too many patients to fall through the cracks."

In an accompanying editorial, Dr. David Hsia describes the study as "valid, robust, understandable, and correct." He emphasizes the importance of improving health care systems rather than blaming individuals.

The study includes quality indicators for inpatient care, such as whether a patient with pneumonia received prompt treatment, and office-based care, such as whether diabetic patients got appropriate care. In particular, nine of the ten measures recently endorsed by hospital associations for voluntary public reporting are included.

The data for the study was collected by the Medicare Quality Improvement Organizations Program, whose mission is to improve care for Medicare beneficiaries. The Program abstracted more than a quarter million hospital records, analyzed bills, and surveyed beneficiaries in order to measure performance of the health care system.

SOME SPECIFIC RESULTS:

* For inpatient care,

1. The percentage of patients receiving beta-blockers at hospital discharge, which reduce complications and death in patients who have had a heart attack, rose from 72% of appropriate patients to 79%,

2. The percentage of patients receiving an effective combination of antibiotics for pneumonia rose from 79 percent to 85%

a. The percentage of patients with high blood pressure and acute stroke who received medication to decrease blood pressure (an inappropriate treatment) dropped from 3% to 1%.

b. No more patients with pneumonia had their blood cultured for bacteria before they received antibiotics in 2000-2001 (82 percent) than in 1998-1999.

c. And, though screening of pneumonia patients for influenza and pneumococcal vaccination improved substantially, only a quarter of patients were being screened in 2000-2001.

3. For outpatient care

a. The percentage of diabetic patients screened for cholesterol problems rose from 56% to 74%

b. The percentage of patients immunized against pneumococcus (a bacterium that causes both pneumonia and devastating bloodstream infections) rose from 55% to 65%

c. The percentage of diabetics who received appropriate eye exams to help prevent blindness increased from 68 to 70 percent.

The study is the first to track a large number of quality indicators over time at national and State levels. It foreshadows the National Quality Report, a more general report on quality of healthcare in the United States that the Department of Health and Human Services will publish in September of this year.

HHS, CMS, the QIOs, the American Medical Association, the American Hospital Association and others will continue to use this data to find ways to improve the quality of care provided to Medicare beneficiaries, as well as identifying additional opportunities to publicly report quality information.

 


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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Content-Type: text/html; charset=us-ascii

<FONT size=2>
<P>From: Jonathan Fishburn [</FONT><A href="mailto:jfishburn@aamc.org"><U><FONT color=#0000ff size=2>mailto:jfishburn@aamc.org</U></FONT></A><FONT size=2>] </P>
<P>AAMC WASHINGTON HEADLINES</P>
<P>Legislative and Regulatory News&nbsp;from the Association of American Medical Colleges</P>
<P>January 10, 2003</P>
<P>Thomas Introduces Legislation To Halt Physician Payment Reductions </P>
<P></P>
<P>January 10, 2003 - Ways and Means Committee Chairman Bill Thomas (R-Calif.) Jan. 7 introduced legislation (H.J. Res. 3) that would prevent the 4.4 percent reduction to the CY 2003 Medicare conversion factor used to calculate physician payments. The joint resolution would "disapprove under the Congressional Review Act of 1996" the Dec. 31, 2002 final rule [67 FR 79966] that revised the Medicare physician fee schedule for CY 2003. Specifically, it would freeze the Medicare conversion factor for physician payments at the CY 2002 level for one year.</P>
<P>The Congressional Review Act of 1996 permits Congress to disapprove a rule issued by a federal agency. Unless action is taken, the Medicare conversion factor for physician payments will drop 4.4 percent on March 1, 2003. This would represent the second consecutive reduction in physician payments (5.4 percent cut in CY 2002).</P>
<P>In a published statement, Chairman Thomas expressed concern that Medicare beneficiaries' access to physician services "is threatened by the additional reductions included in the rule." In June 2002, the House passed a Medicare package (H.R. 4954) that included annual conversion factor increases of 2 percent for CYs 2003, 2004, and 2005. In his statement, Thomas criticized the previously Democrat-controlled Senate for failing to take up the issue before they adjourned in November.</P>
<P>Congress is expected to devote a great deal of January and February to debating an economic stimulus package, finalizing FY 2003 appropriations bills, and working on FY 2004 budget proposals. Subsequently, the House and Senate might not act on H.J. Res. 3 before the CY 2003 payment update is implemented. However, provisions within the Congressional Review Act could potentially expedite the legislative process and halt the reductions before March. </P>
<P>Information:</P>
<P>Christiane Mitchell, Senior Legislative Analyst</P>
<P>AAMC Office of Governmental Relations</P>
<P>cmitchell@aamc.org</P>
<P>(202) 828-0526 </P>
<P>==============================================</P><FONT size=2>
<P>-----Original Message-----</FONT><FONT size=2></P>
<P>To: Recipients of HHS_CMS_PRESS digests</P>
<P>MEDICARE NEWS -- FOR IMMEDIATE RELEASE</P>
<P>CMS Public Affairs Office</P>
<P>Tuesday, January 14, 2003</P>
<P>STUDY SHOWS HEALTH CARE FOR MEDICARE BENEFICIARIES IS IMPROVING: Progress Has Been Made, But More Work Needs to Be Done</P>
<P>Medical care for Medicare beneficiaries improved significantly since 1998, according to a study from the Centers for Medicare &amp; Medicaid Services (CMS) that is published today in the Journal of the American Medical Association. Nevertheless, the study reports that more than a quarter of Medicare beneficiaries still do not receive services that could protect them from disease or prolong life.</P>
<P>The study is the first since a baseline of health care quality was established by a CMS survey published in 2000. It compares current quality of care conditions with those measured in the 1998-1999 study and shows improvement across the board.</P>
<P>The original study of 22 health care measures related to primary prevention, secondary prevention, and/or treatment of six medical conditions, found that the typical beneficiary had a 69 percent chance of receiving care that was appropriate on the typical measure; in 2000-2001 that chance had risen to 73 percent. (If all patients received appropriate care, the rate would be 100 percent.)</P>
<P>"This report shows we're making important progress on quality health care delivery," said HHS Secretary Tommy G. Thompson. "Medicare beneficiaries deserve high quality care -- and more. They deserve a stronger Medicare program with high quality, meaningful choice and effective coverage. They deserve prescription drug coverage, and preventive services that are often already available to those under 65. This administration has taken unprecedented steps to improve quality of care, and our efforts are working. We will continue those efforts as we move ahead to modernize and strengthen Medicare."</P>
<P>HHS and CMS launched the National Nursing Home Quality Initiative in November, 2002 to make quality of care information about the nation's nursing homes available and in 2003 will report similar information for in home health agencies. HHS has also joined with hospitals, consumers, the National Quality Forum and others to begin to develop the public reporting of quality measures for hospitals. That project includes a three-state pilot project and a standardized patient experience survey instrument.</P>
<P>"Progress is taking place and we are accelerating that progress through the publication of this article and the launch of these public reporting initiatives," Tom Scully, CMS Administrator.</P>
<P>The study provides data for individual states as well as for the entire United States and shows that in 2000-2001 beneficiaries in some states were consistently more likely than those in other States to receive these vital services. The pattern of differences among states changed little over the 2 years. The article does not, however, report information on individual hospitals or doctors, which is not currently available.</P>
<P>The gap between care delivered and the care that could be delivered is generally much greater than the differences among states. "It's important to look at these findings as pointing to areas for further improvement for all states, because even the best-performing States have large opportunities to improve," said Stephen F. Jencks, M.D., Assistant Surgeon General and the senior author of the study. "The problem is not bad physicians, bad nurses, or bad hospitals; it is a broken health care system that allows too many patients to fall through the cracks."</P>
<P>In an accompanying editorial, Dr. David Hsia describes the study as "valid, robust, understandable, and correct." He emphasizes the importance of improving health care systems rather than blaming individuals.</P>
<P>The study includes quality indicators for inpatient care, such as whether a patient with pneumonia received prompt treatment, and office-based care, such as whether diabetic patients got appropriate care. In particular, nine of the ten measures recently endorsed by hospital associations for voluntary public reporting are included.</P>
<P>The data for the study was collected by the Medicare Quality Improvement Organizations Program, whose mission is to improve care for Medicare beneficiaries. The Program abstracted more than a quarter million hospital records, analyzed bills, and surveyed beneficiaries in order to measure performance of the health care system.</P>
<P>SOME SPECIFIC RESULTS:</P>
<P>* For inpatient care,</P>
<P>1. The percentage of patients receiving beta-blockers at hospital discharge, which reduce complications and death in patients who have had a heart attack, rose from 72% of appropriate patients to 79%,</P>
<P>2. The percentage of patients receiving an effective combination of antibiotics for pneumonia rose from 79 percent to 85%</P>
<P>a. The percentage of patients with high blood pressure and acute stroke who received medication to decrease blood pressure (an inappropriate treatment) dropped from 3% to 1%.</P>
<P>b. No more patients with pneumonia had their blood cultured for bacteria before they received antibiotics in 2000-2001 (82 percent) than in 1998-1999.</P>
<P>c. And, though screening of pneumonia patients for influenza and pneumococcal vaccination improved substantially, only a quarter of patients were being screened in 2000-2001.</P>
<P>3. For outpatient care</P>
<P>a. The percentage of diabetic patients screened for cholesterol problems rose from 56% to 74%</P>
<P>b. The percentage of patients immunized against pneumococcus (a bacterium that causes both pneumonia and devastating bloodstream infections) rose from 55% to 65%</P>
<P>c. The percentage of diabetics who received appropriate eye exams to help prevent blindness increased from 68 to 70 percent.</P>
<P>The study is the first to track a large number of quality indicators over time at national and State levels. It foreshadows the National Quality Report, a more general report on quality of healthcare in the United States that the Department of Health and Human Services will publish in September of this year.</P>
<P>HHS, CMS, the QIOs, the American Medical Association, the American Hospital Association and others will continue to use this data to find ways to improve the quality of care provided to Medicare beneficiaries, as well as identifying additional opportunities to publicly report quality information.</P>
<P>&nbsp;</P></FONT></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Wed Jan 22 20:04:09 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 22 Jan 2003 12:04:09 -0800 (PST)
Subject: FW: WSJ.com - Marcus Welby Doesn't  Live Here Anymore (Great Read forwarded by Dr. Durkin)
Message-ID: <20030122200409.76990.qmail@web41508.mail.yahoo.com>

--0-1393127487-1043265849=:76939
Content-Type: text/plain; charset=us-ascii


WONDER LAND 

By DANIEL HENNINGER



Marcus Welby Doesn't Live Here Anymore

There was a time in the annals of medicine when the most famous doctor in America was Marcus Welby, M.D. But if you are under 30, you've likely never heard of Marcus Welby. If you are under 30, you've probably never encountered a doctor remotely like the beloved Marcus Welby.

Marcus Welby, of course, wasn't real. Played by actor Robert Young, Dr. Welby -- caring, wise, beloved, willing to move mountains for one patient -- was the central character in a very popular TV series from 1969 to 1976. Real doctors often chided Robert Young for creating a model of overtime compassion that no mortal doc could live up to.

Lyndon Johnson created Medicare four years before the series began, and by the time Marcus Welby retired in the mid-'70s, the American health-care system was in a cost crisis, driven by Medicare spending, inflation, subsidized hospital construction and a golden age of medical technology, such as the mysterious MRI machine. Richard Nixon officially birthed a new word everyone knows: HMO.

Today the "crisis" in health care continues without end, in large part because incumbent politicians are addicted to its continuance. This year the mess will be much in the news because many corporate providers of medical insurance will ask their employees to pay more for health care. Next week, unions at General Electric will strike for two days to protest G.E.'s $200 increase in co-payments. GE says that in 2001 it spent $1.4 billion on its workers' medical needs, which is indeed a lot of money.

Everyone's got a gripe about this subject, and this week the federal government poured its own can of gasoline into the cauldron with a report on 2001's spending Vesuvius. The average outlay on health care by every person in the U.S. was $5,035. Total outlays on doctors and their services: $313.6 billion. On hospitals: $451.2 billion. On drugs: $140.6 billion.

[welby]Marcus Welby, M.D.

Interestingly, the rise in total outlays was not mainly because costs rose but for the quantity of medical care used. There is no other explanation: For Americans, consuming medicine and health has become a major pastime.

When politicians and policy makers meet now to talk about health care in America, they discuss it almost wholly as an interplay of economics, money and insurance. Theirs is a world of utilization rates, first-dollar coverage, provider profiles, outcomes and other such arcana. But for all the effort, if you look at the way we pay for health care today, there has been little real innovation around the subject in more than 100 years.

We live amid an unimaginable cornucopia of medical opportunities, but our relationship to the medical industry hasn't changed in its essential features since Otto von Bismarck mandated health insurance for Germans in the 19th century. We don't light our homes with kerosene anymore, but we still consume medicine the old-fashioned way: We buy some medicine from a doctor or hospital, who sends us a bill, which we or they send to someone somewhere else, and this someone somehow pays for whatever medicine we "bought."

For a hundred years this is the only thing in life that's been paid for by the Tooth Fairy -- whether Medicare, Medicaid or private insurance companies. So how can it surprise anyone that the average American asks the Tooth Fairy to buy them, every year, more than $5,000 of medicine's wonderful products? Politicians may profess to be appalled, but surely no one is shocked that Medicare and Medicaid are crushing public budgets. Not a single consumer of medicine has the faintest clue what the "budget" for medicine is, and therefore no stake in using the system prudently.

Until the era of modern medicine, this system made some sense. Doc Welby knew pretty much everything medicine knew about disease and injury, which relative to today wasn't much. When you got sick, he administered what medical knowledge existed, and for most of this century the most potent thing in his black bag was penicillin. If what he knew didn't work, you gutted it out and either survived or died of myriad infections and ailments, mostly heart disease. Simple insurance paid simple bills because medicine, most of the time, wasn't complicated. The system worked.

There is no need to detail here the explosion in medical knowledge, pharmaceuticals and technology the past 40 years. It is one of the wonders of all history. Less noticed, I think, is what the suddenly marvelous world of medicine has done to create a culture of health. Before, we didn't think about it, until we got sick and went to see Doc Welby. Today we in the middle class think about our health all the time. It's still about life and death -- but it's also a "lifestyle issue."

Back then, you got old and sat home for 20 years bellyaching about sore joints. Now that WebMD has tutored you in osteoarthritis, you take Vioxx, consume Omega-3 via flaxseed oil and work out to be healthy enough to take this year's second vacation in -- how about Beijing? The Vitamin Shoppe and GNC are filled with the same people who pant in health clubs the way people once worshipped God in church pews. Staying well was fine in the old days, but now you've got to stay better than well if you want to keep cycling, jogging, rock-climbing, golfing or whatever it takes to be all that you can be. In this world, going to the doctor is a pit stop. And the data suggests we spend a lot of time asking doctors to give us valve jobs, new wheels and better lubricants so that we can, as we're told, "stay active." And why not? No one anymore says: "Gotta go sometime." There's too much to live for now.

This is not meant to belittle the deadly seriousness of extreme illness or its cost. But it is meant to belittle both Congress and corporations that think yet another variation of Count Bismarck's original Tooth Fairy system of medical insurance is appropriate for a society that has both mapped the human genome and discovered the benefits of St. John's wort.

