Executive Order May Secure Patients\' Rights While Bill Remains Stalled in Congress
On October 8, the New York Times reported that because members of Congress seem unlikely to agree on a version of the patients\' bill of rights, the White House plans to tighten the federal regulation of private healthcare plans. This would, in effect, secure some rights for patients through an executive order. The Times said the rules would be issued in a final form before Election Day.
The rules will set new standards for the handling of claims under employee health benefit plans; this would be the first such revision since 1977. The new rules could give patients better tools with which to deal with the barriers set up by managed care companies. The new rules have been in the writing stage in the US Justice Department for the past 3 years. Under the proposed new rules, the following would occur.
The government will set standards for the information insurers must provide patients about their coverage.
Federal agencies will establish a 15-day limit on the time insurers can take to make decisions on claims. However, if that claim is urgent, the plan would be expected to decide within 72 hours.
Rulings on appeals must occur within 30 days unless the situation is an emergency. In that case, the appeal ruling must be made within 72 hours.
Patients whose claims are denied must be told specifically why and they must be informed of the guidelines or criteria used in making the denial decision.
When a health plan refuses to authorize an operation or other medical procedure, this action will be the same as denying a claim and may be appealed.
A patient may receive a hearing if a health plan attempts to reduce his or her benefits.
When a person appeals a claim denial, the person hearing the appeal must consult an independent medical expert on any issue involving medical judgment.
The Labor Department is expected to issue the rules under the terms of the 1974 Employee Retirement Income Security Act. Although the new rules do establish some protections for patients, they fall short of the legislation passed by the US House more than a year ago because they do not give patients the right to sue health maintenance organizations for injuries resulting from a claim denial. A Senate version of the bill did not give patients the right to sue in that instance, and disputes over this provision have kept the bill in limbo in a conference committee convened to deal with the inconsistencies in the bills passed by the 2 Houses of Congress.
Private employee benefits plans will have to revise their policies on claims and appeals to comply with the new rules.
After a Year, Stents Pose No More Risks for Women Than Men
A German study published in the October 10, 2000, issue of the Journal of the American Medical Association found that although women faced more than twice the risk of death or nonfatal heart attack a month after the placement of a stent in the coronary artery, the risks of either event were the same for each sex at 1 year after the procedure (JAMA. 2000;284:1799\N1805).\
After a year, the heart attack and death rate for both sexes was |mF6\%, said researchers from the Deutsches Herzzentrum and Medizinische Klinik rects der Isar in Munich, Germany. The study, which was led by Julinda Mehilli, MD, of Deutsches Herzzentrum, evaluated a consecutive series of 1001 women and 3263 men who underwent stenting between May 1992 and December 1998 at the 2 centers. The women, on average, were older and more likely to have a complicating health condition such as diabetes, hypertension, or high cholesterol. However, the women had less extensive coronary artery disease, a history of fewer heart attacks, and better left ventricular function than the men. In the 30-day period after the stenting, the death or myocardial infarction rate for women was 3.1\% versus 1.8\% for men. However, at 1 year, the rate was 6\% for women and 5.8\% for men.
Worldwide, |mF1 million stents are implanted in patients\' arteries. In the past decade, stents have become a major tool in the treatment of patients with coronary artery disease.
Federal Funding for Automated External Defibrillators in Rural Areas Is Proposed
A bill passed in the US Senate would provide $25 million over 3 years to purchase automated external defibrillators for rural community hospitals, police and fire departments, and other emergency care providers outside of metropolitan areas. The funding, which will also provide funds for training, will come from the Rural Access to Emergency Devices Act. Automated External Defibrillators have become more prevalent in urban areas and at sites where large crowds gather. This is one of the first measures to take the equipment outside city limits.
Quality of Health Care Deteriorating in 5 Countries, Doctors Say
More than half of the doctors in the United States and 4 other English-speaking nations said their ability to deliver quality health care has deteriorated over the past 5 years, according to a survey released October 12, 2000, by the Harvard University School of Public Health and The Commonwealth Fund. Only 1 in 6 US physicians said his or her ability to provide quality care improved during the last half decade, despite increased spending and advances in medical treatment during that period.
No more than 25\% of physicians in the other 4 countries surveyed (Australia, Canada, New Zealand, and the United Kingdom) believed that their ability to deliver quality care had increased in 5 years. |P`These findings are alarming. What\'s worse is that many doctors in all 5 countries fear this decline in quality will continue,|P' said Robert Blendon, ScD, professor of health policy and political analysis at the Harvard School of Public Health. |P`The good news is that they don\'t view the situation as irreversible.|P'
The doctors said they were concerned that hospitals are doing little to address the problem of medical errors. At the same time, they were themselves overwhelmed with information, making it difficult for them to remain abreast of new findings in their fields. In the United States, a chronic nursing shortage contributed to the deterioration in the quality of care, the doctors said.
The other nations\' physicians were concerned about the long waiting times before patients could receive care. In the United States, physicians were more concerned about whether patients could afford good care, especially prescription medicines.
A major problem across the board was the lack of time to spend discussing problems with patients. Doctors also said they would like to receive reports on patients\' views of the health care they receive.
In general, however, physicians were happier with health care in their respective countries than the public as a whole. In 1998, 14\% to 33\% of the members of the public surveyed in these 5 countries wanted to completely rebuild the healthcare system. However, in the current survey, fewer than 12\% of primary care physicians and 8\% of specialists recommended a total overhaul. The physicians were interviewed from April 27 to July 27, 2000. The survey included 517 Australian physicians, 533 Canadians, 493 from New Zealand, 500 from the United Kingdom, and 528 from the United States. The full report may be found on the web site of The Commonwealth Fund at http://www.cmwf.org.
- Copyright © 2000 by American Heart Association