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THE FRANCIS A. COUNTWAY LlBPcARY OF MEDICINE Harvard MedicalLibrary-Boston Medicallibrary Digitized by the Internet Archive 2016 in https://archive.org/details/ohiomedicinejour8719ohio OHIO Medicine J0L[RNAL of the OHIO STATE MEDICAL ASSOCIATION VOL. 87, NO. 1 JANUARY 1991 • Keeping the “Buy Right ” Plan • Major Issues Facing Dream Alive for Health Care Medicine in 1991 Page 7 Page 19 Page 35 . . . . . . . . . FRANKLIN >a- —• uoi 1 T— <r T— O' t-i V (OM cHn Uo- CJ _i 99-00-5312 > «« uj cH- <f ez> j—E CO O 1^ 0I 0"D XIuC>0O0»<-o O c_> U1 r— no ommunities Scrambling Doctors for IXkea Good Look AT OSMA’s AfeWESTj^MBER .Benefit... V - i i Li ' 1 —\ 1 : I ^ \ j i Featuring: Competitive rates Guaranteed Acceptance Available to members, their families, and office staff Average two week turnaround on claims $1,000 calendar year maximum per insured $50 Deductible/$100 Family 100% Diagnostic/X Ray 80% Minor Restoration 50% Major Restoration 50% Orthodontia Formore information and toapplyforcoverage, contact yourOSMA Benefit representative atAmerican Physicians Lifetoll free, 1-800-742-1275. OSMA Dental available through American Physicians Life, the OSMA’s life and health carrier, committed to maintaining thefinest benefitsfor members at the lowest possible price. BatesDrive,PO Box281 Pickerington,Ohio43147 (614)864-3900 1-800-742-1275 Contents OHIO Medicine / January 1991 Vol. 87 No. 1 Departments 25 COVER STORY: Rural communities are 3 Presidential scrambling to recruit Perspectives physicians. Monroe County thinks foreign 5 Auxiliary Page medical graduates may be the answer to the 21 Commentary doctor shortage. 38 fr'c Obituaries Loss Awareness: I ^V^; / BQST 'jE 42 Effective doctor- Continuing MecM^Scene patient Medical Education relationships serve 44 as a major element 10 Closer look at Classified in reducing migrating “snow Advertising malpractice suits. birds.” 47 Journal Advertisers Legislation: What 11 Book reveals 48 are the major humorous incidents Medical Aids issues facing in physicians’ lives. medicine in 1991? 12 Substance-sniffing Peer Review: Peer deaths on the rise. Articles Review is shifting 13 OSMA produces emphasis from its sports videotapes. Second Opinion: case-by-case Keeping the dream assessments to the 16 NASA working alive. larger-picture goal with CWRU to of education. benefit orthopedics. Reimbursement: Cleveland initiates Research: New 17 Physician “buy right” plan drugs for AIDS Effectiveness for health care. treatment; heart Program plans to attack risk- hire full-time 28 OSMA: Changing reduction; treating director. directions in the addicted veterans; — ISSN 0892-2454 ’90s Part II study on infections. USPS 405-200 January 1991 1 EDITORIAL STAFF Executive Director Herbert E. Gillen Director, DepartmentofCommunications Carol Wright Mullinax Executive Editor Karen S. Edwards Associate Editor Karen Kirk Production Assistant Nancy Hacker JOURNAL ADVISORY BOARD Outstanding Richard Reiling, MD, Chair Dayton, Ohio MD Obstetrics-Gynecology Charles L. Heaton, Cincinnati, Ohio William Marshall, MD practice opportunity! J. Dayton, Ohio Richard Nowak, MD Cleveland, Ohio MD James Ravin, Located on Ohio's North coast with the best Toledo, Ohio William B. Rogers, MD of four seasons in a city with excellent Cuyahoga Falls, Ohio schools and cultural attractions. OSMA OFFICERS President MD John A. Devany, President-Elect Joseph Sudimack, Jr., MD 600-f bed tertiary care medical center. Immediate Past PresidenMtD Comprehensive services provided in a growing William Marshall, Secretary-TJr.easurer OB/GYN department. Excellent clinical and MD John F. Kroner, Jr., diagnostic facilities. Very competitive financial ADVERTISING package available for qualified BE/BC physician. George R. Quigley 4015 Executive Park Dr. Suite 304 Interested individuals may send CV Cincinnati, Ohio 45241 (513) 563-9666 in confidence to: PHARMACEUTICAL ADVERTISING Ellen F. Yunker Terry Gladman Manager, Physician Recruitment Lifetime Learning 15 W 700 North Frontage Rd. St. Vincent Medical Center Hinsdale, IL 60521 2213 Cherry Street (708) 655-2500 Toledo, OH 43608-2691 A&ddRerpersisntAlRleqCuoersrtes(upnolnedssenocteh,erwAidsderenostsedC)h:aEnxgeec,- Or call utiveEditor, OHIOMedicine, 1500LakeShore (419) 321-4462 Drive, Columbus, Ohio 43204-3824. Phone: (614) 486-2401.. PublishedmonthlyunderthedirectionofTheCoun- cilforandbymembersofOHIOMedicine, 1500Lake ShoreDrive, Columbus, Ohio43204-3824, ascientific society,nonprofitorganization,withadefinitemember- shipforscientificandeducational purposes. 1991Subscription:S25 peryear. Sendaddresschangesto;OHIOMedicine,1500Lake ShoreDrive, Columbus, Ohio43204-3824. SecondClassPostagepaidatColumbus,Ohioandat additionalmailingoffices. OHIOMedicinedoesnotassumeresponsibilityforopi- nionsexpressedbytheessayistsorinthecolumn "Se- condOpinion."Advertisersmustconformtopoliciesand regulationsestablishedbyTheCounciloftheOhioState MedicalAssociation. 