Updated January 10, 2003


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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Content-Type: text/html; charset=us-ascii

<FONT size=2>
<P>WONDER LAND </P>
<P>By DANIEL HENNINGER</P>
<P></P>
<P>Marcus Welby Doesn't Live Here Anymore</P>
<P>There was a time in the annals of medicine when the most famous doctor in America was Marcus Welby, M.D. But if you are under 30, you've likely never heard of Marcus Welby. If you are under 30, you've probably never encountered a doctor remotely like the beloved Marcus Welby.</P>
<P>Marcus Welby, of course, wasn't real. Played by actor Robert Young, Dr. Welby -- caring, wise, beloved, willing to move mountains for one patient -- was the central character in a very popular TV series from 1969 to 1976. Real doctors often chided Robert Young for creating a model of overtime compassion that no mortal doc could live up to.</P>
<P>Lyndon Johnson created Medicare four years before the series began, and by the time Marcus Welby retired in the mid-'70s, the American health-care system was in a cost crisis, driven by Medicare spending, inflation, subsidized hospital construction and a golden age of medical technology, such as the mysterious MRI machine. Richard Nixon officially birthed a new word everyone knows: HMO.</P>
<P>Today the "crisis" in health care continues without end, in large part because incumbent politicians are addicted to its continuance. This year the mess will be much in the news because many corporate providers of medical insurance will ask their employees to pay more for health care. Next week, unions at General Electric will strike for two days to protest G.E.'s $200 increase in co-payments. GE says that in 2001 it spent $1.4 billion on its workers' medical needs, which is indeed a lot of money.</P>
<P>Everyone's got a gripe about this subject, and this week the federal government poured its own can of gasoline into the cauldron with a report on 2001's spending Vesuvius. The average outlay on health care by every person in the U.S. was $5,035. Total outlays on doctors and their services: $313.6 billion. On hospitals: $451.2 billion. On drugs: $140.6 billion.</P>
<P>[welby]Marcus Welby, M.D.</P>
<P>Interestingly, the rise in total outlays was not mainly because costs rose but for the quantity of medical care used. There is no other explanation: For Americans, consuming medicine and health has become a major pastime.</P>
<P>When politicians and policy makers meet now to talk about health care in America, they discuss it almost wholly as an interplay of economics, money and insurance. Theirs is a world of utilization rates, first-dollar coverage, provider profiles, outcomes and other such arcana. But for all the effort, if you look at the way we pay for health care today, there has been little real innovation around the subject in more than 100 years.</P>
<P>We live amid an unimaginable cornucopia of medical opportunities, but our relationship to the medical industry hasn't changed in its essential features since Otto von Bismarck mandated health insurance for Germans in the 19th century. We don't light our homes with kerosene anymore, but we still consume medicine the old-fashioned way: We buy some medicine from a doctor or hospital, who sends us a bill, which we or they send to someone somewhere else, and this someone somehow pays for whatever medicine we "bought."</P>
<P>For a hundred years this is the only thing in life that's been paid for by the Tooth Fairy -- whether Medicare, Medicaid or private insurance companies. So how can it surprise anyone that the average American asks the Tooth Fairy to buy them, every year, more than $5,000 of medicine's wonderful products? Politicians may profess to be appalled, but surely no one is shocked that Medicare and Medicaid are crushing public budgets. Not a single consumer of medicine has the faintest clue what the "budget" for medicine is, and therefore no stake in using the system prudently.</P>
<P>Until the era of modern medicine, this system made some sense. Doc Welby knew pretty much everything medicine knew about disease and injury, which relative to today wasn't much. When you got sick, he administered what medical knowledge existed, and for most of this century the most potent thing in his black bag was penicillin. If what he knew didn't work, you gutted it out and either survived or died of myriad infections and ailments, mostly heart disease. Simple insurance paid simple bills because medicine, most of the time, wasn't complicated. The system worked.</P>
<P>There is no need to detail here the explosion in medical knowledge, pharmaceuticals and technology the past 40 years. It is one of the wonders of all history. Less noticed, I think, is what the suddenly marvelous world of medicine has done to create a culture of health. Before, we didn't think about it, until we got sick and went to see Doc Welby. Today we in the middle class think about our health all the time. It's still about life and death -- but it's also a "lifestyle issue."</P>
<P>Back then, you got old and sat home for 20 years bellyaching about sore joints. Now that WebMD has tutored you in osteoarthritis, you take Vioxx, consume Omega-3 via flaxseed oil and work out to be healthy enough to take this year's second vacation in -- how about Beijing? The Vitamin Shoppe and GNC are filled with the same people who pant in health clubs the way people once worshipped God in church pews. Staying well was fine in the old days, but now you've got to stay better than well if you want to keep cycling, jogging, rock-climbing, golfing or whatever it takes to be all that you can be. In this world, going to the doctor is a pit stop. And the data suggests we spend a lot of time asking doctors to give us valve jobs, new wheels and better lubricants so that we can, as we're told, "stay active." And why not? No one anymore says: "Gotta go sometime." There's too much to live for now.</P>
<P>This is not meant to belittle the deadly seriousness of extreme illness or its cost. But it is meant to belittle both Congress and corporations that think yet another variation of Count Bismarck's original Tooth Fairy system of medical insurance is appropriate for a society that has both mapped the human genome and discovered the benefits of St. John's wort.</P>
<P>Updated January 10, 2003</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From akazzi@UCI.EDU  Thu Jan 23 18:21:36 2003
From: akazzi@UCI.EDU (Kazzi, A. Antoine)
Date: Thu, 23 Jan 2003 10:21:36 -0800
Subject: Bush Abandons Rule On Limiting ER Use (Two articles)
Message-ID: <59CDD9FF884EAE4AB86132E86110D72201EAB1A1@wicket.ndc.mc.uci.edu>

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-----Original Message-----
From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 
Sent: Thursday, January 23, 2003 10:02 AM



 


Bush Administration Reverses Decision on Limits on Medicaid Emergency
Service 


01/23/2003 

 


 

 


The Bush administration yesterday reversed a recent decision that would have
allowed states to limit some emergency services for Medicaid beneficiaries,
the Wall Street Journal reports (Lueck, Wall Street Journal, 1/23). In a
letter last month to state Medicaid directors, the Bush administration said
that managed care organizations can limit and restrict coverage of emergency
services for Medicaid beneficiaries. The decision would have removed
restrictions established in the 1997 Balanced Budget Act and in rules issued
by the Clinton administration in January 2001 and by the Bush administration
in June 2002. Under the 1997 law, states can require Medicaid beneficiaries
to enroll in HMOs or other MCOs. However, the law requires MCOs to provide
coverage for emergency services in cases that a "prudent layperson" would
consider an emergency. The law also allows Medicaid beneficiaries enrolled
in MCOs to have access to emergency services "immediately at the nearest
provider." The administration said the decision would have allowed states to
place certain limits on coverage of emergency services "to facilitate more
appropriate use of preventive care and primary care" (
<http://www.californiahealthline.org/members/basecontent.asp?contentid=47720
&collectionid=3&program=1&contentarea=21729%20> California Healthline,
1/17). Republican and Democratic Senate aides criticized the decision, which
they said could affect the ability of Medicaid beneficiaries to access
"rapid care" in an emergency. In addition, Sen. Bob Graham (D-Fla.) had
planned to ask the Senate to vote to overturn the decision (Goldstein,
<http://www.washingtonpost.com/wp-dyn/articles/A30202-2003Jan22.html>
Washington Post, 1/23). Senate aides said that lawmakers would have
overturned the decision (Pear,
<http://www.nytimes.com/2003/01/23/politics/23HEAL.html> New York Times,
1/23). In a letter to Senate Finance Committee Chair Charles Grassley
(R-Iowa), CMS Administrator Tom Scully said that the administration reversed
the decision to end the dispute over a "rather overblown issue." The
reversal "delighted" a number of lawmakers from both parties, as well as
health care advocacy groups, the Post reports (Washington Post, 1/23). 

 

 

 

Bush Abandons Rule On Limiting ER Use 
Congress Fought Medicaid Regulation 


 


 




By Amy Goldstein
Washington Post Staff Writer
Thursday, January 23, 2003; Page A03 

The Bush administration yesterday abandoned a rule it had issued a month ago
that allowed states to limit the use of hospital emergency rooms by patients
on Medicaid, acquiescing to fierce opposition from members of Congress and
advocates for the poor.

In a letter sent late yesterday to leaders of the Senate Finance Committee,
the top federal administrator who oversees Medicaid wrote that "we are
rescinding" the rule, which essentially undercut a basic protection that
Congress had guaranteed every Medicaid patient in managed care.

The abrupt pivot came a day after Republican and Democratic Senate aides
protested restrictions on emergency room use at a meeting with
administration health officials -- and hours before a Democratic senator had
planned to seek a Senate vote to try to overturn it. The shift also comes
just a week before President Bush intends to ask Congress to make expensive
and controversial changes to other aspects of federal health policy, notably
Medicare, the other large public insurance program, which covers the
elderly.

The letter's author, Thomas A. Scully, administrator of the Centers for
Medicare and Medicaid Services, said the administration was eager to defuse
a dispute over what he called the "rather overblown issue" of emergency room
use by Medicaid patients, at a time when "we are trying to get a lot of
stuff done."

"We weren't troubled by the policy. We were troubled by the controversy it
caused," Scully said in an interview. "We want to get off to a friendly,
happy, bipartisan start of the year. This clearly wasn't doing it."

A White House official said the president's aides were aware of the agency's
latest decision and supported it.

The pivot delighted senators and House members of both political parties,
along with outside consumer health lobbyists, who had said the rule might
impede the ability of some of the nation's neediest patients to get rapid
care when they need it. "Hallelujah!" said Ron Pollack, executive director
of Families USA, a liberal health care lobby, who had said late last week
that opponents were preparing to contest the policy in federal court.

Sen. Bob Graham (D-Fla.), who sponsored the emergency room protection and
had been preparing to ask for the Senate vote last night, praised the
administration for changing its position. "Returning to the original
standard will not only protect coverage for Medicaid patients, it will save
lives," Graham said. Sen. Edward M. Kennedy (D-Mass.) was more pointed,
saying in a statement that "it is unconscionable that the administration
would have issued and defended this policy in the first place."

The reversal ends a brief, and unusual, episode in the history of Medicaid,
a program shared by the federal government and states that provides
insurance to 37 million poor or disabled people. The rule had the potential
to affect as many as 23 million Medicaid patients who are required by states
to belong to health maintenance organizations or other forms of managed
care.

Already, states are permitted to restrict payments for use of emergency
rooms by people under "fee for service" Medicaid, in which patients choose
whatever doctors they want. But under a 1997 law, intended to protect the
increasing proportion of Medicaid patients in managed care, states must pay
for emergency room services whenever a "prudent layperson" could reasonably
think they have a true medical emergency. The rule, issued in late December,
reinterpreted that law.

The change was odd because the nation's governors and Medicaid directors had
not requested it, even though they lobby often for other kinds of freedom to
run their Medicaid programs -- and many of them lately have been leaning
hard, and unsuccessfully, on the administration for financial help with
Medicaid deficits.

Gregory A. Vadner, vice chairman of the National Association of State
Medicaid Directors, said the reversal would have little practical effect
because states had not begun planning to restrict emergency room use based
on the administration's rule. "Really, in the big scheme of things, I don't
think it will be something that all the states will be greatly disappointed
about," said Vadner, Missouri's Medicaid director.

When members of Congress began to protest last week, administration
officials defended their decision by saying their new policy would create
equal rules for all Medicaid patients, regardless of whether they were in
managed care. The administration also said the rule was an attempt to curb
reliance on emergency rooms for routine care that is more efficient -- and
economical -- for them to get in doctors' offices.

In yesterday's letter to Senate Finance Committee Chairman Charles E.
Grassley (R-Iowa) and the ranking member, Sen. Max Baucus (D-Mont.), Scully
said the administration wanted to work with Congress to find other ways of
discouraging unnecessary use of emergency rooms.

(c) 2003 The Washington Post Company

 



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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b> California Healthline
[mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] <br>
<b><span style='font-weight:bold'>Sent:</span></b> </span></font>Thursday, January 23, 2003 10:02 AM<br>
<br>
</p>

<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
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  <p class=MsoNormal><b><font size=2 color=black face=Arial><span
  style='font-size:10.5pt;font-family:Arial;color:black;font-weight:bold'>Bush
  Administration Reverses Decision on Limits on Medicaid Emergency Service </span></font></b></p>
  </td>
 </tr>
 <tr>
  <td style='padding:1.5pt 1.5pt 1.5pt 1.5pt'>
  <p class=MsoNormal><i><font size=1 color=black face=Arial><span
   style='font-size:9.0pt;font-family:Arial;color:black;font-style:italic'>01/23/2003</span></font></i><font
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<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
9.0pt;font-family:Arial;color:black;display:none'>&nbsp;</span></font></p>

<table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%"
 style='width:100.0%'>
 <tr>
  <td style='padding:1.5pt 1.5pt 1.5pt 1.5pt'>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
  </td>
 </tr>
</table>

<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
9.0pt;font-family:Arial;color:black;display:none'>&nbsp;</span></font></p>

<table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%"
 style='width:100.0%'>
 <tr>
  <td style='padding:1.5pt 1.5pt 1.5pt 1.5pt'>
  <div>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>The Bush administration
  yesterday reversed a recent decision that would have allowed states to limit
  some emergency services for Medicaid beneficiaries, the <cite><i><font
  face=Arial><span style='font-family:Arial'>Wall Street Journal</span></font></i></cite>
  reports (Lueck, <cite><i><font face=Arial><span style='font-family:Arial'>Wall
  Street Journal</span></font></i></cite>, 1/23). In a letter last month to
  state Medicaid directors, the Bush administration said that managed care
  organizations can limit and restrict coverage of emergency services for Medicaid
  beneficiaries. The decision would have removed restrictions established in
  the 1997 Balanced Budget Act and in rules issued by the </span></font><font
    size=1 color=black face=Arial><span style='font-size:9.0pt;font-family:
    Arial;color:black'>Clinton</span></font><font size=1 color=black
  face=Arial><span style='font-size:9.0pt;font-family:Arial;color:black'>
  administration in January 2001 and by the Bush administration in June 2002.
  Under the 1997 law, states can require Medicaid beneficiaries to enroll in
  HMOs or other MCOs. However, the law requires MCOs to provide coverage for
  emergency services in cases that a &quot;prudent layperson&quot; would
  consider an emergency. The law also allows Medicaid beneficiaries enrolled in
  MCOs to have access to emergency services &quot;immediately at the nearest
  provider.&quot; The administration said the decision would have allowed
  states to place certain limits on coverage of emergency services &quot;to
  facilitate more appropriate use of preventive care and primary care&quot; (<a
  href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47720&amp;collectionid=3&amp;program=1&amp;contentarea=21729%20"
  target=blank><cite><i><font face=Arial><span style='font-family:Arial'>California
  Healthline</span></font></i></cite></a>, 1/17). Republican and Democratic
  Senate aides criticized the decision, which they said could affect the
  ability of Medicaid beneficiaries to access &quot;rapid care&quot; in an
  emergency. In addition, Sen. Bob Graham (D-Fla.) had planned to ask the
  Senate to vote to overturn the decision (</span></font><font size=1
    color=black face=Arial><span style='font-size:9.0pt;font-family:Arial;
    color:black'>Goldstein</span></font><font size=1 color=black face=Arial><span
   style='font-size:9.0pt;font-family:Arial;color:black'>, <a
   href="http://www.washingtonpost.com/wp-dyn/articles/A30202-2003Jan22.html"
   target=blank><cite><i><font face=Arial><span style='font-family:Arial'>Washington</span></font></i></cite><cite><i><font
  face=Arial><span style='font-family:Arial'> Post</span></font></i></cite></a>,
  1/23). Senate aides said that lawmakers would have overturned the decision
  (Pear, <a href="http://www.nytimes.com/2003/01/23/politics/23HEAL.html"
  target=blank><cite><i><font face=Arial><span style='font-family:Arial'>New
  York Times</span></font></i></cite></a>, 1/23). In a letter to Senate Finance
  Committee Chair Charles Grassley (R-Iowa), CMS Administrator Tom Scully said
  that the administration reversed the decision to end the dispute over a
  &quot;rather overblown issue.&quot; The reversal &quot;delighted&quot; a
  number of lawmakers from both parties, as well as health care advocacy
  groups, the <cite><i><font face=Arial><span style='font-family:Arial'>Post</span></font></i></cite>
  reports (<cite><i><font face=Arial><span style='font-family:Arial'>Washington
  Post</span></font></i></cite>, 1/23). </span></font></p>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
  </div>
  <p class=MsoNormal><font size=1 color=black face=Arial><span
  style='font-size:9.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
  </td>
 </tr>
</table>

