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Scjen°eS qS lA'rS c« caL Uni Ubrar> NOT TO CIRCULATE Digitized by the Internet Archive 2016 in https://archive.org/details/newjerseymedicin9411medi HEALTH SCIENCES LIBRARY UNIVERSITY OF MARYLAND. AT BALTIMORE mnin nninIlI Y O U R - - - PRACTICE MADE MORE PERFECT WITH OVERHEAD EXPENSE INSURANCE FROM BLANKSTEEN Ifyou get sick, we’d like to help keep your practice well with overhead expense coverage that can reimburse office salaries, rent, insurance premiums, and utilities during an extended disability. Your needs are special, so call and talk with us. The only time to draw a blank in your insurance is when you fill it in with Blanksteen. TheBlanksteenCompanies253WashingtonStreetJerseyCity,NJ07302 201-333-4340 1-800-BLANK-AG TheBlanksteenCompanies161WilliamStreetNewYork,NY10038 212-732-9435 1-800-BLANK-AG TheMEDICALSOCIETYOFNEWJERSEYendorsedplans,includingProfessionalOverheadExpenseunderwrittenbyNational CasualtyCompany. NewJerseyMedium; Tobacco marketing tochildren prominent tobacco control advocate continues to drawthe ire of health John D. Slade, MD, displayed "collec- policy makers, especially in New tnoers"sciogfarJeoteteCpaamckealgeasndfeaottuhreirngttohbealcickeo- Jersey. Backing regulations iconsthatcouldappealonlytochildrenor proposed bydeparting Food and veryunsophisticatedadults. Drug Commissioner David A. Thecampaign againsttobacco also is Kessler, MD, JD, theWhitman entering physicians' offices in a bigway, administration entered thefederal as HMOs and other forces implement tobaccocessationmeasures. Channeling courtcase testing the their anger, clinicians are expected to groundbreaking regulations' inquire about tobacco use, and encour- legality. ageandassistquitting,almostreflexively. In aGarden Stateaversetothetobac- To cool our anger, let's turn to coleaf,scoresoftownshavebannedcig- managed care. The new arette vending machines, which service Washington, DC-based Center for youth disproportionately. According to Health System Change reviewed New Jersey BREATHES a tobacco three recent studies of Medicare control coalition based at the Medical HMOs and concluded that per- Society of New Jersey (MSNJ) haps HMOs are overpaid. almost one-half of municipal vending Astudyteam led byGerald F. Riley, machine bans in the United States were MSPH oftheHealth Care Financing adopted here but now are vulnerable. Administration (HCFA) found that Unless the Whitman administration Medicare HMO enrollees were healthier applies for a waiver, local bans will be than their fee-for-service counterparts pre-empted by the federal regulations, basedon leveloffunctioning, activitylim- which allow cigarette vending machines itations,andself-perceptionsofhealthsta- in bars and other supposedly "adults tus. Research byChristopher Hogan, only" spots. PhD of the Physician Payment The local bans also are being chal- Review Commission determined that lenged in New Jersey courts, where enrollees generated relatively low health MSNJ hasappeared as amicuscuriaein care costs for six months before joining, support. Tobacco is an arena where and relatively high costs for six months physicians and Health and Senior afterleaving, HMOs. Services Commissioner Len Fishman, Bycontrast, Jack Rodgers, PhD, of lastyear'sNewJerseyMEDICINE Person Price Waterhouse, in a study funded oftheYear, frequentlyappearin mutually by the American Association of supporting roles. Health Plans, the HMOs' tradeassoci- Why do Fishman and MSNJ care so ation, found that HMO enrollees on bal- much? Every day about 40 New ance were no healthier than the fee-for- Jerseyans dieoftobacco-related disease. servicepopulation. Dr. Rodgers' method- Three-fourths of smokers begin before ology was criticized by the Center on reaching age 18. Evidence is piling up three counts: a small sample including that tobacco's appeal to children results only371 respondents; useofadatabase largely from the sleazy industry's youth- twoyears olderthan HCFA's; and exclu- directed marketing. At a recent New sionofenrolleeswhodiedorshiftedinor Jersey BREATHES meeting, nationally outofan HMO. NewJerseyMedkt\e 1 NewJerseyMedicine In response to the findings, analysts development ofall review criteria, incor- proposed policy initiatives that included poratecomplaintreviewintoqualityman- incentivesforHMOstofurnishHCFAwith agement, ban retrospectivedenials inthe betterutilization data, lower paymentsto absenceoffalse information, and letclin- HMOs coupled with higher premiums iciansobtain reasonsfordenial. NJM paid by enrollees, and more accurate adjustments for risk coupled with a pay- Utilization reviewgenerallyis prospec- ment increase from 95 percent to 100 tiveorconcurrent,whereasclaimsreview percent of adjusted average per capita isretrospective. URACstandardsarefol- lowedmostlyinthefee-for-servicemarket. costs. As to physician pay, Xact, the A "chronic care perspective" is Medicare carrier for New Jersey, being touted byThe RobertWood NJM announced regional fee changes. Johnson Foundation (RWJF), in The changes reflect a reduction in Princeton, whose newest chart- the number of payment localities bookshowsthat99millionAmer- nationwide,from 210to 89. icans suffer from chronic medical conditions. Authors note thatthis Fees will not change in Area 1, con- population accounts for 70 per- sisting of Bergen, Essex, Hudson, cent of personal health care Hunterdon, Middlesex, Morris, expenditures in the United States NJM Passaic, Somerset, Sussex, Union, and that tax dollars are used to and Warren counties. But, central pay 40 percent of chronic care New Jersey physicians (situated in old expenditures, compared with Area 2 consisting of Mercer, Mon- only 20 percent of acute care mouth, Ocean, and Burlington expenditures. counties) will sustain an average 1 per- centdecrease,whilesouthernNewJersey Infurtheranceofthisperspective, more physicians (situated in oldArea 3, which preventiveeffortsandsupportforinformal NJM consists of Atlantic, Camden, Cape caregivers,oftenthewivesanddaughters May, Cumberland, Gloucester, and ofpatients, are urged. RWJF's incoming Salem counties)enjoyanaverage 1.5 executive vice-president, Lewis G. percentrise, as thesegroups consolidate Sandy, MD, observes that the health intoa newArea99. care system is far more accommodating topatientswithacuteneedsthan patients As the National Committee for with chronic conditions. Moreover, the Quality Assurance garners enor- mEmopulsoypeurbliDciattyafoarnidts HIenaflotrhmatPiloann ccahraertibnodoukstrdyecovlearraelslhtahastye"tthteoimmapnleamgeendt NJM Set (HEDIS) standards assessing . . . practices that would meet" chronic careneeds. HMOs, attention must be paid as well to the URAC National Utili- The nationally praised exhibit zationManagementStandardsfor "Hospice: A Photographic Inquiry" is on utilization revieworganizations. view until February 23 at The Morris Proposed URAC changes, supported MofutsheeuNmewinMJoerrrsiestyowHno,scpoiucrteesOyrignapnar-t NJM by the American Medical Association, ization. Call 201/538-0454. "And wreoquulidre repsrtroimctptactceelsesphotonecltarianmssferdsatat,o death shall havenodominion." NJM reviewers, involve relevant specialists in 2 NewJerseyMebicine