Highmark settles suit

http://www.bizjournals.com/pittsburgh/stories/2008/01/07/story1.html?b=1199682000%5E1571338

Highmark Inc. will pay $9.9 million and change the way it does business with doctors, including how appeals are handled, to settle a class action lawsuit that was filed in 2003 against Blue Cross Blue Shield plans nationwide, according to terms of a preliminary agreement.

"The news is the reforms Highmark has agreed to adopt," said attorney William Maruca, who practices with the Downtown offices of Fox Rothschild LLC and represents the Allegheny County Medical Society. "The major impact will be in improving the way Highmark deals with physicians."
Among the terms of the proposed settlement is disclosure of fee schedules to participating physicians; expanded arbitration provisions for claim disputes; an end to recovering overpayments after 18 months except in cases of fraud; and establishment of a 12-person physician advisory committee to consult with the insurer on a variety of matters, such as clinical quality improvements. The tentative agreement also requires a committee of physician peers to evaluate medical necessity issues and an external review panel to mediate appeals of insurance claims that have been denied.
"Payments vary sometimes, and it's hard to tell why," Maruca said.

Do Primary Care Physicians Treating Minority Patients Report Problems Delivering High-Quality Care?

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w222

Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance payments than their counterparts treating fewer such patients, according to a national study published today as a Health Affairs Web Exclusive. These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. In addition, the Commonwealth Fund-sponsored study examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.

Two Tier Health Care

State budget includes drug discount cards for seniors, millions more for hospitals

http://http://www.buffalonews.com/home/story/313292.html

ALBANY — The 2008 state budget will prod Medicaid patients into less expensive outpatient and home settings, provide prescription drug discount cards for 400,000 senior citizens and disabled people and restore hundreds of millions of dollars that hospitals and nursing homes were facing in cutbacks.