<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
9.0pt;font-family:Arial;color:black;display:none'>&nbsp;</span></font></p>

<p class=MsoNormal><b><font size=4 color=black face=Arial><span
style='font-size:13.5pt;font-family:Arial;color:black;font-weight:bold'>Bush
Abandons Rule On Limiting ER Use </span></font></b><font size=2 color=black
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:black'><br>
Congress Fought Medicaid Regulation </span></font></p>

<table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 align=right>
 <tr>
  <td width=17 style='width:12.75pt;padding:0in 0in 0in 0in'>
  <p class=MsoNormal><font size=2 color=black face=Arial><span
  style='font-size:10.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
  </td>
  <td style='padding:0in 0in 0in 0in'>
  <div align=center>
  <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width=228
   style='width:171.0pt'>
   <tr>
    <td width=228 valign=top style='width:171.0pt;padding:0in 0in 0in 0in'>
    <p class=MsoNormal><font size=2 color=black face=Arial><span
    style='font-size:10.0pt;font-family:Arial;color:black'>&nbsp;</span></font></p>
    </td>
   </tr>
  </table>
  </div>
  <p class=MsoNormal align=center style='text-align:center'><font size=2
  color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
  color:black'><br clear=all>
  </span></font></p>
  </td>
 </tr>
</table>

<p class=MsoNormal><i><font size=2 color=black face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:black;font-style:italic'>By Amy
Goldstein</span></font></i><font size=2 color=black face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:black'><br>
</span></font><font size=2 color=black face=Arial><span style='font-size:10.0pt;
  font-family:Arial;color:black'>Washington</span></font><font size=2
color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'> Post Staff Writer<br>
Thursday, </span></font><font size=2 color=black face=Arial><span
 style='font-size:10.0pt;font-family:Arial;color:black'>January 23, 2003</span></font><font
size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'>; Page A03 </span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The Bush administration yesterday
abandoned a rule it had issued a month ago that allowed states to limit the use
of hospital emergency rooms by patients on Medicaid, acquiescing to fierce
opposition from members of Congress and advocates for the poor.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>In a letter sent late yesterday to
leaders of the Senate Finance Committee, the top federal administrator who
oversees Medicaid wrote that &quot;we are rescinding&quot; the rule, which
essentially undercut a basic protection that Congress had guaranteed every
Medicaid patient in managed care.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The abrupt pivot came a day after
Republican and Democratic Senate aides protested restrictions on emergency room
use at a meeting with administration health officials -- and hours before a
Democratic senator had planned to seek a Senate vote to try to overturn it. The
shift also comes just a week before President Bush intends to ask Congress to
make expensive and controversial changes to other aspects of federal health
policy, notably Medicare, the other large public insurance program, which
covers the elderly.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The letter's author, Thomas A. Scully,
administrator of the Centers for Medicare and Medicaid Services, said the
administration was eager to defuse a dispute over what he called the
&quot;rather overblown issue&quot; of emergency room use by Medicaid patients,
at a time when &quot;we are trying to get a lot of stuff done.&quot;</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>&quot;We weren't troubled by the policy.
We were troubled by the controversy it caused,&quot; Scully said in an
interview. &quot;We want to get off to a friendly, happy, bipartisan start of
the year. This clearly wasn't doing it.&quot;</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>A White House official said the
president's aides were aware of the agency's latest decision and supported it.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The pivot delighted senators and House
members of both political parties, along with outside consumer health
lobbyists, who had said the rule might impede the ability of some of the
nation's neediest patients to get rapid care when they need it.
&quot;Hallelujah!&quot; said Ron Pollack, executive director of Families USA, a
liberal health care lobby, who had said late last week that opponents were
preparing to contest the policy in federal court.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>Sen. Bob Graham (D-Fla.), who sponsored
the emergency room protection and had been preparing to ask for the Senate vote
last night, praised the administration for changing its position.
&quot;Returning to the original standard will not only protect coverage for
Medicaid patients, it will save lives,&quot; Graham said. Sen. Edward M.
Kennedy (D-Mass.) was more pointed, saying in a statement that &quot;it is
unconscionable that the administration would have issued and defended this
policy in the first place.&quot;</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The reversal ends a brief, and unusual,
episode in the history of Medicaid, a program shared by the federal government
and states that provides insurance to 37 million poor or disabled people. The
rule had the potential to affect as many as 23 million Medicaid patients who
are required by states to belong to health maintenance organizations or other
forms of managed care.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>Already, states are permitted to restrict
payments for use of emergency rooms by people under &quot;fee for service&quot;
Medicaid, in which patients choose whatever doctors they want. But under a 1997
law, intended to protect the increasing proportion of Medicaid patients in
managed care, states must pay for emergency room services whenever a
&quot;prudent layperson&quot; could reasonably think they have a true medical
emergency. The rule, issued in late December, reinterpreted that law.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>The change was odd because the nation's
governors and Medicaid directors had not requested it, even though they lobby
often for other kinds of freedom to run their Medicaid programs -- and many of
them lately have been leaning hard, and unsuccessfully, on the administration
for financial help with Medicaid deficits.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>Gregory A. Vadner, vice chairman of the
National Association of State Medicaid Directors, said the reversal would have
little practical effect because states had not begun planning to restrict
emergency room use based on the administration's rule. &quot;Really, in the big
scheme of things, I don't think it will be something that all the states will
be greatly disappointed about,&quot; said </span></font><font size=2
  color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
  color:black'>Vadner</span></font><font size=2 color=black face=Arial><span
 style='font-size:10.0pt;font-family:Arial;color:black'>, </span></font><font
  size=2 color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
  color:black'>Missouri</span></font><font size=2 color=black face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:black'>'s Medicaid director.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>When members of Congress began to protest
last week, administration officials defended their decision by saying their new
policy would create equal rules for all Medicaid patients, regardless of
whether they were in managed care. The administration also said the rule was an
attempt to curb reliance on emergency rooms for routine care that is more
efficient -- and economical -- for them to get in doctors' offices.</span></font></p>

<p class=MsoNormal><font size=2 color=black face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:black'>In yesterday's letter to Senate Finance
Committee Chairman Charles E. Grassley (R-Iowa) and the ranking member, Sen.
Max Baucus (D-Mont.), Scully said the administration wanted to work with
Congress to find other ways of discouraging unnecessary use of emergency rooms.</span></font></p>

<p class=MsoNormal align=center style='text-align:center'><font size=2
color=black face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:black'>&copy; 2003 The Washington Post Company</span></font></p>

<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>&nbsp;</span></font></p>

</div>

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From pottsbri@yahoo.com  Mon Jan 27 20:13:52 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Mon, 27 Jan 2003 12:13:52 -0800 (PST)
Subject: FW: WSJ.com - Behind California Budget Mess Is Pattern of Political Paralysis (another good selection forwarded by Dr. Durkin)
Message-ID: <20030127201352.81056.qmail@web41509.mail.yahoo.com>

--0-213055780-1043698432=:80531
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Behind California Budget Mess Is Pattern of Political Paralysis

Conflicting Voter Initiatives, Partisanship Built A $35 Billion Hole Tying Sacramento in Knots

By SCOTT THURM and RHONDA L. RUNDLE 

Staff Reporters of THE WALL STREET JOURNAL

California Gov. Gray Davis says the state faces a shocking $35 billion budget gap over the next 18 months. That amount represents roughly $1,000 for each person in the state. In percentage terms, it's more than the budget shortfalls of most Latin American countries. Painful cuts in spending for education, health care and the poor are almost certainly on the way.

But for all of California's money troubles, the real problem in Sacramento is as much political as economic.

The state gorged on mammoth tax receipts during the stock-market and technology boom of the 1990s. Now most of that revenue has disappeared. In theory, California could solve much of its budget mess by turning the clock back five years and undoing boom-era tax cuts and spending increases. That would be politically unlikely in any state. In California, politicians lately have preferred budget gimmicks and partisan brinkmanship to bold solutions. And the long-established California tradition of governing by citizen initiative has handcuffed its leaders.

The fallout could be grim. School districts around the state are already contemplating large teacher layoffs. Standard & Poor's last month dropped its ratings on California bonds to the lowest level of any state, making it more expensive for California to borrow.

[California Budget Charts]Mr. Davis Friday is scheduled to outline his spending plan for the fiscal year that begins July 1. The recently re-elected Democrat enjoys healthy Democratic majorities in both houses of the state legislature. But history and the current political mood suggest that reaching a resolution still won't be easy.

Part of the reason is that for decades California voters have restricted their elected representatives with a succession of ballot initiatives that are in severe tension with one another.

Some initiatives have amended the state constitution to require that specified percentage levels of the budget are spent on particular areas, such as education. But other measures have added language to the constitution that requires a super-majority of two-thirds in each house of the legislature to raise taxes or pass a budget.

This unusual combination -- insulating spending increases, discouraging new taxes and requiring an extremely broad budget consensus -- will make it difficult for politicians in Sacramento to sort out the current mess. State law requires the budget to be balanced annually, at least on paper.

Riding High

When the stock market peaked in 2000, California's coffers overflowed with $17 billion in tax payments on capital gains and the exercise of stock options. Much of that reflected spectacular wealth flowing to a relatively small circle in Silicon Valley. Just 44,000 taxpayers with incomes higher than $1 million -- 0.3% of the state's tax filers -- paid a collective $15 billion in taxes. That accounted for 24% of general-fund revenues, which finance most state operations including education and social services.

But much of that money vanished when high tech and the stock market collapsed. The state estimates that market-related revenue dipped last year to $4.7 billion, a 72% decline in two years.

As many states face excruciating post-boom budget crunches, California is providing an extreme example of the perils of relying on volatile revenue sources. California's plight is the most bleak in part because it has so many technology companies that distribute options widely and whose share prices crashed after the boom. Another reason why things are worse in California is that the nation's most populous state and largest economy derives an unusually large share of its budget from a sharply progressive personal-income tax.

Republicans accuse Mr. Davis of having squandered the boom-era tax bonus and say he is now exaggerating the budget gap. The governor and his allies defend their numbers and say they spent responsibly to redress years of neglect in education and other areas.

Despite the anticipated budget gap, Republican Assembly Leader Dave Cox says his ranks are unanimously opposed to tax increases -- at least until the Democrats agree to a constitutional cap on total state spending and to repeal of a host of labor and environmental protections. That could be early-stage political rhetoric. Budget season technically ends with the fiscal year, on June 30. But last summer, Republican lawmakers adopted the same antitax stance, and they made it stick, even after a political impasse delayed approval of any spending plan by a record three months.

As a result, the current budget relies on a series of one-time funding shifts and other gimmicks. By selling bonds tied to the state's share of the national tobacco settlement, the state plans to raise about $4.5 billion. But all of that money is scheduled to be spent this year, with little thought of how it will be replaced next year and beyond. Roughly one-third of the estimated $35 billion gap reflects one-time past maneuvers in the budget that don't carry forward.

On Dec. 6, Mr. Davis proposed $10 billion in spending cuts to begin to close the gap, including $2 billion in midyear reductions for the current fiscal year in such areas as education. With each passing day, it becomes more difficult to cut money from the current year, but lawmakers have yet to take up his proposals. Legislators on both sides of the aisle privately attribute this to a general tendency in Sacramento to postpone difficult fiscal choices until the last possible minute.

Nor is there much public pressure to act, despite the potential implications for vital human services and the state's overall economy. "I know that [the budget crisis] affects schools and housing, but it's so huge and vague that it seems unsolvable and removed from daily life," says Natasha Metzler, a 26-year-old freelance writer in Los Angeles.

Using Revenue

State politicians understood that at least some of the boom-era revenue wouldn't last. They used extra tax money to pay down debt, build up rainy-day funds and make one-time expenditures for roads, housing and other purposes.

But the state also cut corporate taxes and car-registration fees. It increased personal tax exemptions to the point where a family of four with an income of $42,358 or less pays no state income tax.

About half of the windfall went to expand or create new programs that must continue to be funded year after year. Many of these were social endeavors that Mr. Davis and Democratic lawmakers argued had been given short shrift under previous Republican administrations.

Schools were the biggest beneficiaries, as the state tried to lift its sub-par spending closer to national averages and reverse decades of declining test scores. Boom-era revenues helped the state fund an older program to reduce classes to 20 students in kindergarten through third grade.

Spending on subsidized child care more than tripled, with the help of federal aid. And Medi-Cal, the state's health-care program for the poor, grew rapidly as the state eased eligibility requirements and boosted fees for doctors and nursing homes for the first time in more than a decade.

Similar Troubles

California faced similar budget troubles in the early 1990s. Then, the state was in a nasty recession. It lost 750,000 jobs, and unemployment hit 9.7%. This time, California is still growing overall and has lost only about 80,000 jobs, putting its unemployment rate at 6.4%.

But the political environment was different a decade ago. Republican Gov. Pete Wilson worked diligently with veteran lawmakers in the Democratic-controlled legislature. Despite sharp ideological disagreements, they managed to fashion a plan that relied in roughly equal measures on tax increases, including a temporary income-tax surcharge on high earners, and cuts in state aid to local governments.

By many accounts, Mr. Davis didn't work especially hard during his first term to build bridges with key lawmakers in either party. A spokesman says the governor has "cordial" relations with legislators. What's beyond debate is that Mr. Davis now faces a legislature that is more ideologically polarized than it was during the Wilson era. And because of term limits, the legislature is stacked with relative newcomers who may not yet appreciate the need to make painful tax increases or spending cuts.

In fact, Republican lawmakers accuse Mr. Davis of exaggerating the state's fiscal woes to create public support for tax increases. "The governor is trying to cook the books," says Mr. Cox, the assembly leader.

B. Timothy Gage, Mr. Davis' finance director, denies any fudging and says the governor is basing the $35 billion estimate on economic-growth expectations that are less optimistic than those of the legislature's nonpartisan budget office.

Whatever the precise budget gap turns out to be, it is likely that many of the state's recent spending increases will be reversed. In his first round of proposed cuts last month, Mr. Davis suggested reinstating stricter eligibility rules for Medi-Cal and cutting doctors' fees. The Center on Budget and Policy Priorities, a Washington think tank, estimates that the changes would exclude 500,000 mostly low-income working parents from the program. Those people would then have to seek care primarily from county-run emergency rooms, which are suffering their own funding problems.

Mr. Davis also wants to trim what Medi-Cal offers. He proposed saving roughly $220 million a year by eliminating dental coverage for adults, for example. Another proposal would kill coverage for medical supplies. This step, says Angela Gilliard of the Western Center on Law and Poverty, a nonprofit legal-services group in Los Angeles, would make it much more difficult for one of her clients, a 40-year-old woman who had her bladder removed, to obtain catheters.

Mr. Gage, the governor's finance director, says simply reversing boom-era largess won't be enough. For one thing, demands for services continue to grow with California's population. Elementary- and secondary-school enrollment has risen by about 500,000 children in the past five years. Deep cuts are inevitable, the aide says, but the governor will try to minimize damage to the most vital programs.

Cutting Education

Mr. Davis has proposed cutting $1.9 billion from the current year's education budget. But local school superintendents say this would be almost impossible to carry out. That's because state laws limit their ability to lay off employees in the middle of a school year.

Boom-era spending increases were used to boost teacher salaries, which can't be rolled back, superintendents say. Instead, some administrators are considering economies such as abandoning the program that reduces class sizes. The 41,000-student Riverside Unified School District east of Los Angeles dropped that program for third-graders this year, saving $1.7 million in local matching funds. Third-grade classes ballooned to an average of 30 students, from 20 last year, says Michael Fine, the deputy superintendent. If further spending cuts are mandated, he says, Riverside might drop the program in other grades.

Also at risk: athletics and slots for teachers who develop curricula and train other teachers. "We're all running scared," Mr. Fine says.

