Local, State, Federal

by Elaine Sanchez

The Bill Box
HIPAA: Help or Hindrance?
Fighting for Funds to Fight Cancer

The Bill Box

Official Suggests Doctors Pay $50,000 to Fill Insurance Deficit

New York Superintendent Eric Dinallo caused an uproar in November when he suggested that the 30,000 New York physicians who get malpractice insurance through two large nonprofit companies could pay $50,000 each to cover the $500 million deficit of an insurance carrier.

However, the Rochester Democrat and Chronicle reports that if the doctors are forced to pay that much on top of their normal insurance premiums, at least some would just quit the profession.

“We will definitely lose doctors,” Dr William Dolan, an orthopedic surgeon with a Brighton office, told the newspaper. “They’ll retire early or they’ll leave the state.”

For the third time in three decades, New York is looking at increasing premiums for doctors and large deficits for malpractice insurance carriers.

“After years of failing to confront the fundamental problems that have led to this current environment, we have inherited the worst of both worlds: physicians who cannot afford to practice medicine and insurers whose financial condition is rapidly eroding,” said Dinallo, leader of a task force created by Gov Eliot Spitzer.

FCC Dishes Out $417 Million in Grants to Rural Health Care

The Federal Communications Commis-sion (FCC) recently announced that rural health care groups are set to receive $417 million in grants to build high-speed Internet networks connecting clinics to medical resources in urban areas, according to The Washington Post.

Focusing on expanding broadband communication lines and, in many cases, upgrading from dial-up connections, the 3-year pilot project will include about 6,000 rural hospitals, research centers, universities, and clinics. The campaign, made possible with money allocated for telehealth services from the universal service fund, will allow rural care providers to upload patient records or send medical images to physicians at other facilities.

FCC Chair Kevin Martin told The Washington Post that the program will “play a critical role in the way technology will transform health care. … Not only will a telehealth network connect doctors to patients who have never had access to medical treatment, but they can have access to the top resources on the other side of the country.”

The universal service fund, collected from long-distance and wireless service subscribers, subsidizes phone and Internet services to educational institutions and libraries, and low-income people in rural areas, according to the newspaper.

Maryland Senate Approves Health Care Expansion Bill

The Maryland Senate recently voted to approve legislation that would expand Medicaid eligibility for adults and extend health insurance premium subsidies to small businesses and their employees.

According to The Baltimore Sun, the 30-17 vote comes just months after state lawmakers rejected a similar measure.

Legislation would increase the Medicaid income eligibility threshold for adults from about 40% of the federal poverty level to 116%, allowing an estimated 20,000 uninsured parents and an increasing number of children to qualify for the program. After implementing employee wellness programs, small businesses that do not offer health benefits to workers could receive subsidies of up to $1,000 per year, as well as $1,000 per year to each employee who enrolls in an employer-sponsored plan.

The plan is anticipated to extend insurance to about 100,000 state residents and cost more than $600 million annually, including federal matching funds and $250 million in additional state revenue. The Sun reports that some of the provisions may be canceled if funding is unavailable.

HIPAA: Help or Hindrance?

Variability in the interpretation of the Health Insurance Portability and Accountability Act (HIPAA) has created a hurdle for scientific research, making it more costly and time-consuming, according to a recent national survey published by the Journal of the American Medical Association. In effect, some academic institutional review boards are shutting down research operations, the report found.

More than 1,500 epidemiology practitioners took part in the survey, and only a quarter of them indicated they believed HIPAA has enhanced participants’ confidentiality and privacy. Instead, the study, authored by Roberta Ness, chairman of the Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health, concluded that the privacy rule was perceived to have a substantial, negative influence on human subjects for health research. Forty percent of survey participants said the rule has increased research costs by a “large degree.” Moreover, 50% of the respondents said the rule prompted them to add “significant” time toward finishing projects.

Enacted by Congress in 1996, HIPAA was de-signed to mandate the use of standards for the electronic exchange of health care data, protect patient health information, and provide patients with greater access to their own medical records. As a result of its Privacy and Security rules, physicians and medical centers have had to undergo major changes in their methods of operation, facing civil and criminal penalties for noncompliance.

“A looming danger exists for health care providers on non-HIPAA compliant portals. Physicians can inadvertently violate HIPAA rules and subject themselves to tremendous liability,” said Fred Zolla, CEO and president of videoconferencing company Vemics. “With all the extra tools out there now for the health care community, choosing which online tools to use is more important than ever in light of patient privacy concerns, and liability for doctors, their legal counsel in advising them, and health care insurers in general.”

