Biomedical subjects

M Rothouse

Publications and source records attributed to M Rothouse.

11 recordsLinked to original sources

PubMed2000

Finance, providers issue brief: HMO medical directors.

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Among the issues with which they have begun to grapple: whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Health Maintenance Organizations↗

PubMed2000

Finance, providers issue brief: insurer liability.

When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.

Humans↗

PubMed1999

Finance, providers issue brief: insurer liability.

When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those are questions 29 states considered in 1998, and at least 35 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.

Humans↗

PubMed1999

Providers issue brief: change in nonprofit entities.

Heightened competition in the health care industry is prompting a growing number of nonprofit hospitals to merge with or sell to for-profit firms, in the hope of shoring up their financial base. The conversion trend--which has many public officials concerned about the fate of the charitable assets and care to indigent population that nonprofit hospitals have traditionally provided the communities in which they are located--has, in turn, led to an overall decline in the number of hospitals still in business. To protect the public's investment and ensure continued access to care, a growing number of states are thus exploring legislation that would open the conversion process to the public; strengthen oversight authority, typically through the attorney general; and make certain that the proceeds from such transactions are used appropriately.

Forecasting↗

PubMed1999

Providers issue brief: provider profiles.

In the past, when a consumer wanted to choose a doctor, there was little, if any, opportunity to research the doctor's experience, medical training, or malpractice history, except through word of mouth. Most recently, state lawmakers are trying to help educate consumers in their search for a physician, by requiring health care licensees to provide such information and making the physician or other health care provider profiles available on the Internet or through a 1-800 number.

Health Personnel↗

PubMed1999

Providers issue brief: alternative providers.

Access by managed care plan enrollees, scope of practice issues and fee reimbursement by Medicaid and third parties such as insurance carriers is the engine that drives legislation recognizing alternative health care providers--chiropractors, acupuncturists, physical therapists, naturopaths, massage therapists, homeopaths, and dietitians and nutritionists.

Complementary Therapies↗

PubMed1999

Providers issue brief: end-of-life issues.

One of the most controversial ethical issues of recent times has been euthanasia and mercy killing. An offshoot of this morally charged issue has been physician-assisted suicide and the "right to die" and "die with dignity" movements. With modern technology, people are living longer, and states are making efforts to learn how to better treat those people who suffer from terminal illnesses and to improve the quality of end-of-life care. Legislators are working to improve laws regarding pain management, do-not-resuscitate orders and advance directives.

Advance Directives↗

PubMed1999

Providers issue brief: telemedicine.

State interest in telemedicine--cutting-edge electronics linking underserved, mainly rural, communities, with medical experts in teaching institutions or the private sector--has intensified since the late 1980s. Besides offering a way to consult with specialists in other parts of the country on medical problems or procedures, telemedicine programs allow primary care providers in isolated practice settings to communicate with colleagues and take classes to further their skills--something states hope will convince them to stay put. Today, 39 states have laws or regulations governing telemedicine, and as more research is conducted on existing telemedicine systems, both the private and public sectors are learning how to take full advantage of the benefits that telemedicine has to offer to help improve the delivery of health care services throughout the country.

Financing, Government↗

PubMed1999

Providers issue brief: automated external defibrillators.

With expanded access to automatic external defibrillators, hundreds of lives could be saved on a daily basis. By training nonphysician providers, such as emergency medical service personnel or first responders, this life-saving medical equipment could help improve the survival rates for people suffering from cardiac arrest. During the last two years, state lawmakers have begun to enact legislation that develops training standards and provides immunity from civil liability for automatic external defibrillator users.

Electric Countershock↗

PubMed1999

Finance, providers issue brief: HMO medical directors.

Medical directors of managed care organizations have the ultimate responsibility of deciding which treatments a health plan will pay for. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Among the issues with which they have begun to grapple: whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Decision Making↗

PubMed1999

Providers issue brief: organ and tissue donation.

Few other public policy debates involve the sensitive personal decisions that surround organ and tissue donation for transplants or medical research, or cover issues ranging from drivers' licenses and eye banks to informed consent for anatomical gifts.

Eligibility Determination↗