Still, there may be ways the state can soften the blows. James Fleming, superintendent of the 49,000-student Capistrano Unified School District north of San Diego, says the state could loosen restrictions on money earmarked for textbooks, teacher training and other "targeted" programs. Mr. Fleming says he could find more urgent uses for the $400,000 he is supposed to spend this year on antitobacco education, for example. All told, billions of dollars could be shuffled around in this manner.

Some analysts see another option, under which the state would float multi-year bonds to cover a portion of the deficit, as it did in the early 1990s. The governor so far has opposed such measures, saying he wants to close the gap this year. But Renee Boicourt, a managing director at Moody's Investors Service, argues the numbers are "simply too big" to make that feasible.

Write to Scott Thurm at scott.thurm@wsj.com <mailto:scott.thurm@wsj.com> and Rhonda L. Rundle at rhonda.rundle@wsj.com <mailto:rhonda.rundle@wsj.com> 

Updated January 10, 2003


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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--0-213055780-1043698432=:80531
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<FONT size=2>
<P>Behind California Budget Mess Is Pattern of Political Paralysis</P>
<P>Conflicting Voter Initiatives, Partisanship Built A $35 Billion Hole Tying Sacramento in Knots</P>
<P>By SCOTT THURM and RHONDA L. RUNDLE </P>
<P>Staff Reporters of THE WALL STREET JOURNAL</P>
<P>California Gov. Gray Davis says the state faces a shocking $35 billion budget gap over the next 18 months. That amount represents roughly $1,000 for each person in the state. In percentage terms, it's more than the budget shortfalls of most Latin American countries. Painful cuts in spending for education, health care and the poor are almost certainly on the way.</P>
<P>But for all of California's money troubles, the real problem in Sacramento is as much political as economic.</P>
<P>The state gorged on mammoth tax receipts during the stock-market and technology boom of the 1990s. Now most of that revenue has disappeared. In theory, California could solve much of its budget mess by turning the clock back five years and undoing boom-era tax cuts and spending increases. That would be politically unlikely in any state. In California, politicians lately have preferred budget gimmicks and partisan brinkmanship to bold solutions. And the long-established California tradition of governing by citizen initiative has handcuffed its leaders.</P>
<P>The fallout could be grim. School districts around the state are already contemplating large teacher layoffs. Standard &amp; Poor's last month dropped its ratings on California bonds to the lowest level of any state, making it more expensive for California to borrow.</P>
<P>[California Budget Charts]Mr. Davis Friday is scheduled to outline his spending plan for the fiscal year that begins July 1. The recently re-elected Democrat enjoys healthy Democratic majorities in both houses of the state legislature. But history and the current political mood suggest that reaching a resolution still won't be easy.</P>
<P>Part of the reason is that for decades California voters have restricted their elected representatives with a succession of ballot initiatives that are in severe tension with one another.</P>
<P>Some initiatives have amended the state constitution to require that specified percentage levels of the budget are spent on particular areas, such as education. But other measures have added language to the constitution that requires a super-majority of two-thirds in each house of the legislature to raise taxes or pass a budget.</P>
<P>This unusual combination -- insulating spending increases, discouraging new taxes and requiring an extremely broad budget consensus -- will make it difficult for politicians in Sacramento to sort out the current mess. State law requires the budget to be balanced annually, at least on paper.</P>
<P>Riding High</P>
<P>When the stock market peaked in 2000, California's coffers overflowed with $17 billion in tax payments on capital gains and the exercise of stock options. Much of that reflected spectacular wealth flowing to a relatively small circle in Silicon Valley. Just 44,000 taxpayers with incomes higher than $1 million -- 0.3% of the state's tax filers -- paid a collective $15 billion in taxes. That accounted for 24% of general-fund revenues, which finance most state operations including education and social services.</P>
<P>But much of that money vanished when high tech and the stock market collapsed. The state estimates that market-related revenue dipped last year to $4.7 billion, a 72% decline in two years.</P>
<P>As many states face excruciating post-boom budget crunches, California is providing an extreme example of the perils of relying on volatile revenue sources. California's plight is the most bleak in part because it has so many technology companies that distribute options widely and whose share prices crashed after the boom. Another reason why things are worse in California is that the nation's most populous state and largest economy derives an unusually large share of its budget from a sharply progressive personal-income tax.</P>
<P>Republicans accuse Mr. Davis of having squandered the boom-era tax bonus and say he is now exaggerating the budget gap. The governor and his allies defend their numbers and say they spent responsibly to redress years of neglect in education and other areas.</P>
<P>Despite the anticipated budget gap, Republican Assembly Leader Dave Cox says his ranks are unanimously opposed to tax increases -- at least until the Democrats agree to a constitutional cap on total state spending and to repeal of a host of labor and environmental protections. That could be early-stage political rhetoric. Budget season technically ends with the fiscal year, on June 30. But last summer, Republican lawmakers adopted the same antitax stance, and they made it stick, even after a political impasse delayed approval of any spending plan by a record three months.</P>
<P>As a result, the current budget relies on a series of one-time funding shifts and other gimmicks. By selling bonds tied to the state's share of the national tobacco settlement, the state plans to raise about $4.5 billion. But all of that money is scheduled to be spent this year, with little thought of how it will be replaced next year and beyond. Roughly one-third of the estimated $35 billion gap reflects one-time past maneuvers in the budget that don't carry forward.</P>
<P>On Dec. 6, Mr. Davis proposed $10 billion in spending cuts to begin to close the gap, including $2 billion in midyear reductions for the current fiscal year in such areas as education. With each passing day, it becomes more difficult to cut money from the current year, but lawmakers have yet to take up his proposals. Legislators on both sides of the aisle privately attribute this to a general tendency in Sacramento to postpone difficult fiscal choices until the last possible minute.</P>
<P>Nor is there much public pressure to act, despite the potential implications for vital human services and the state's overall economy. "I know that [the budget crisis] affects schools and housing, but it's so huge and vague that it seems unsolvable and removed from daily life," says Natasha Metzler, a 26-year-old freelance writer in Los Angeles.</P>
<P>Using Revenue</P>
<P>State politicians understood that at least some of the boom-era revenue wouldn't last. They used extra tax money to pay down debt, build up rainy-day funds and make one-time expenditures for roads, housing and other purposes.</P>
<P>But the state also cut corporate taxes and car-registration fees. It increased personal tax exemptions to the point where a family of four with an income of $42,358 or less pays no state income tax.</P>
<P>About half of the windfall went to expand or create new programs that must continue to be funded year after year. Many of these were social endeavors that Mr. Davis and Democratic lawmakers argued had been given short shrift under previous Republican administrations.</P>
<P>Schools were the biggest beneficiaries, as the state tried to lift its sub-par spending closer to national averages and reverse decades of declining test scores. Boom-era revenues helped the state fund an older program to reduce classes to 20 students in kindergarten through third grade.</P>
<P>Spending on subsidized child care more than tripled, with the help of federal aid. And Medi-Cal, the state's health-care program for the poor, grew rapidly as the state eased eligibility requirements and boosted fees for doctors and nursing homes for the first time in more than a decade.</P>
<P>Similar Troubles</P>
<P>California faced similar budget troubles in the early 1990s. Then, the state was in a nasty recession. It lost 750,000 jobs, and unemployment hit 9.7%. This time, California is still growing overall and has lost only about 80,000 jobs, putting its unemployment rate at 6.4%.</P>
<P>But the political environment was different a decade ago. Republican Gov. Pete Wilson worked diligently with veteran lawmakers in the Democratic-controlled legislature. Despite sharp ideological disagreements, they managed to fashion a plan that relied in roughly equal measures on tax increases, including a temporary income-tax surcharge on high earners, and cuts in state aid to local governments.</P>
<P>By many accounts, Mr. Davis didn't work especially hard during his first term to build bridges with key lawmakers in either party. A spokesman says the governor has "cordial" relations with legislators. What's beyond debate is that Mr. Davis now faces a legislature that is more ideologically polarized than it was during the Wilson era. And because of term limits, the legislature is stacked with relative newcomers who may not yet appreciate the need to make painful tax increases or spending cuts.</P>
<P>In fact, Republican lawmakers accuse Mr. Davis of exaggerating the state's fiscal woes to create public support for tax increases. "The governor is trying to cook the books," says Mr. Cox, the assembly leader.</P>
<P>B. Timothy Gage, Mr. Davis' finance director, denies any fudging and says the governor is basing the $35 billion estimate on economic-growth expectations that are less optimistic than those of the legislature's nonpartisan budget office.</P>
<P>Whatever the precise budget gap turns out to be, it is likely that many of the state's recent spending increases will be reversed. In his first round of proposed cuts last month, Mr. Davis suggested reinstating stricter eligibility rules for Medi-Cal and cutting doctors' fees. The Center on Budget and Policy Priorities, a Washington think tank, estimates that the changes would exclude 500,000 mostly low-income working parents from the program. Those people would then have to seek care primarily from county-run emergency rooms, which are suffering their own funding problems.</P>
<P>Mr. Davis also wants to trim what Medi-Cal offers. He proposed saving roughly $220 million a year by eliminating dental coverage for adults, for example. Another proposal would kill coverage for medical supplies. This step, says Angela Gilliard of the Western Center on Law and Poverty, a nonprofit legal-services group in Los Angeles, would make it much more difficult for one of her clients, a 40-year-old woman who had her bladder removed, to obtain catheters.</P>
<P>Mr. Gage, the governor's finance director, says simply reversing boom-era largess won't be enough. For one thing, demands for services continue to grow with California's population. Elementary- and secondary-school enrollment has risen by about 500,000 children in the past five years. Deep cuts are inevitable, the aide says, but the governor will try to minimize damage to the most vital programs.</P>
<P>Cutting Education</P>
<P>Mr. Davis has proposed cutting $1.9 billion from the current year's education budget. But local school superintendents say this would be almost impossible to carry out. That's because state laws limit their ability to lay off employees in the middle of a school year.</P>
<P>Boom-era spending increases were used to boost teacher salaries, which can't be rolled back, superintendents say. Instead, some administrators are considering economies such as abandoning the program that reduces class sizes. The 41,000-student Riverside Unified School District east of Los Angeles dropped that program for third-graders this year, saving $1.7 million in local matching funds. Third-grade classes ballooned to an average of 30 students, from 20 last year, says Michael Fine, the deputy superintendent. If further spending cuts are mandated, he says, Riverside might drop the program in other grades.</P>
<P>Also at risk: athletics and slots for teachers who develop curricula and train other teachers. "We're all running scared," Mr. Fine says.</P>
<P>Still, there may be ways the state can soften the blows. James Fleming, superintendent of the 49,000-student Capistrano Unified School District north of San Diego, says the state could loosen restrictions on money earmarked for textbooks, teacher training and other "targeted" programs. Mr. Fleming says he could find more urgent uses for the $400,000 he is supposed to spend this year on antitobacco education, for example. All told, billions of dollars could be shuffled around in this manner.</P>
<P>Some analysts see another option, under which the state would float multi-year bonds to cover a portion of the deficit, as it did in the early 1990s. The governor so far has opposed such measures, saying he wants to close the gap this year. But Renee Boicourt, a managing director at Moody's Investors Service, argues the numbers are "simply too big" to make that feasible.</P>
<P>Write to Scott Thurm at scott.thurm@wsj.com &lt;</FONT><A href="mailto:scott.thurm@wsj.com"><U><FONT color=#0000ff size=2>mailto:scott.thurm@wsj.com</U></FONT></A><FONT size=2>&gt; and Rhonda L. Rundle at rhonda.rundle@wsj.com &lt;</FONT><A href="mailto:rhonda.rundle@wsj.com"><U><FONT color=#0000ff size=2>mailto:rhonda.rundle@wsj.com</U></FONT></A><FONT size=2>&gt; </P>
<P>Updated January 10, 2003</P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
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From pottsbri@yahoo.com  Wed Jan 29 00:26:57 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Tue, 28 Jan 2003 16:26:57 -0800 (PST)
Subject: Judge Recommends Dismissal of ABEM Lawsuit, -and- California's MICRA Cap Sets Model for the Nation
Message-ID: <20030129002657.82392.qmail@web41503.mail.yahoo.com>

--0-71668343-1043800017=:81519
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FW: ACEP's EM Today Digital January 13, 2003

Judge Recommends Dismissal of ABEM Lawsuit

Ruling States that Plaintiffs Lack Standing

EM Today

January 13, 2003 

A federal judge presiding over an antitrust lawsuit challenging the requirements for emergency physician certification recommended last month to dismiss the 12-year-old case.

Gregory F. Daniel, MD, later joined by more than 100 other physicians who are not residency trained in emergency medicine, sued the American Board of Emergency Medicine (ABEM) in 1990, claiming that their practice experience should allow them to take the certification exam, and that ABEM conspired to restrain trade and exclude non-certified emergency physicians from practice.

In late December 2002, Magistrate Judge Leslie G. Foschio recommended the case be dismissed because of the plaintiffs' lack of standing to bring antitrust claims. The Federal District Judge must still review and agree with the recommendation before the case can be dismissed. The plaintiffs have until mid-February to file an appeal.

ABEM Executive Director Mary Ann Reinhart, PhD, said her organization is very pleased with the latest legal development.

"Very clearly this is a strong report and recommendation from the magistrate judge, and we are confident it will stand," she said.

Dr. Reinhart added that completing an emergency medicine residency became an integral part of certification because of the value it brings to an emergency physician's practice.

"ABEM firmly believes that its not just the test, it is the training," she said. "That's something we always say, and we believe the training is very important part of the process, as well as the exam."

Representatives for the plaintiffs could not be reached for comment. In his recommendation, Judge Foschio wrote that the plaintiff's claims were not covered by antitrust protections.

"Plaintiffs' immediate and long term economic interest lies only in keeping the price of these services artificially elevated so that they may use ABEM certification to obtain the extra degree of compensation they specifically allege they will receive upon obtaining such certification," he wrote. "Because plaintiffs allege no injury the antitrust laws were intended to prevent, plaintiffs lack standing." The Magistrate Judge also said that the plaintiffs would not be "efficient enforcers" of the antitrust laws.

ABEM, which was formed in the 1970s, administers a certifying exam in emergency medicine where physicians, once deemed eligible, may become ABEM certified in emergency medicine as a specialist if they pass the written and oral examinations. Many physicians attained certification though the so-called "practice track," which required 7,000 hours and 60 months practice in emergency medicine, among other criteria. The practice track closed in 1988 when formal residency training became a required pre-requisite for eligibility to take the ABEM exam.

================================================

From: CMA_ALERT [mailto:cma_alert@cmanet.org] 

Sent: Friday, January 17, 2003 12:43 PM 

1. California's MICRA Cap Sets Model for the Nation

President George W. Bush this week challenged Congress to pass a national malpractice liability cap, citing California's MICRA as a national model. In arguing for a nationwide cap, Bush said that the states' failure to adopt liability limits is damaging the nation's health care system and costing billions of dollars in higher health costs. The Republican-controlled U.S. House of Representatives passed a MICRA-like tort reform bill last year, but the bill never made it to the Democratic-led Senate floor for a vote.

Immediately following the President's speech, U.S. Senator Dianne Feinstein (D-California) announced that she was introducing legislation that would create a national version of California's MICRA law, which caps noneconomic damages at $250,000. 

"Senator Feinstein made a pledge to us during our trip to Washington, D.C., last week, that she would carry a MICRA bill in the senate this year," says CMA CEO Jack Lewin, M.D. "CMA is thrilled that Senator Feinstein is providing leadership on the Democratic side to balance the President's challenge."

While President Bush proposed that the national version also cap punitive damages, Sen. Feinstein's bill will be a "pure MICRA" legislation. "By not including a punitive damages cap, Senator Feinstein feels that it will be easier to get support in the senate from moderate Democrats," says CMA CEO Jack Lewin. The reality is that the contribution of punitive damages has not been significant in California, in terms of malpractice rates. They are very hard to plead, and are only allowed in the most egregious circumstances."