2 OHIO Medicine — Presidential Perspectives New Happy Ifear! L et’s start the New Year with Camardese, MD, who recently won a positive note. It seems we the case on Medicare billing of have to look long and hard office laboratory procedures. The for something to be happy about Federal Appeals Court has refused after that budget-reconciliation to reverse the decision of the lower — fiasco but small steps are court. Nino has also been helpful. nominated for the Benjamin Rush Your efforts and contacts with award of the AMA. There is Congres—s got the anti-hassle bill certainly no question that he is passed the section regarding willing to put his money where his publicizing the “screens” did not mouth is, and there is no question pass. Agree with the passing or of his devotion to God, country not, the anti- and medicine. competitive It is encouraging to see that the reason used governor’s Task Force has come up to reject it with a plan (Access Ohio) for By John A. has some financing the health-care needs of MD logic. Ohioans. The plan bears striking Devany, You really congruity with Health Access did it in a America, but even more storm of interesting, I thought, were Gov. President of 50,000 letters Celeste’s remarks in accepting the the OSMA that report. He stated that this problem descended on cannot be solved by state action 8 Washington, alone, but must be a conjoint protesting effort of business, the — ^ and pointing professionals and government si wiA out the that from a man who fancies senselessness, himself to be a political impracticality and increased philosopher. That is as realistic expense of the proposed office thinking as we’ll get. laboratory regulations. The whole The process of dialogue takes proposal has been withdrawn effort. Many of the provisions of because you let our representatives Health Access America have been know, in no uncertain terms, that introduced in Congress and will be it just wouldn’t work. Even the back next session. Bill 3042 sponsor of the initial legislation (Coburn, R-Maine), got on the bandwagon, stating that “Comprehensive Health-Care Act the proposal was fantastic overkill of 1990,” contains a variety of — to the problem (actually directed at provisions payment for Pap smear interpretation). It will physicians and hospitals, favorable be at least September before the tax treatment of health insurance new regulations are published. Stay experts, long-term care insurance, tuned. uninsurable risk pools, Medicaid Congratulations, also, to Nino standardization expansion and January 1991 3 Presidential Perspectives medical liability reform (all are in 1. Does a physician generate The FTC is reported to be Health Access America). profit by bringing in an evaluating office space contracts The medical liability provisions economically favorable patient between hospitals and doctors to unfortunately do not have any mix? see what “sweetheart’’ provisions effect on our problem in Ohio 2. Does individual utilization amount to rebates. So check the with the statute of limitations, but review illustrate financi—al and/or market, check with your attorney they do put great emphasis on the quality of care issues which and remember that there are development of treatment practice cause the hospital to lose money? wolves out in those woods. Am parameters (TPGs). I alone All of the bowing and scraping There is good reason in today’s when I get a slight chill listening that I see with hospitals courting climate to feel that we have lost to talk of specifying appropriate- physicians with physician staff the ability to affect our own inappropriate and permissive counselors who function as a destiny, so we must cut the best methods of evaluation and concierge is as phony as a $3 bill. deal for ourselves. This is no time treatmen—t? All of us want to be “Everything is just so great at to go it alone. The next two to five current but think of some of Better Samaritan Hospital!’’ years will demand an intelligent the ideas that were current 25 Physicians must be aware that look at professional militancy. years ago (e.g. carotid body there is a Medicare regulation The picture is not all dark. surgery). However, the against rebates between physicians When we stand together as anesthesiologists and the OB-GYN and between hospitals and doctors, we can be heard! OSMA group has demonstrated that physicians. (We are not providers.) — protocols do have a place and they successfully affected their malpractice rates by following them. The idea being that TPGs ATTENTION RESIDENTS establish a rebillable prescription that the services prescribed by the AND TPGs are the appropriate standard of care. Peer review organizations MEDICAL STUDENTS! could use these parameters in making payment determination (screens again). OHIOMedicineinvites you to enteroursecond "Medicai Most of you have heard me rave Writing Contest." about the persistent The competition is open onlyto Ohio medical residents and d—eprofessionalization of medicine students. A plaque and a $250 prizewill be awarded to both a which can be attributed to the resident and a medicai studentwho submitthe most government, notably the Federal outstanding scientific paperasjudged by a distinguished Trade Commission, and to the panei of medicai experts. insurance industry. But let us not let our friends in hospital The papers should be submitted between nowand March 1, administration off the hook too 1991. Winners will beannounced and prizes awarded atthe early. We must each rem—ember that 1991 OSMA Annuai Meeting in Columbus, Ohio. dhoosnp’ittaflosrgaerteita. bWuesinneosws heatrheayt MedTihceinwei.nning entrieswill also be published in OHIO meetings of “economic credentialling” becoming a basis Aii entries should be no morethan 10typed, double-spaced for hospital privileges. A recent pages in iength, and shouid be sentto: study reported in AMNews says that a review of how a physician OHIO Medicine uses a hospital’s service can affect "Medical Writing Contest" the hospital’s bottom line is now 1500 Lake Shore Drive in place. As Ray Gifford, MD, has Columbus, Ohio 43204-3824 pointed out, that concept has two different factors: 4 OHIO Medicine