Please Watch "Sick Around The World" on Frontline

If you didn't get a chance to watch the latest episode of Frontline on PBS, I highly recommend that you take the time to see it. It will help you to understand how other advanced countries have organized their health care systems, and the strengths and weaknesses of each approach.

You can watch it online by Clicking Here

This piece advances our knowledge of how health care provides better access at lower cost in other countries, while maintaining acceptable standards of quality. It dispels the belief by many Americans that only the profit motive can drive people and organizations to excel -- particularly in health care. It also shows how universal coverage can work, without necessarily going to a single payer system -- even in countries like Germany that are far more liberal than the U.S.

We can learn a lot from this program as we ready ourselves for the challenging task of transforming our health care system in the next several years.

Independent Medical Review Legislation Needed At Federal Level

The article below provides yet another example of how external medical review legislation and oversight is highly fragmented in this country, and needs unification at the national level. It also points to the need for national patient's bill of rights legislation that requires all health insurance payers to submit their appeals to independent medical review, in order to ensure fair and objective evaluation and health insurance coverage decisions.

April 04, 2008

Suit Challenging Role of Regulators in Health Plan Disputes Rejected
California Healthline - http://www.californiahealthline.org/

A panel of the 3rd District Court of Appeals unanimously rejected a consumer lawsuit, ruling that the Department of Managed Health Care does not have to help patients challenge health plans when they are denied medical care or refused coverage for specific treatments, the Los Angeles Daily Journal reports.

The panel issued the ruling on Feb. 29 but agreed to publish portions of the opinion on Tuesday after DMHC officials said they were looking to set a precedent.

Plaintiffs in the lawsuit sought to require the department, which regulates HMOs, to heighten its role in patient-health plan disputes.

Lynne Randolph, a spokesperson for DMHC, said the plaintiffs mistook the duties of the agency and the law does not require the agency to "be the go-between."

Michael McClelland, senior counsel for DMHC, said he hoped the published opinion would inform consumers of their right to an independent medical review in cases where members disagree with health plans' coverage decisions.

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National Physican Performance Standards Will Improve Patient Safety

According to this article, at long last it looks like there will be single set of performance metrics that will help payers and consumers to get objective information on physicians, BEFORE they decide to use them. If this is done right, it will be a very good thing, raising the level of transparency and supporting the continued move toward consumerism.

What we'd like to see go along with this, is a clear set of national standards surrounding peer review, that will guide hospitals and medical groups to more effectively evaluate their practitioners' performance. This is sorely needed, since many under-performing physicians are still not being scrutinized through objective, evidence-based peer review. Furthermore, with national peer review standards, ALL physicians would be effectively evaluated on a systematic basis; not only for sentinel events, but also as an integral step in credentialing, re-credentialing, granting new privileges, and as a part of periodic departmental performance evaluations.

National Standards to Rank Physicians Planned


By REED ABELSON, The New York Times
Published: April 1, 2008

Doctors and health insurers called a tentative truce Tuesday in their long-standing dispute over how health plans rank physicians’ efforts in taking care of patients.

The parties said on Tuesday that they would develop a national set of standards to measure physician performance.

While insurers increasingly have been measuring doctors’ performance through public report cards or designating tiers of physicians that try to steer people to certain doctors, so far such rating efforts have been controversial. Doctors complain that the health plans have focused too much on cost, without regard to the quality of care physicians actually provide, and that rankings are often inaccurate.

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