CMA advocates and MICRA provides prompt payment to patients for their injuries and adequate funds to cover all future medical expenses, rehabilitation, and lost wages, as well as limited damages for pain and suffering.

Please contact Sen. Feinstein and thank her for her leadership on this issue and let her know that California physicians support her effort to create a $250,000 national cap on non-economic damages.

For more information, including contact information for Senator Feinstein, click <http://www.calphys.org/html/bb094.asp> here.


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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<FONT size=2>
<P>FW: ACEP's EM Today Digital January 13, 2003</P>
<P>Judge Recommends Dismissal of ABEM Lawsuit</P>
<P>Ruling States that Plaintiffs Lack Standing</P>
<P>EM Today</P>
<P>January 13, 2003 </P>
<P>A federal judge presiding over an antitrust lawsuit challenging the requirements for emergency physician certification recommended last month to dismiss the 12-year-old case.</P>
<P>Gregory F. Daniel, MD, later joined by more than 100 other physicians who are not residency trained in emergency medicine, sued the American Board of Emergency Medicine (ABEM) in 1990, claiming that their practice experience should allow them to take the certification exam, and that ABEM conspired to restrain trade and exclude non-certified emergency physicians from practice.</P>
<P>In late December 2002, Magistrate Judge Leslie G. Foschio recommended the case be dismissed because of the plaintiffs' lack of standing to bring antitrust claims. The Federal District Judge must still review and agree with the recommendation before the case can be dismissed. The plaintiffs have until mid-February to file an appeal.</P>
<P>ABEM Executive Director Mary Ann Reinhart, PhD, said her organization is very pleased with the latest legal development.</P>
<P>"Very clearly this is a strong report and recommendation from the magistrate judge, and we are confident it will stand," she said.</P>
<P>Dr. Reinhart added that completing an emergency medicine residency became an integral part of certification because of the value it brings to an emergency physician's practice.</P>
<P>"ABEM firmly believes that its not just the test, it is the training," she said. "That's something we always say, and we believe the training is very important part of the process, as well as the exam."</P>
<P>Representatives for the plaintiffs could not be reached for comment. In his recommendation, Judge Foschio wrote that the plaintiff's claims were not covered by antitrust protections.</P>
<P>"Plaintiffs' immediate and long term economic interest lies only in keeping the price of these services artificially elevated so that they may use ABEM certification to obtain the extra degree of compensation they specifically allege they will receive upon obtaining such certification," he wrote. "Because plaintiffs allege no injury the antitrust laws were intended to prevent, plaintiffs lack standing." The Magistrate Judge also said that the plaintiffs would not be "efficient enforcers" of the antitrust laws.</P>
<P>ABEM, which was formed in the 1970s, administers a certifying exam in emergency medicine where physicians, once deemed eligible, may become ABEM certified in emergency medicine as a specialist if they pass the written and oral examinations. Many physicians attained certification though the so-called "practice track," which required 7,000 hours and 60 months practice in emergency medicine, among other criteria. The practice track closed in 1988 when formal residency training became a required pre-requisite for eligibility to take the ABEM exam.</P>
<P>================================================<FONT size=2></P>
<P>From: CMA_ALERT [</FONT><A href="mailto:cma_alert@cmanet.org"><U><FONT color=#0000ff size=2>mailto:cma_alert@cmanet.org</U></FONT></A><FONT size=2>] </P>
<P>Sent: Friday, January 17, 2003 12:43 PM&nbsp;</P>
<P>1. California's MICRA Cap Sets Model for the Nation</P>
<P>President George W. Bush this week challenged Congress to pass a national malpractice liability cap, citing California's MICRA as a national model. In arguing for a nationwide cap, Bush said that the states' failure to adopt liability limits is damaging the nation's health care system and costing billions of dollars in higher health costs. The Republican-controlled U.S. House of Representatives passed a MICRA-like tort reform bill last year, but the bill never made it to the Democratic-led Senate floor for a vote.</P>
<P>Immediately following the President's speech, U.S. Senator Dianne Feinstein (D-California) announced that she was introducing legislation that would create a national version of California's MICRA law, which caps noneconomic damages at $250,000. </P>
<P>"Senator Feinstein made a pledge to us during our trip to Washington, D.C., last week, that she would carry a MICRA bill in the senate this year," says CMA CEO Jack Lewin, M.D. "CMA is thrilled that Senator Feinstein is providing leadership on the Democratic side to balance the President's challenge."</P>
<P>While President Bush proposed that the national version also cap punitive damages, Sen. Feinstein's bill will be a "pure MICRA" legislation. "By not including a punitive damages cap, Senator Feinstein feels that it will be easier to get support in the senate from moderate Democrats," says CMA CEO Jack Lewin. The reality is that the contribution of punitive damages has not been significant in California, in terms of malpractice rates. They are very hard to plead, and are only allowed in the most egregious circumstances."</P>
<P>CMA advocates and MICRA provides prompt payment to patients for their injuries and adequate funds to cover all future medical expenses, rehabilitation, and lost wages, as well as limited damages for pain and suffering.</P>
<P>Please contact Sen. Feinstein and thank her for her leadership on this issue and let her know that California physicians support her effort to create a $250,000 national cap on non-economic damages.</P>
<P>For more information, including contact information for Senator Feinstein, click &lt;</FONT><A href="http://www.calphys.org/html/bb094.asp"><U><FONT color=#0000ff size=2>http://www.calphys.org/html/bb094.asp</U></FONT></A><FONT size=2>&gt; here.</FONT></P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Wed Jan 29 21:29:29 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Wed, 29 Jan 2003 13:29:29 -0800 (PST)
Subject: OIG Posts Malpractice Guidance Letter, -and- WSJ: Doctors' Activism Revives Malpractice Legislation
Message-ID: <20030129212929.22278.qmail@web41501.mail.yahoo.com>

--0-901085484-1043875769=:20123
Content-Type: text/plain; charset=us-ascii


From: AAEM [mailto:info@aaem.org] 

Sent: Tuesday, January 21, 2003 12:06 AM

Subject: OIG Posts Malpractice Guidance Letter

To AAEM members,

The HHS Office of Inspector General (OIG) has posted a letter addressing the issue of hospital subsidies for malpractice insurance. While not absolutely blessing the practice, the OIG indicates that it is aware of the crisis and plans to be supportive of attempts to ensure access to care. The letter outlines directs one how to seek an advisory opinion for specific arrangements.

To access the letter: http://oig.hhs.gov/fraud/docs/alertsandbulletins/MalpracticeProgram.pdf 

AAEM     611 East Wells Street   Milwaukee, WI 53202

800-884-2236    Fax: 414-276-3349   E-mail: info@aaem.org 

Website: www.aaem.org

=========================================================

 

From: Paul Windham [mailto:pcwindham@elite.net] 

Sent: Monday, January 13, 2003 2:41 PM 

Doctors' Activism Revives Malpractice Legislation Inspired by Bush, Physicians Are Pressuring Congress for Bill Limiting Damage Awards

By JEANNE CUMMINGS 

Staff Reporter of THE WALL STREET JOURNAL

WASHINGTON -- Across the country, doctors are walking off the job and joining protest rallies. A new strategy by organized labor? Hardly. Physicians say they were inspired to take to the streets by President Bush.

Donald Palmisano, president of the American Medical Association, traces the doctor revolt to a private meeting last July in a High Point, N.C., hospital conference room just before Mr. Bush delivered a speech demanding that Congress pass legislation to limit some damage awards in malpractice cases. Seated with patients and doctors, Mr. Bush vowed to make medical-malpractice revisions a top legislative priority. "We can fix it now, but we need your help," he said, according to Dr. Palmisano. "You need to get out the grass-roots."

Since that session, doctors have staged rallies in Florida, Georgia, Ohio and New Jersey supporting state and federal legislation to limit medical-malpractice awards. West Virginia surgeons kicked off the New Year by walking out of four hospitals on Jan. 1 to protest the rising insurance premiums that are driving some to quit and others to abandon high-risk specialties such as obstetrics, some surgeries, and trauma treatment. "We have taken the president's advice," Dr. Palmisano, a Louisiana surgeon, said during a break at a December conference where he persuaded fellow doctors to help raise $15 million to finance a Capitol Hill lobbying campaign.

A White House official confirmed Mr. Bush's message to the patients and doctors, but said the president's call for action was aimed at more-traditional civic participation -- like calling their representatives in Congress. Even so, the AMA's unorthodox tactics are buoying advocates' expectations that legislation might pass this year.

Mr. Bush is expected to plug medical-malpractice changes on Thursday in Pennsylvania, and other health-care events could come in the run-up to his Jan. 28 State of the Union speech as he unveils a broader package of health-care initiatives.

The president argues that a national cap on malpractice awards is the best way to quickly contain insurance premiums. The administration also is examining other ways to reduce legal costs. One possibility: have doctors offer injured patients early financial settlements for economic losses and medical and rehabilitation costs -- if those patients agree not to file lawsuits later for pain-and-suffering or punitive damages. While patients could volunteer to do this now, enshrining it in federal law would go a long way toward reducing trial lawyers' leverage.

But Mr. Bush faces determined opposition from trial lawyers, patients' rights groups and their Democratic allies in Congress. Armed with their own studies, foes argue that insurance rates fluctuate based on the overall economy and the performance of insurers' investments. "The proposals will do nothing to improve premium rates and availability, and have terrible consequences for innocent people who have suffered catastrophic injuries due to medical errors," says Joanne Doroshow, executive director of the Center for Justice & Democracy and co-founder of Americans for Insurance Reform.

They accuse the White House of pushing malpractice-law changes to reward physicians who helped Republicans in the midterm elections. In late October, the National Republican Congressional Committee ran a full-page advertisement in The Wall Street Journal thanking its "physicians advisory board."

By taking on medical malpractice, Mr. Bush would attempt to blemish the reputation of one of the Democratic Party's most reliable supporters -- 90% of the American Trial Lawyers Association's $3.4 million of political donations in 2002 went to Democrats. He also would have an early shot at North Carolina Democratic Sen. John Edwards, the Senate's only trial lawyer and an announced presidential contender for 2004. Mr. Edwards's good looks, deep pockets and lawyer's debating skills have some Republican political advisers nervous. He became a millionaire after winning a malpractice case against a North Carolina physician.

Mr. Bush's business allies also believe the White House medical-malpractice campaign will aid their own efforts to win changes in the legal system that would protect corporations from big jury awards. Several powerful business groups in Washington, including the U.S. Chamber of Congress and the National Association of Manufacturers, are organizing an advertising and grass-roots lobbying campaign to build support for legislation already languishing in Congress.

The House last year passed a bill that would allow defendants in class actions to consolidate cases in federal court, but the bill stalled in the Senate. Firms facing claims for asbestos-related industries also are looking for relief. But several business lobbyists said that behind-the-scenes disagreement among the companies about a preferred solution is slowing that effort.

In the health-care field, the AMA says 12 states are in "crisis" because rising insurance premiums are forcing doctors to quit practicing or move to other states. The group also argues that fear of litigation drives up overall medical costs because it encourages doctors to do more tests and procedures on patients than may be necessary. A recent Bush administration study estimated that the threat -- or reality -- of suits costs taxpayers about $25 billion a year through higher outlays for Medicare and other government health programs.

The president is calling for passage of a bill that limits some noneconomic patient damages to $250,000, shortens the statute of limitations for filing complaints and allows judges to review lawyers' contingency fees. That legislation cleared the House last year, but never got out of committee in the Democrat-held Senate.

White House strategists figure they have a better chance this year. Republicans now have a two-vote margin in the Senate, and new majority leader Bill Frist of Tennessee is that chamber's only medical doctor and an ally of the AMA.

Last year's stalled bill probably will get to the Senate floor this year, but its passage is hardly assured. The legislation is likely to generate opposition from all types of trial lawyers, since malpractice isn't as specialized an area of the law as, say, asbestos litigation. In addition, some lawmakers don't like federally mandated limits on state-court juries. Last year, Republican Gov. Kenny Guinn of Nevada -- one of the states on the AMA's "crisis" list -- launched a state-run program offering doctors discount insurance coverage and the legislature passed a $350,000 cap on noneconomic awards in medical-malpractice cases. "Let's have the states take care of issues relating to medical malpractice," said Nevada Democrat Sen. Harry Reid.

Mr. Reid also made the political calculus more difficult for the White House by arguing that the Republican party's allies, the insurance industry, should be subjected to "reform" as well; two-thirds of that industry's $32.4 million in contributions went to Republicans in 2002. The AMA reports that the medical-malpractice insurers have raised premiums for liability coverage in some fields an average of 25% annually, even for doctors who have never had a complaint filed against them. In the AMA's "crisis" states, rates have doubled and even quadrupled in a single year.

With its top legislative priority on the line, the AMA has moved all its leadership meetings in 2003 to Washington, giving the doctors who attend plenty of opportunity to lobby their representatives. "We are going to take every opportunity to visit the House and Senate to convince those who haven't been in favor and thank those who have been," says Dr. Palmisano.

Write to Jeanne Cummings at <mailto:jeanne.cummings@wsj.com> jeanne.cummings@wsj.com


