Published 6/1/2008

Second Look: Reimbursement and Regulation

Report warns that U.S. health system is inadequate to handle aging population
The National Academies has released a report asserting that the healthcare workforce in the United States will be unprepared to meet the needs of the aging baby boom population. “Retooling for an Aging America: Building the Health Care Workforce” calls for immediate initiatives to train all healthcare providers in the basics of geriatric care and to prepare family members and other informal caregivers to tend to their aging relatives. The report also proposes that Medicare, Medicaid, and other health plans increase reimbursement levels to boost recruitment and retention of geriatric specialists and care aides.

Medical school enrollment projected to increase 21 percent in 4 years
The Association of American Medical Schools (AAMC) reports that more than 86 percent of existing medical schools have already expanded or plan to expand the number of enrollment slots for first-year students within the next 5 years. This expansion, along with the opening of nine new medical schools under development or discussion, would result in an additional 3,400 students per year by 2012, or an increase of 21 percent. Fears of a looming physician shortage had previously prompted the AAMC to recommend a 30 percent increase in the number of medical students by 2015.

NEJM articles look at responses to physician shortage
A pair of articles published in the April 17 issue of the New England Journal of Medicine (NEJM) examines factors surrounding a growing physician shortage in the United States. A health policy report states that although medical schools have begun to increase the size of their first-year classes and the total number of students entering U.S. medical and osteopathic schools last fall was the largest in history, neither the federal government nor the private health insurance industry has taken steps to address the shortage. An accompanying perspective piece questions the need for more physicians and questions why the Council on Graduate Medical Education recently predicted a 10 percent shortfall of physicians by 2020 despite the fact that there are currently more physicians per capita in the United States than at any time in the last 50 years.

AAMC report recommends medical schools take action to limit industry influence
The AAMC has released a report recommending that drug and medical device companies be banned from offering free food, gifts, travel, and ghost-writing services to physicians, staff members, and students in all 129 U.S. medical schools and that the schools strongly discourage faculty participation in industry-sponsored speakers’ bureaus. The report is the result of a 2-year effort to design a model policy governing interactions between schools and industry. Medical schools are under no obligation to accept the association’s advice, although most follow its recommendations, and some experts suggest that the report could exert influence across the medical industry.

FDA to use insurer data to detect adverse event trends
According to a Wall Street Journal report, the FDA plans to announce a series of collaborative efforts with health insurers to begin mining patients’ medical information to look for hidden patterns or spikes in adverse events that could be linked to certain medications. The current monitoring system relies largely on reports from physicians and drug companies and, according to GAO estimates, finds less than 10 percent of bad reactions. In the aftermath of several recent drug safety controversies, Congress mandated that FDA set up a more comprehensive computerized system to scan for medication problems. Rather than create its own database, FDA will contract with insurers and other health systems to cull data from existing databases.

Final approval granted in RICO lawsuit against Blues
The California Medical Association reports that another settlement has been reached in the Racketeer Influenced and Corrupt Organizations (RICO) lawsuit against the Blue Cross/Blue Shield Association. The lawsuit alleges that the insurers’ payment practices defrauded physicians out of payments for patient care. The class-action lawsuit includes all physicians who billed any of the Blues companies or their contracted intermediaries for services provided between Jan. 1, 1996, and March 12, 2008. The deadline to submit a claim is June 20.