Physician payment reform: Congress's turn

Article Abstract:

The Physician Payment Review Commission (PPRC) was created in 1986 to advise Congress on methods for payment to physicians by Medicare. The 1989 annual report included the recommendation of a Medicare Fee Schedule based primarily on resource costs. Limits on balance billing were recommended, as well as the use of expenditure targets, increased research on the effectiveness of medical services and the development of practical guidelines to control the growth in spending. These recommendations will more than likely be passed into law by Congress, which is intent upon changing the current payment policies of Medicare. The PPRC is composed of professionals from diverse backgrounds with both political and technical expertise, and was devised to represent the interests of the public rather than interested parties such as the American Medical Association. The PPRC recommends replacing the current method of reimbursing physicians with a fee schedule based on resource costs associated with the service rendered. The reform includes redistribution of fees from specialists to general practitioners and a redistribution of fees based on geographical variation that considers only differences in overhead costs. Large metropolitan cities will lose approximately 14 percent on the currently allowed charges. The professionals are concerned about the bureaucratic intrusion into medicine, and favor the development of guidelines to reduce unnecessary spending. It is questionable whether reviewing medical practices would actually cut costs, for while there is unnecessary care, there is also underservice. Congress feels that it cannot wait for guidelines to be developed to solve cost problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Laws, regulations and rules, Social policy, Political aspects, Medical care, Cost of, Health care costs, Medicare, Prospective payment systems (Medical care), editorial, United States. Physician Payment Review Commission

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The irritable bowel syndrome: long-term prognosis and the physician-patient interaction

Article Abstract:

Most patients diagnosed with irritable bowel syndrome (IBS) appear to be diagnosed correctly and have favorable outcomes. Also, a good physician-patient interaction at initial diagnosis could result in fewer IBS-related return visits. IBS is an intestinal disorder, marked by abdominal pain and constipation or diarrhea, for which there is no known cause or effective treatment. Researchers reviewed medical records of 112 patients diagnosed with IBS from 1961 to 1963. Patients were followed up to 32 years, and their survival correlated with expected survival for the general population group. Only 10 patients were subsequently diagnosed with other gastrointestinal diseases, and these did not appear to be associated with IBS. A second review of the records rated the physician-patient interaction based on physicians' notes. Patients whose physician-patient interaction scores were most positive tended to make fewer outpatient visits for IBS complaints.

Health aspects, Physician and patient, Physician-patient relations, Prognosis, Irritable bowel syndrome

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Ethical practice in managed care: a dose of realism

Article Abstract:

A set of ethical guidelines that physicians in managed care can follow is presented. The most important factor in medical care is patient trust, which can be determined by analyzing the patient's willingness to comply with treatment. Financial incentives should not be eliminated completely but can be considered along with other factors. Physicians should maximize the health of their patients without regard to the patients' insurance status. If insurance status is considered, the physician should explain this to the patient.

Standards, Practice, Physicians, Medical professions, Ethical aspects, Managed care plans (Medical care), Medical ethics

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