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2><FONT size=2>
<P>From: AAEM [</FONT><A href="mailto:info@aaem.org"><U><FONT color=#0000ff size=2>mailto:info@aaem.org</U></FONT></A><FONT size=2>] </P>
<P>Sent: Tuesday, January 21, 2003 12:06 AM</P>
<P>Subject: OIG Posts Malpractice Guidance Letter</P>
<P>To AAEM members,</P>
<P>The HHS Office of Inspector General (OIG) has posted a letter addressing the issue of hospital subsidies for malpractice insurance. While not absolutely blessing the practice, the OIG indicates that it is aware of the crisis and plans to be supportive of attempts to ensure access to care. The letter outlines directs one how to seek an advisory opinion for specific arrangements.</P>
<P>To access the letter: </FONT><A href="http://oig.hhs.gov/fraud/docs/alertsandbulletins/MalpracticeProgram.pdf"><U><FONT color=#0000ff size=2>http://oig.hhs.gov/fraud/docs/alertsandbulletins/MalpracticeProgram.pdf</U></FONT></A><FONT size=2> </FONT></P>
<P><FONT size=2>AAEM&nbsp;&nbsp;&nbsp;&nbsp; 611 East Wells Street&nbsp;&nbsp; Milwaukee, WI 53202</P>
<P>800-884-2236&nbsp;&nbsp;&nbsp; Fax: 414-276-3349&nbsp;&nbsp; E-mail: info@aaem.org </P>
<P>Website: </FONT><A href="http://www.aaem.org"><U><FONT color=#0000ff size=2>www.aaem.org</U></FONT></A></P>
<P>=========================================================</P>
<P>&nbsp;</P>
<P>From: Paul Windham [</FONT><A href="mailto:pcwindham@elite.net"><U><FONT color=#0000ff size=2>mailto:pcwindham@elite.net</U></FONT></A><FONT size=2>] </P>
<P>Sent: Monday, January 13, 2003 2:41 PM </P>
<P>Doctors' Activism Revives Malpractice Legislation Inspired by Bush, Physicians Are Pressuring Congress for Bill Limiting Damage Awards</P>
<P>By JEANNE CUMMINGS </P>
<P>Staff Reporter of THE WALL STREET JOURNAL</P>
<P>WASHINGTON -- Across the country, doctors are walking off the job and joining protest rallies. A new strategy by organized labor? Hardly. Physicians say they were inspired to take to the streets by President Bush.</P>
<P>Donald Palmisano, president of the American Medical Association, traces the doctor revolt to a private meeting last July in a High Point, N.C., hospital conference room just before Mr. Bush delivered a speech demanding that Congress pass legislation to limit some damage awards in malpractice cases. Seated with patients and doctors, Mr. Bush vowed to make medical-malpractice revisions a top legislative priority. "We can fix it now, but we need your help," he said, according to Dr. Palmisano. "You need to get out the grass-roots."</P>
<P>Since that session, doctors have staged rallies in Florida, Georgia, Ohio and New Jersey supporting state and federal legislation to limit medical-malpractice awards. West Virginia surgeons kicked off the New Year by walking out of four hospitals on Jan. 1 to protest the rising insurance premiums that are driving some to quit and others to abandon high-risk specialties such as obstetrics, some surgeries, and trauma treatment. "We have taken the president's advice," Dr. Palmisano, a Louisiana surgeon, said during a break at a December conference where he persuaded fellow doctors to help raise $15 million to finance a Capitol Hill lobbying campaign.</P>
<P>A White House official confirmed Mr. Bush's message to the patients and doctors, but said the president's call for action was aimed at more-traditional civic participation -- like calling their representatives in Congress. Even so, the AMA's unorthodox tactics are buoying advocates' expectations that legislation might pass this year.</P>
<P>Mr. Bush is expected to plug medical-malpractice changes on Thursday in Pennsylvania, and other health-care events could come in the run-up to his Jan. 28 State of the Union speech as he unveils a broader package of health-care initiatives.</P>
<P>The president argues that a national cap on malpractice awards is the best way to quickly contain insurance premiums. The administration also is examining other ways to reduce legal costs. One possibility: have doctors offer injured patients early financial settlements for economic losses and medical and rehabilitation costs -- if those patients agree not to file lawsuits later for pain-and-suffering or punitive damages. While patients could volunteer to do this now, enshrining it in federal law would go a long way toward reducing trial lawyers' leverage.</FONT><A href="http://But"><FONT size=2></P>
<P>But</A> Mr. Bush faces determined opposition from trial lawyers, patients' rights groups and their Democratic allies in Congress. Armed with their own studies, foes argue that insurance rates fluctuate based on the overall economy and the performance of insurers' investments. "The proposals will do nothing to improve premium rates and availability, and have terrible consequences for innocent people who have suffered catastrophic injuries due to medical errors," says Joanne Doroshow, executive director of the Center for Justice &amp; Democracy and co-founder of Americans for Insurance Reform.</P>
<P>They accuse the White House of pushing malpractice-law changes to reward physicians who helped Republicans in the midterm elections. In late October, the National Republican Congressional Committee ran a full-page advertisement in The Wall Street Journal thanking its "physicians advisory board."</P>
<P>By taking on medical malpractice, Mr. Bush would attempt to blemish the reputation of one of the Democratic Party's most reliable supporters -- 90% of the American Trial Lawyers Association's $3.4 million of political donations in 2002 went to Democrats. He also would have an early shot at North Carolina Democratic Sen. John Edwards, the Senate's only trial lawyer and an announced presidential contender for 2004. Mr. Edwards's good looks, deep pockets and lawyer's debating skills have some Republican political advisers nervous. He became a millionaire after winning a malpractice case against a North Carolina physician.</P>
<P>Mr. Bush's business allies also believe the White House medical-malpractice campaign will aid their own efforts to win changes in the legal system that would protect corporations from big jury awards. Several powerful business groups in Washington, including the U.S. Chamber of Congress and the National Association of Manufacturers, are organizing an advertising and grass-roots lobbying campaign to build support for legislation already languishing in Congress.</P>
<P>The House last year passed a bill that would allow defendants in class actions to consolidate cases in federal court, but the bill stalled in the Senate. Firms facing claims for asbestos-related industries also are looking for relief. But several business lobbyists said that behind-the-scenes disagreement among the companies about a preferred solution is slowing that effort.</P>
<P>In the health-care field, the AMA says 12 states are in "crisis" because rising insurance premiums are forcing doctors to quit practicing or move to other states. The group also argues that fear of litigation drives up overall medical costs because it encourages doctors to do more tests and procedures on patients than may be necessary. A recent Bush administration study estimated that the threat -- or reality -- of suits costs taxpayers about $25 billion a year through higher outlays for Medicare and other government health programs.</P>
<P>The president is calling for passage of a bill that limits some noneconomic patient damages to $250,000, shortens the statute of limitations for filing complaints and allows judges to review lawyers' contingency fees. That legislation cleared the House last year, but never got out of committee in the Democrat-held Senate.</P>
<P>White House strategists figure they have a better chance this year. Republicans now have a two-vote margin in the Senate, and new majority leader Bill Frist of Tennessee is that chamber's only medical doctor and an ally of the AMA.</P>
<P>Last year's stalled bill probably will get to the Senate floor this year, but its passage is hardly assured. The legislation is likely to generate opposition from all types of trial lawyers, since malpractice isn't as specialized an area of the law as, say, asbestos litigation. In addition, some lawmakers don't like federally mandated limits on state-court juries. Last year, Republican Gov. Kenny Guinn of Nevada -- one of the states on the AMA's "crisis" list -- launched a state-run program offering doctors discount insurance coverage and the legislature passed a $350,000 cap on noneconomic awards in medical-malpractice cases. "Let's have the states take care of issues relating to medical malpractice," said Nevada Democrat Sen. Harry Reid.</P>
<P>Mr. Reid also made the political calculus more difficult for the White House by arguing that the Republican party's allies, the insurance industry, should be subjected to "reform" as well; two-thirds of that industry's $32.4 million in contributions went to Republicans in 2002. The AMA reports that the medical-malpractice insurers have raised premiums for liability coverage in some fields an average of 25% annually, even for doctors who have never had a complaint filed against them. In the AMA's "crisis" states, rates have doubled and even quadrupled in a single year.</P>
<P>With its top legislative priority on the line, the AMA has moved all its leadership meetings in 2003 to Washington, giving the doctors who attend plenty of opportunity to lobby their representatives. "We are going to take every opportunity to visit the House and Senate to convince those who haven't been in favor and thank those who have been," says Dr. Palmisano.</P>
<P>Write to Jeanne Cummings at &lt;</FONT><A href="mailto:jeanne.cummings@wsj.com"><U><FONT color=#0000ff size=2>mailto:jeanne.cummings@wsj.com</U></FONT></A><FONT size=2>&gt; <A href="mailto:jeanne.cummings@wsj.com">jeanne.cummings@wsj.com</A></P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Fri Jan 31 02:13:49 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Thu, 30 Jan 2003 18:13:49 -0800 (PST)
Subject: 4 articles showing progress in movement to reject Medi-Cal cuts and reimbursement cuts
Message-ID: <20030131021349.47037.qmail@web41511.mail.yahoo.com>

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From: California Healthline 





Assembly Budget Committee Rejects Proposed Mid-Year Budget Reductions for Medi-Cal 

01/24/2003 

The Assembly Budget Committee yesterday rejected many of the mid-fiscal-year budget reductions for Medi-Cal proposed by Gov. Gray Davis (D), the <http://www.latimes.com/news/local/la-me-budget24jan24.story> Los Angeles Times reports (Halper/Ingram, Los Angeles Times, 1/24). Davis last month proposed $2 billion in budget reductions for health care programs. Under the proposal, the state would reduce Medi-Cal income eligibility limits for parents who apply for the program to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the proposal would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The proposal also would reduce Medi-Cal reimbursement to physicians and other providers by 10%( http://www.californiahealthline.org/members/basecontent.asp?contentid=47716&collectionid=3&program=1 California Healthline, 1/16). The committee app!
roved a number of mid-year budget reductions but refused to revise Medi-Cal eligibility rules and provider reimbursement rates or to eliminate optional benefits. Assembly Budget Committee Chair Jenny Oropeza (D-Long Beach) said that the provisions approved by the committee represent a "balance of both tough cuts and responsible revenue increases" (Los Angeles Times, 1/24). The Senate Budget Committee on Tuesday approved $1.2 billion in mid-year budget reductions but rejected most of the proposed Medi-Cal reductions ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47752&collectionid=3&program=1 California Healthline, 1/22). The full Assembly and Senate will consider the mid-year reductions next week (Los Angeles Times, 1/24). 

Clinics Prepare for Reductions 

In related news, community clinics statewide are "bracing for the worst" as a result of Davis' proposals to "dramatically slash" funds for Medi-Cal and other low-income health care programs, the <http://www.bayarea.com/mld/cctimes/5021196.htm> Contra Costa Times reports. The clinics provide care to many low-income and uninsured individuals, regardless of their ability to pay. Clinic officials said that the proposal to revise income eligibility limits for Medi-Cal would "hurt the most," because the clinics would have to "swallow the cost" of care for those who lost coverage, the Times reports. Aimee Chitayat, executive director of the Community Clinic Consortium of Contra Costa County, said, "The clinics will have to see more uninsured people, and for those who are insured by Medi-Cal, they'll get less money." She added, "In some cases, we won't have the money to make up the difference, so people would end up being turned away" (Chang, Contra Costa Times, 1/24). 

=========================================================

From: California Healthline

Senate Budget Committee Rejects Proposed Mid-Year Budget Reductions for Medi-Cal 

01/22/2003 

The Senate Budget Committee yesterday "rebuffed" many of the mid-fiscal-year budget reductions for Medi-Cal proposed by Gov. Gray Davis (D), the <http://www.fresnobee.com/local/story/5955752p-6915597c.html> Fresno Bee reports (Maxwell, Fresno Bee, 1/22). Davis last month proposed $2 billion in budget reductions for health care programs. Under the proposal, the state would reduce Medi-Cal income eligibility limits for parents who apply for the program to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the proposal would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The proposal also would reduce Medi-Cal reimbursement to physicians and other providers by 10% ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47716&collectionid=3&program=1 California Healthline, 1/16). The committee approved $1.2 billion !
in mid-year budget reductions but rejected most of the proposed Medi-Cal reductions. Committee Chair Wes Chesbro (D-Arcata) said that "it was premature" to reduce reimbursement rates for Medi-Cal providers and eliminate coverage for optional benefits. "Our job is not to simply rubber stamp what the governor has proposed. This requires a lot more examination and discussion," Chesbro said (Fresno Bee, 1/22). Hilary McLean, a spokesperson for Davis, said that the governor proposed the Medi-Cal reductions to address the state's estimated $34.8 billion budget deficit over the next 18 months. "Each dollar we don't save now means more pain down the road," McLean said (Hill, <http://www.sacbee.com/content/politics/story/5955916p-6915686c.html> Sacramento Bee, 1/22). 

=========================================================

From: California Healthline

Providers Threaten Lawsuits in Response to Proposed Medi-Cal Reimbursement Reductions

01/21/2003

The California Medical Association <http://www.cmanet.org/> and the California Association of <http://www.cahf.org/> Health Facilities have said that they will use a "legal blockade" to prevent Medi-Cal provider reimbursement reductions included in Gov. Gray Davis' (D) fiscal year 2003-2004 budget proposal if the Legislature does not reject them, the <http://www.latimes.com/news/local/la-me-health18jan18.story> Los Angeles Times reports (Ornstein, Los Angeles Times, 1/18). The budget proposal, released by Davis earlier this month, would decrease state Medi-Cal expenditures by $3.6 billion to $24.7 billion. Under the proposal, the state would revise Medi-Cal eligibility requirements, a move that would reduce enrollment in the program by about 570,000. Medi-Cal also would no longer provide coverage for many optional benefits, such as artificial limbs, optometry, hearing aids, physical therapy and hospice care. In December, Davis also proposed the elimination of Medi-Cal covera!
ge for dentistry, medical supplies and podiatry. The budget proposal also would reduce Medi-Cal reimbursements for physicians, pharmacists and other providers by 5%, in addition to a 10% reduction that Davis proposed last month ( http://www.californiahealthline.org/members/basecontent.asp?contentid=47672&collectionid=3&program=1&contentarea=21284 California Health Line, 1/13). Federal regulations require states to provide Medicaid beneficiaries with "adequate access to medical services." Providers plan to file lawsuits to prevent the proposed reductions in Medi-Cal reimbursements, which they argue would prompt many providers to decide not to treat beneficiaries. Jack Lewin, CEO of the California Medical Association, said that physicians hope to protect a 16.7% Medi-Cal reimbursement increase that took effect in August 2000 and that the group would file suit to prevent reductions. Jim Gomez, president of the California Association of Health Facilities, added, "If we're not ab!
le to legislatively win this, we will go to the courts" (Los Angeles Times, 1/18). 

=======================================================



-----Original Message-----

From: CMA_ALERT [mailto:cma_alert@cmanet.org] 

Sent: Friday, January 17, 2003 12:43 PM 



BM_22. Governor's Budget Will Devastate California's Health Care System



Governor Davis unveiled his proposed budget on January 10 for the 2003-2004 fiscal year. Under the proposal, total spending for health programs administered by the state Department of Health Services would drop to $27.7 billion, down from $32.2 billion in the current fiscal year. Health and Human Services, with a 34 percent reduction, would take the largest hit of any state agency. Medi-Cal would lose $3 billion, down 28.9 percent from last year, and for every Medi-Cal dollar cut, California would also lose $1 in federal matching funds. 

Of the Medi-Cal "savings," $720 million would come as the result of a 15 percent reduction in provider reimbursement. This cut would essentially rescind the 16.7 percent average rate increase physicians received in 2000, the first across-the-board increase since 1985. 

The governor's proposal also includes: reinstatement of the Medi-Cal Quarterly Status Report, which would reduce eligibility for adults adding up to 250,000 people to the uninsured ranks; elimination of optional Medi-Cal benefits, such as adult dental care and medical supplies; and a rollback of Medi-Cal eligibility to include only those families with income at or below 61 percent of the federal poverty level. Currently all families at or below the federal poverty level-which is $14,600 for a family of four, for example-are eligible. This would leave an additional 150,000 of the working poor without health insurance.

CMA leaders and many other state health care experts believe that California's health-care safety net will collapse if all of Gov. Davis's proposed funding cuts are approved. These cuts will actually cost the state money as more Californians turn to emergency rooms for expensive care that could be delivered more efficiently elsewhere. 

CMA physicians and lobbyists are already scrutinizing all existing sources of revenue and exploring new ways to protect California's health-care system. <http://www.calphys.org/html/bb095.asp> Click here for more details on the governor's proposed budget.

Contact: Heather Campbell, 916/444-5532 or <mailto:hcampbell@cmanet.org> hcampbell@cmanet.org.


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


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<FONT size=2><FONT size=2>
<P>From: California Healthline </FONT><FONT size=2></P>
<P></P>
<P></P>
<P>Assembly Budget Committee Rejects Proposed Mid-Year Budget Reductions for Medi-Cal </P>
<P>01/24/2003 </P>
<P>The Assembly Budget Committee yesterday rejected many of the mid-fiscal-year budget reductions for Medi-Cal proposed by Gov. Gray Davis (D), the &lt;</FONT><A href="http://www.latimes.com/news/local/la-me-budget24jan24.story"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/local/la-me-budget24jan24.story</U></FONT></A><FONT size=2>&gt; Los Angeles Times reports (Halper/Ingram, Los Angeles Times, 1/24). Davis last month proposed $2 billion in budget reductions for health care programs. Under the proposal, the state would reduce Medi-Cal income eligibility limits for parents who apply for the program to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the proposal would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The proposal also would reduce Medi-Cal reimbursement to physicians and other providers by 10%( </FO!
NT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47716&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7716&amp;collectionid=3&amp;program=1</A> California Healthline, 1/16). The committee approved a number of mid-year budget reductions but refused to revise Medi-Cal eligibility rules and provider reimbursement rates or to eliminate optional benefits. Assembly Budget Committee Chair Jenny Oropeza (D-Long Beach) said that the provisions approved by the committee represent a "balance of both tough cuts and responsible revenue increases" (Los Angeles Times, 1/24). The Senate Budget Committee on Tuesday approved $1.2 billion in mid-year budget reductions but rejected most of the proposed Medi-Cal reductions ( </FONT><A href="http://www.californiahealthl!
ine.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47752&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7752&amp;collectionid=3&amp;program=1</A> California Healthline, 1/22). The full Assembly and Senate will consider the mid-year reductions next week (Los Angeles Times, 1/24). </P>
<P>Clinics Prepare for Reductions </P>
<P>In related news, community clinics statewide are "bracing for the worst" as a result of Davis' proposals to "dramatically slash" funds for Medi-Cal and other low-income health care programs, the &lt;</FONT><A href="http://www.bayarea.com/mld/cctimes/5021196.htm"><U><FONT color=#0000ff size=2>http://www.bayarea.com/mld/cctimes/5021196.htm</U></FONT></A><FONT size=2>&gt; Contra Costa Times reports. The clinics provide care to many low-income and uninsured individuals, regardless of their ability to pay. Clinic officials said that the proposal to revise income eligibility limits for Medi-Cal would "hurt the most," because the clinics would have to "swallow the cost" of care for those who lost coverage, the Times reports. Aimee Chitayat, executive director of the Community Clinic Consortium of Contra Costa County, said, "The clinics will have to see more uninsured people, and for those who are insured by Medi-Cal, they'll get less money." She added, "In some cases, we won't h!
ave the money to make up the difference, so people would end up being turned away" (Chang, Contra Costa Times, 1/24). </FONT></P>
<P><FONT size=2>=========================================================</FONT><FONT size=2></P>
<P>From: California Healthline</FONT><FONT size=2></P>
<P>Senate Budget Committee Rejects Proposed Mid-Year Budget Reductions for Medi-Cal </P>
<P>01/22/2003 </P>
<P>The Senate Budget Committee yesterday "rebuffed" many of the mid-fiscal-year budget reductions for Medi-Cal proposed by Gov. Gray Davis (D), the &lt;</FONT><A href="http://www.fresnobee.com/local/story/5955752p-6915597c.html"><U><FONT color=#0000ff size=2>http://www.fresnobee.com/local/story/5955752p-6915597c.html</U></FONT></A><FONT size=2>&gt; Fresno Bee reports (Maxwell, Fresno Bee, 1/22). Davis last month proposed $2 billion in budget reductions for health care programs. Under the proposal, the state would reduce Medi-Cal income eligibility limits for parents who apply for the program to 61% of the federal poverty level. The proposal also would require Medi-Cal beneficiaries to reverify their eligibility each quarter rather than each year. In addition, the proposal would eliminate optional Medi-Cal benefits, such as dental care and medical supplies. The proposal also would reduce Medi-Cal reimbursement to physicians and other providers by 10% ( </FONT><A href="http://!
www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47716&amp;collectionid=3&amp;program=1">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7716&amp;collectionid=3&amp;program=1</A> California Healthline, 1/16). The committee approved $1.2 billion in mid-year budget reductions but rejected most of the proposed Medi-Cal reductions. Committee Chair Wes Chesbro (D-Arcata) said that "it was premature" to reduce reimbursement rates for Medi-Cal providers and eliminate coverage for optional benefits. "Our job is not to simply rubber stamp what the governor has proposed. This requires a lot more examination and discussion," Chesbro said (Fresno Bee, 1/22). Hilary McLean, a spokesperson for Davis, said that the governor proposed the Medi-Cal reductions to address the state's estimated $34.8 billion budget defici!
t over the next 18 months. "Each dollar we don't save now means more pain down the road," McLean said (Hill, &lt;</FONT><A href="http://www.sacbee.com/content/politics/story/5955916p-6915686c.html"><U><FONT color=#0000ff size=2>http://www.sacbee.com/content/politics/story/5955916p-6915686c.html</U></FONT></A><FONT size=2>&gt; Sacramento Bee, 1/22). </P></FONT>
<P>=========================================================</P>
<P>From: California Healthline</FONT><FONT size=2></P>
<P>Providers Threaten Lawsuits in Response to Proposed Medi-Cal Reimbursement Reductions</P>
<P>01/21/2003</P>
<P>The California Medical Association &lt;</FONT><A href="http://www.cmanet.org/"><U><FONT color=#0000ff size=2>http://www.cmanet.org/</U></FONT></A><FONT size=2>&gt; and the California Association of &lt;</FONT><A href="http://www.cahf.org/"><U><FONT color=#0000ff size=2>http://www.cahf.org/</U></FONT></A><FONT size=2>&gt; Health Facilities have said that they will use a "legal blockade" to prevent Medi-Cal provider reimbursement reductions included in Gov. Gray Davis' (D) fiscal year 2003-2004 budget proposal if the Legislature does not reject them, the &lt;</FONT><A href="http://www.latimes.com/news/local/la-me-health18jan18.story"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/local/la-me-health18jan18.story</U></FONT></A><FONT size=2>&gt; Los Angeles Times reports (Ornstein, Los Angeles Times, 1/18). The budget proposal, released by Davis earlier this month, would decrease state Medi-Cal expenditures by $3.6 billion to $24.7 billion. Under the proposal, the s!
tate would revise Medi-Cal eligibility requirements, a move that would reduce enrollment in the program by about 570,000. Medi-Cal also would no longer provide coverage for many optional benefits, such as artificial limbs, optometry, hearing aids, physical therapy and hospice care. In December, Davis also proposed the elimination of Medi-Cal coverage for dentistry, medical supplies and podiatry. The budget proposal also would reduce Medi-Cal reimbursements for physicians, pharmacists and other providers by 5%, in addition to a 10% reduction that Davis proposed last month ( </FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=47672&amp;collectionid=3&amp;program=1&amp;contentarea=21284">http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A><FONT size=2>7672&amp;collectionid=3&amp;program=1&amp;contenta!
rea=21284</A> California Health Line, 1/13). Federal regulations require states to provide Medicaid beneficiaries with "adequate access to medical services." Providers plan to file lawsuits to prevent the proposed reductions in Medi-Cal reimbursements, which they argue would prompt many providers to decide not to treat beneficiaries. Jack Lewin, CEO of the California Medical Association, said that physicians hope to protect a 16.7% Medi-Cal reimbursement increase that took effect in August 2000 and that the group would file suit to prevent reductions. Jim Gomez, president of the California Association of Health Facilities, added, "If we're not able to legislatively win this, we will go to the courts" (Los Angeles Times, 1/18). </FONT></P>
<P><FONT size=2>=======================================================</P><FONT size=2>
<P></P>
<P>-----Original Message-----</P>
<P>From: CMA_ALERT [</FONT><A href="mailto:cma_alert@cmanet.org"><U><FONT color=#0000ff size=2>mailto:cma_alert@cmanet.org</U></FONT></A><FONT size=2>] </P>
<P>Sent: Friday, January 17, 2003 12:43 PM </P>
<P></P>
<P>BM_22. Governor's Budget Will Devastate California's Health Care System</P>
<P></P>
<P>Governor Davis unveiled his proposed budget on January 10 for the 2003-2004 fiscal year. Under the proposal, total spending for health programs administered by the state Department of Health Services would drop to $27.7 billion, down from $32.2 billion in the current fiscal year. Health and Human Services, with a 34 percent reduction, would take the largest hit of any state agency. Medi-Cal would lose $3 billion, down 28.9 percent from last year, and for every Medi-Cal dollar cut, California would also lose $1 in federal matching funds. </P>
<P>Of the Medi-Cal "savings," $720 million would come as the result of a 15 percent reduction in provider reimbursement. This cut would essentially rescind the 16.7 percent average rate increase physicians received in 2000, the first across-the-board increase since 1985. </P>
<P>The governor's proposal also includes: reinstatement of the Medi-Cal Quarterly Status Report, which would reduce eligibility for adults adding up to 250,000 people to the uninsured ranks; elimination of optional Medi-Cal benefits, such as adult dental care and medical supplies; and a rollback of Medi-Cal eligibility to include only those families with income at or below 61 percent of the federal poverty level. Currently all families at or below the federal poverty level-which is $14,600 for a family of four, for example-are eligible. This would leave an additional 150,000 of the working poor without health insurance.</P>
<P>CMA leaders and many other state health care experts believe that California's health-care safety net will collapse if all of Gov. Davis's proposed funding cuts are approved. These cuts will actually cost the state money as more Californians turn to emergency rooms for expensive care that could be delivered more efficiently elsewhere. </P>
<P>CMA physicians and lobbyists are already scrutinizing all existing sources of revenue and exploring new ways to protect California's health-care system. &lt;</FONT><A href="http://www.calphys.org/html/bb095.asp"><U><FONT color=#0000ff size=2>http://www.calphys.org/html/bb095.asp</U></FONT></A><FONT size=2>&gt; Click here for more details on the governor's proposed budget.</P>
<P>Contact: Heather Campbell, 916/444-5532 or &lt;</FONT><A href="mailto:hcampbell@cmanet.org"><U><FONT color=#0000ff size=2>mailto:hcampbell@cmanet.org</U></FONT></A><FONT size=2>&gt; <A href="mailto:hcampbell@cmanet.org">hcampbell@cmanet.org</A>.</FONT></P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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From pottsbri@yahoo.com  Fri Jan 31 23:38:14 2003
From: pottsbri@yahoo.com (CAL/AAEM News Service)
Date: Fri, 31 Jan 2003 15:38:14 -0800 (PST)
Subject: 4 articles showing progress in movement to stop MEDICARE reimbursement cuts
Message-ID: <20030131233814.99706.qmail@web41502.mail.yahoo.com>

--0-439059572-1044056294=:99354
Content-Type: text/plain; charset=us-ascii


-----Original Message-----

From: AAEM [mailto:info@aaem.org] 

Sent: Wednesday, January 29, 2003 8:28 AM

Subject: Medicare Provider Payments

To AAEM members,

Good news from Washington. 

AAEM Washington Update:

The Senate late Thursday (1/23) agreed to an amendment to use $900 million in the FY 2003 omnibus spending bill to prevent a 4.4% cut in Medicare payments to physicians. If the House agrees to this action during the Conference to be held to iron out the differences between the Senate and House bills, the physician payment reduction scheduled to take effect March 1 will not occur.

AAEM    611 East Wells Street    Milwaukee, WI 53202

800-884-2236          Fax: 414-276-3349

E-mail: info@aaem.org    website: www.aaem.org

================================================

Senate passes bill to stop Medicare fee cut

Measure effective until Sept. 1, gives Congress time to make permanent changes 

By Leigh Page <mailto:lpage@crain.com>

Jan 24, 2003 



After months of frenzied physician lobbying and false starts, the U.S. Senate on Thursday night finally passed legislation to cancel a planned 4.4% reduction in Medicare physician fees for the next six months. 

The measure, part of Congress' $390 billion appropriations bill and effective until Sept. 1, is now almost certain to pass, allowing Congress time to make permanent changes, say lobbyists for physicians' organizations in Washington, D.C.. 

"This is fee freeze, not a fee fix," says Priscilla Perry, M.D., chair of the government relations committee of the American Society of Cataract and Refractive Surgery, part of a coalition of specialty societies that has lobbied against the fee cuts. 

"We very much appreciate the Senate being willing to take these steps, which will give some time to work on what we feel is the underlying problem: a deeply flawed payment formula," Perry adds. 

The Senate passed the appropriations bill with the fee freeze in it at around 9 p.m. EST Friday, according to Nancey McCann, director of government relations, American Society of Cataract and Refractive Surgery. 

McCann says the bill, which already passed the House without a fee freeze in it, now goes to a House-Senate conference committee next week after the House convenes next Tuesday. 

Bush is expected to include longer-term changes for physician fees in his budget, which will be released in February, she says. 

While the House last year passed a bill to avert the 2003 fee cuts, the Senate failed to follow up. Cherie McNett, director of government affairs for the American Urological Association, attributes the Senate's change of heart to the new Senate majority leader, Sen. Bill Frist (R-Tenn.). 

"It's not because he is a physician; it's because he is a legislator," McNett says. "Under his leadership, I think you'll find that the Senate will move ahead with a variety of bills this year." 

=====

Promising comments from Tom Scully...



Antoine Kazzi



-----Original Message-----

From: California Healthline [mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM] 

Sent: Thursday, January 23, 2003 10:02 AM



CMS Administrator Scully Says Bush Administration Opposes Medicare Physician Fee Cuts 

01/23/2003 







CMS <http://www.cms.gov/> Administrator Tom Scully yesterday said the Bush administration opposes scheduled reductions in Medicare reimbursements to physicians, "all but ensur[ing]" that the 4.4% drop in physician payment levels scheduled for March 1 will not go into effect, the <http://www.latimes.com/news/nationworld/nation/la-na-medicare23jan23,0,

1891606.story?coll=la%2Dheadlines%2Dnation> Los Angeles Times reports. Speaking at a health policy conference in Los Angeles yesterday, Scully said, "The physician thing is an emergency, and it needs to be fixed now" (Kemper, Los Angeles Times, 1/23). Earlier this month, House Ways and Means Committee Chair Bill Thomas (R-Calif.) sponsored a bill that would use the Congressional Review Act, which allows Congress to overturn regulations recently published by a federal agency, to cancel the scheduled reduction. Scully said that a bill to overturn the regulation in order to prevent the scheduled cuts also would block "other things in the rule that are essential to running the [Medicare] program" ( <http://www.californiahealthline.org/members/basecontent.asp?contentid=4

7659&collectionid=3&program=1%20> California Healthline, 1/10). Meanwhile, Sen. Charles Grassley (R-Iowa) has added a Medicare payment adjustment to the omnibus 2003 appropriations package that would freeze physician payments at 2002 levels and increase reimbursements to rural and small urban hospitals, the Times reports. However, Scully said in his remarks yesterday that the administration is only seeking to address physician payment levels, not reimbursements to other Medicare providers, adding, "The doctors' thing is a big mistake. All the other stuff can wait." 





Medical Community Response 



Last year, Bush's health care advisers said the president would not support higher reimbursement rates for providers without also implementing a prescription drug benefit for Medicare, but that position has "evolved significantly," according to the Times. A 5.4% reduction in Medicare reimbursement rates to physicians in 2002, combined with Congressional "deadlock" on a Medicare prescription drug plan, has prompted doctors to stop accepting Medicare patients "in droves," and many seniors are now "scrounging for care," the Times reports. The American Medical <http://www.ama-assn.org/> Association and other groups have lobbied "relentlessly" against the cuts, saying that the reductions would cause private insurers -- most of which tie their payment rates to federal levels -- to lower reimbursements, according to the Times. "It's all about access and keeping doctors afloat," Dr. John Armstrong, member of the AMA board of trustees, said, adding that he was "very pleased" with Scu!
lly's comments. Scully also indicated that President Bush in his State of the Union address next week will highlight a Medicare prescription drug benefit and tax credits for the uninsured as critical domestic issues, according to the Times (Los Angeles Times, 1/23). 





==========================================

This is interesting. Look at your top 10 codes and see what your hit will be, factoring in your percentage of Medicare, which is a number you need to make the calculation of your loss due the Medicare new reduction for providers.

Elizabeth Woodcock is a well known expert in Medical Practice Management. Her perspective - on where Medicare is headed - is worth reading.

A. Antoine Kazzi, MD, FAAEM, FACEP

Vice President, the American Academy of Emergency Medicine

-----Original Message-----

From: docalerts@epocrates.com [mailto:docalerts@epocrates.com] 

Sent: Thursday, January 16, 2003 6:54 PM

Subject: Requested DocAlert information about Medicare Fee Schedule

Dear ePocrates Subscriber,

Here is the information you requested from the ePocrates DocAlert system: 

PRACTICE MANAGEMENT PEARLS (SM)

A Weekly Report on Practice Management Issues

By Elizabeth Woodcock, FACMPE

Medicare Fee Schedule Cut Again

DOWN, NOT OUT. Medical practices all over the country have been calling and e-mailing, anxious to know when the 2003 Medicare Physician Fee Schedule would be out. Usually released mid-November, the schedule for 2003 was not published until December 31, 2002, thanks to Congressional debates and delays.

It was not worth the wait. The "conversion factor" for 2003 -- a basic way to tell which direction reimbursement is moving -- dropped 4.4 percent from 2002's already low payments. Carriers will start paying on this schedule on March 1, 2003. The 2002 Fee Schedule remains in effect until then.

What does this mean for you?

Expect to make less -- or lose more -- on Medicare patients. For example, reimbursement for a 99204 office visit will drop to an average $124.19 from 2002's $139.68. A mammogram of both breasts, CPT code 76091, will drop 3 percent from $90.50 to $88.21. Brace yourself, too, for lower reimbursement from commercial payers, who figure that if you'll take low fees from the government, you'll take them from private sources, too.

But before you panic, it's important to find out exactly how your particular practice will be affected and plan adjustments accordingly. Knowledge is your best defense.

Get a copy of the 2003 Medicare Physician Fee Schedule to find out what you can expect to get paid this year for your most common procedures. You can download a copy of the Fee Schedule from www.cms.gov/REGULATIONS/PFS/.

You should download addendum B. Or, for an easier-to-read and easier-to-get version of the Fee Schedule, visit the Tools area of www.PhysiciansPractice.com. The Fee Schedule also includes global periods for every CPT code and values for new codes for 2003.

* Analyze the impact of the new, lower rates on your practice. Depending on what services you offer most often, your practice may be affected differently than others. It's important to know exactly what you are up against. To measure this, use the Fee Schedule to figure out what you'll be paid by Medicare for your top 10 services. One very easy way to do this is to use the 2003 Medicare Reimbursement Calculator in the Tools area of www.PhysiciansPractice.com.

* Prepare accordingly. Once you understand what your practice will face starting in March, you can plan a counterattack. Sadly, some physicians are considering dropping out of Medicare or at least closing to new Medicare patients. Others are looking for ways to cut overhead to keep afloat during this difficult year. For example, one practice I know is asking employees to pay for more of their own health insurance. Another has decided to stop taking call at one of its local hospitals, a decision that lowered its malpractice insurance rates. Perhaps there are new ways you can raise revenue or cut costs to offset Medicare's cuts.

Keep in mind that the impact of the 2003 Fee Schedule will, hopefully, be short-lived. Congress seems to agree that the formula used to compute physician reimbursement for Medicare has to change -- for the better. The devil is in the details, but physicians can hope realistically for better times in 2004.

To sign up to receive free Practice Management Pearls from Physicians Practice Inc., please visit: http://www.physicianspractice.com/index.cfm?method=parent&submethod=newsletter&&r=

If you would like to learn more about ePocrates DocAlerts, please visit 

http://www.epocrates.com/products/docalert.cfm.

Best wishes, 

The ePocrates Team


Brian Potts 
Managing Editor, CAL/AAEM News Service 
MS-IV, UC Irvine 
MD/MBA candidate 
pottsbri@yahoo.com


---------------------------------
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Yahoo! Mail Plus - Powerful. Affordable. Sign up now
--0-439059572-1044056294=:99354
Content-Type: text/html; charset=us-ascii

<FONT size=2>
<P>-----Original Message-----</P>
<P>From: AAEM [</FONT><A href="mailto:info@aaem.org"><U><FONT color=#0000ff size=2>mailto:info@aaem.org</U></FONT></A><FONT size=2>] </P>
<P>Sent: Wednesday, January 29, 2003 8:28 AM</P>
<P>Subject: Medicare Provider Payments</P>
<P>To AAEM members,</P>
<P>Good news from Washington. </P>
<P>AAEM Washington Update:</P>
<P>The Senate late Thursday (1/23) agreed to an amendment to use $900 million in the FY 2003 omnibus spending bill to prevent a 4.4% cut in Medicare payments to physicians. If the House agrees to this action during the Conference to be held to iron out the differences between the Senate and House bills, the physician payment reduction scheduled to take effect March 1 will not occur.</P>
<P>AAEM&nbsp;&nbsp;&nbsp; 611 East Wells Street&nbsp;&nbsp;&nbsp; Milwaukee, WI 53202</P>
<P>800-884-2236&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Fax: 414-276-3349</P>
<P>E-mail: <A href="mailto:info@aaem.org">info@aaem.org</A>&nbsp;&nbsp;&nbsp; website: </FONT><A href="http://www.aaem.org"><U><FONT color=#0000ff size=2>www.aaem.org</U></FONT></A></P>
<P>================================================</P><FONT size=2>
<P>Senate passes bill to stop Medicare fee cut</P>
<P>Measure effective until Sept. 1, gives Congress time to make permanent changes </P>
<P>By Leigh Page &lt;</FONT><A href="mailto:lpage@crain.com"><U><FONT color=#0000ff size=2>mailto:lpage@crain.com</U></FONT></A><FONT size=2>&gt;</FONT></P>
<P><FONT size=2>Jan 24, 2003 </P>
<P></P>
<P>After months of frenzied physician lobbying and false starts, the U.S. Senate on Thursday night finally passed legislation to cancel a planned 4.4% reduction in Medicare physician fees for the next six months. </P>
<P>The measure, part of Congress' $390 billion appropriations bill and effective until Sept. 1, is now almost certain to pass, allowing Congress time to make permanent changes, say lobbyists for physicians' organizations in Washington, D.C.. </P>
<P>"This is fee freeze, not a fee fix," says Priscilla Perry, M.D., chair of the government relations committee of the American Society of Cataract and Refractive Surgery, part of a coalition of specialty societies that has lobbied against the fee cuts. </P>
<P>"We very much appreciate the Senate being willing to take these steps, which will give some time to work on what we feel is the underlying problem: a deeply flawed payment formula," Perry adds. </P>
<P>The Senate passed the appropriations bill with the fee freeze in it at around 9 p.m. EST Friday, according to Nancey McCann, director of government relations, American Society of Cataract and Refractive Surgery. </P>
<P>McCann says the bill, which already passed the House without a fee freeze in it, now goes to a House-Senate conference committee next week after the House convenes next Tuesday. </P>
<P>Bush is expected to include longer-term changes for physician fees in his budget, which will be released in February, she says. </P>
<P>While the House last year passed a bill to avert the 2003 fee cuts, the Senate failed to follow up. Cherie McNett, director of government affairs for the American Urological Association, attributes the Senate's change of heart to the new Senate majority leader, Sen. Bill Frist (R-Tenn.). </P>
<P>"It's not because he is a physician; it's because he is a legislator," McNett says. "Under his leadership, I think you'll find that the Senate will move ahead with a variety of bills this year." </P>
<P>=====<FONT size=2></P>
<P>Promising comments from Tom Scully...</P>
<P></P>
<P>Antoine Kazzi</P>
<P></P>
<P>-----Original Message-----</P>
<P>From: California Healthline [</FONT><A href="mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM"><U><FONT color=#0000ff size=2>mailto:CALIFORNIAHEALTHLINE@ADVISORY.COM</U></FONT></A><FONT size=2>] </P>
<P>Sent: Thursday, January 23, 2003 10:02 AM</P>
<P></P>
<P>CMS Administrator Scully Says Bush Administration Opposes Medicare Physician Fee Cuts </P>
<P>01/23/2003 </P>
<P></P>
<P></P>
<P></P>
<P>CMS &lt;</FONT><A href="http://www.cms.gov/"><U><FONT color=#0000ff size=2>http://www.cms.gov/</U></FONT></A><FONT size=2>&gt; Administrator Tom Scully yesterday said the Bush administration opposes scheduled reductions in Medicare reimbursements to physicians, "all but ensur[ing]" that the 4.4% drop in physician payment levels scheduled for March 1 will not go into effect, the &lt;</FONT><A href="http://www.latimes.com/news/nationworld/nation/la-na-medicare23jan23,0"><U><FONT color=#0000ff size=2>http://www.latimes.com/news/nationworld/nation/la-na-medicare23jan23,0</U></FONT></A><FONT size=2>,</P>
<P>1891606.story?coll=la%2Dheadlines%2Dnation&gt; Los Angeles Times reports. Speaking at a health policy conference in Los Angeles yesterday, Scully said, "The physician thing is an emergency, and it needs to be fixed now" (Kemper, Los Angeles Times, 1/23). Earlier this month, House Ways and Means Committee Chair Bill Thomas (R-Calif.) sponsored a bill that would use the Congressional Review Act, which allows Congress to overturn regulations recently published by a federal agency, to cancel the scheduled reduction. Scully said that a bill to overturn the regulation in order to prevent the scheduled cuts also would block "other things in the rule that are essential to running the [Medicare] program" ( &lt;</FONT><A href="http://www.californiahealthline.org/members/basecontent.asp?contentid=4"><U><FONT color=#0000ff size=2>http://www.californiahealthline.org/members/basecontent.asp?contentid=4</U></FONT></A></P><FONT size=2>
<P>7659&amp;collectionid=3&amp;program=1%20&gt; California Healthline, 1/10). Meanwhile, Sen. Charles Grassley (R-Iowa) has added a Medicare payment adjustment to the omnibus 2003 appropriations package that would freeze physician payments at 2002 levels and increase reimbursements to rural and small urban hospitals, the Times reports. However, Scully said in his remarks yesterday that the administration is only seeking to address physician payment levels, not reimbursements to other Medicare providers, adding, "The doctors' thing is a big mistake. All the other stuff can wait." </P>
<P></P>
<P></P>
<P>Medical Community Response </P>
<P></P>
<P>Last year, Bush's health care advisers said the president would not support higher reimbursement rates for providers without also implementing a prescription drug benefit for Medicare, but that position has "evolved significantly," according to the Times. A 5.4% reduction in Medicare reimbursement rates to physicians in 2002, combined with Congressional "deadlock" on a Medicare prescription drug plan, has prompted doctors to stop accepting Medicare patients "in droves," and many seniors are now "scrounging for care," the Times reports. The American Medical &lt;</FONT><A href="http://www.ama-assn.org/"><U><FONT color=#0000ff size=2>http://www.ama-assn.org/</U></FONT></A><FONT size=2>&gt; Association and other groups have lobbied "relentlessly" against the cuts, saying that the reductions would cause private insurers -- most of which tie their payment rates to federal levels -- to lower reimbursements, according to the Times. "It's all about access and keeping doctors afloa!
t," Dr. John Armstrong, member of the AMA board of trustees, said, adding that he was "very pleased" with Scully's comments. Scully also indicated that President Bush in his State of the Union address next week will highlight a Medicare prescription drug benefit and tax credits for the uninsured as critical domestic issues, according to the Times (Los Angeles Times, 1/23). </P>
<P></P>
<P></P>
<P></FONT>==========================================</P><FONT size=2>
<P>This is interesting. Look at your top 10 codes and see what your hit will be, factoring in your percentage of Medicare, which is a number you need to make the calculation of your loss due the Medicare new reduction for providers.</P>
<P>Elizabeth Woodcock is a well known expert in Medical Practice Management. Her perspective - on where Medicare is headed - is worth reading.</P>
<P>A. Antoine Kazzi, MD, FAAEM, FACEP</P>
<P>Vice President, the American Academy of Emergency Medicine</P>
<P>-----Original Message-----</P>
<P>From: docalerts@epocrates.com [</FONT><A href="mailto:docalerts@epocrates.com"><U><FONT color=#0000ff size=2>mailto:docalerts@epocrates.com</U></FONT></A><FONT size=2>] </P>
<P>Sent: Thursday, January 16, 2003 6:54 PM</P>
<P>Subject: Requested DocAlert information about Medicare Fee Schedule</P>
<P>Dear ePocrates Subscriber,</P>
<P>Here is the information you requested from the ePocrates DocAlert system: </P>
<P>PRACTICE MANAGEMENT PEARLS (SM)</P>
<P>A Weekly Report on Practice Management Issues</P>
<P>By Elizabeth Woodcock, FACMPE</P>
<P>Medicare Fee Schedule Cut Again</P>
<P>DOWN, NOT OUT. Medical practices all over the country have been calling and e-mailing, anxious to know when the 2003 Medicare Physician Fee Schedule would be out. Usually released mid-November, the schedule for 2003 was not published until December 31, 2002, thanks to Congressional debates and delays.</P>
<P>It was not worth the wait. The "conversion factor" for 2003 -- a basic way to tell which direction reimbursement is moving -- dropped 4.4 percent from 2002's already low payments. Carriers will start paying on this schedule on March 1, 2003. The 2002 Fee Schedule remains in effect until then.</P>
<P>What does this mean for you?</P>
<P>Expect to make less -- or lose more -- on Medicare patients. For example, reimbursement for a 99204 office visit will drop to an average $124.19 from 2002's $139.68. A mammogram of both breasts, CPT code 76091, will drop 3 percent from $90.50 to $88.21. Brace yourself, too, for lower reimbursement from commercial payers, who figure that if you'll take low fees from the government, you'll take them from private sources, too.</P>
<P>But before you panic, it's important to find out exactly how your particular practice will be affected and plan adjustments accordingly. Knowledge is your best defense.</P>
<P>Get a copy of the 2003 Medicare Physician Fee Schedule to find out what you can expect to get paid this year for your most common procedures. You can download a copy of the Fee Schedule from </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.cms.gov/REGULATIONS/PFS/"><U><FONT color=#0000ff size=2>www.cms.gov/REGULATIONS/PFS/</U></FONT></A><FONT size=2>.</P>
<P>You should download addendum B. Or, for an easier-to-read and easier-to-get version of the Fee Schedule, visit the Tools area of </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.PhysiciansPractice.com"><U><FONT color=#0000ff size=2>www.PhysiciansPractice.com</U></FONT></A><FONT size=2>. The Fee Schedule also includes global periods for every CPT code and values for new codes for 2003.</P>
<P>* Analyze the impact of the new, lower rates on your practice. Depending on what services you offer most often, your practice may be affected differently than others. It's important to know exactly what you are up against. To measure this, use the Fee Schedule to figure out what you'll be paid by Medicare for your top 10 services. One very easy way to do this is to use the 2003 Medicare Reimbursement Calculator in the Tools area of </FONT><A href="http://us.f415.mail.yahoo.com/ym/www.PhysiciansPractice.com"><U><FONT color=#0000ff size=2>www.PhysiciansPractice.com</U></FONT></A><FONT size=2>.</P>
<P>* Prepare accordingly. Once you understand what your practice will face starting in March, you can plan a counterattack. Sadly, some physicians are considering dropping out of Medicare or at least closing to new Medicare patients. Others are looking for ways to cut overhead to keep afloat during this difficult year. For example, one practice I know is asking employees to pay for more of their own health insurance. Another has decided to stop taking call at one of its local hospitals, a decision that lowered its malpractice insurance rates. Perhaps there are new ways you can raise revenue or cut costs to offset Medicare's cuts.</P>
<P>Keep in mind that the impact of the 2003 Fee Schedule will, hopefully, be short-lived. Congress seems to agree that the formula used to compute physician reimbursement for Medicare has to change -- for the better. The devil is in the details, but physicians can hope realistically for better times in 2004.</P>
<P>To sign up to receive free Practice Management Pearls from Physicians Practice Inc., please visit: </FONT><A href="http://www.physicianspractice.com/index.cfm?method=parent&amp;submethod=news"><U><FONT color=#0000ff size=2><A href="http://www.physicianspractice.com/index.cfm?method=parent&amp;submethod=newsletter&amp;&amp;r=If">http://www.physicianspractice.com/index.cfm?method=parent&amp;submethod=news</U></FONT></A><FONT size=2>letter&amp;&amp;r=</P>
<P>If</A> you would like to learn more about ePocrates DocAlerts, please visit </P>
<P></FONT><A href="http://www.epocrates.com/products/docalert.cfm"><U><FONT color=#0000ff size=2><A href="http://www.epocrates.com/products/docalert.cfm.Best">http://www.epocrates.com/products/docalert.cfm</U></FONT></A><FONT size=2>.</P>
<P>Best</A> wishes, </P>
<P>The ePocrates Team</FONT></P></FONT><BR><BR><STRONG>Brian Potts <BR>Managing Editor, CAL/AAEM News Service</STRONG> <BR>MS-IV, UC Irvine <BR>MD/MBA candidate <BR>pottsbri@yahoo.com<p><br><hr size=1>Do you Yahoo!?<br>
<a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Yahoo! Mail Plus</a> - Powerful. Affordable. <a href="http://rd.yahoo.com/mail/mailsig/*http://mailplus.yahoo.com">Sign up now</a>
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