Through his company, Zolla has seized the opportunity to address what he recognized as a lack in modern communication between doctors and other health care workers. What resulted was iMedicor™, the health industry’s first free, HIPAA-compliant online personal health data exchange and secure messaging portal for physician collaboration, community, and referrals.

Since it went live on October 10, the portal has already recorded more than 17,800 registrations from health providers interested in the HIPAA-compliant exchange of x-rays, mammography, and other medical record data. It is also equipped with an online referral and consultation community, expansive multispecialty video and text-based CME/CEU catalog, a voice recognition drive medical documentation system, and access to numerous resources in health care.

“The acceptance of our new portal reaffirms that our decision to develop HIPAA-compliant tools was right on the mark,” Zolla said, also announcing new partnerships with the Hypertrophic Cardiomyopathy Association, Association of Black Cardiologists, and Pulmonary Hypertension Association. “iMedicor is quickly becoming the ‘Doctor’s Internet.’ ”

Fighting for Funds to Fight Cancer

NAS report says government must recommit to nuc med research

Robert W. Atcher, PhD, was on his way to demonstrating the biologic effectiveness of radioactive isotopes used to kill cancer cells and reduce radiation dose to normal tissues. Two more years, and the National Institutes of Health (NIH) would consider funding his work.

But, before that could happen, his research project was “zeroed out.” In one fell swoop, $400,000 in federal grants was taken away.

“The Department of Energy (DOE)-supported high-risk/high-reward nuclear medicine research has been directed at the fundamental and technological aspects of biomedical imaging and radiotherapy that make technological breakthroughs possible,” said Atcher, president-elect of the Society of Nuclear Medicine, and a professor of pharmacy at the University of New Mexico/Los Alamos National Laboratory. “We are potentially losing the ability to treat some very resistant cancers with this new technology because we don’t have the funding to continue the research on our idea.”

At the request of the DOE and the NIH, a committee was assembled to take a look at cases like Atcher’s. It was asked to investigate the current state of nuclear medicine, examine future opportunities in research, and provide recommendations on how to advance the area of study.

The resulting 176-page report from the National Academy of Sciences (NAS) recommended that federal funding for basic molecular imaging and nuclear medicine research should be restored to the Department of Energy.

The catalyst for the study was a $23 million cut in funding from the DOE Office of Sciences’ fiscal year 2006 budget—a cut that ultimately eliminated most support for research in the field.

According to the report, titled “Advancing Nuclear Medicine Through Innovation,” the federal government must “enhance” its commitment to nuclear medicine, which has grown to become a routine and integral part of diagnosing cancers, cardiovascular disease, and certain neurological disorders.

In recent years, funding for research has been drastically reduced, dropping 85% from 2005 to 2006.

Peter S. Conti, MD, PhD, chair of the Society of Nuclear Medicine’s Govern-ment Relations Committee, said that if funding is not restored in the next fiscal year, researchers and their labs would face harmful impacts.

“This is the only federal government research money dedicated to basic nuclear medicine research, and there are no plans to move this research to another federal agency,” Conti said. “Our country needs to invest in the basic scientific research necessary to develop future breakthroughs in nuclear medicine imaging and therapy that will allow for earlier detection and treatment of cancer and other serious illnesses.”

SNM President Alexander J. McEwan, MD, who represents 16,000 physicians, technologies, and scientists, agrees with his colleague. He said the removal of support is hugely detrimental not only to the future of nuclear medicine but also to the patients who benefit from the practice.

“The loss of funding for nuclear medicine research in the US Department of Energy budget has been a tremendous blow to, most importantly, our current and future patients and our field,” McEwan said. “This report confirms that funding for this nation’s basic research program must be restored or future life-saving diagnostic and treatment procedures could be lost.”

The report also identifies a critical shortage of clinical and research personnel in all nuclear medicine disciplines, specifically university faculty who specialize in nuclear chemistry and radiochemistry. Training of nuclear medicine scientists has not kept up with the demands of universities, medical institutions, and industry, the report stipulates.

Offering a solution to the problem of insufficiency, the report recommended that the NIH and DOE convene expert panels to identify the most critical national needs for training nuclear scientists. Furthermore, the panel would suggest guidelines for developing appropriate curricula to train the next generation of scientists.

Among other recommendations, the NAS report called for the clarification and simplification of regulatory requirements for toxicology and manufacturing practices at facilities. It also noted that domestic medical radionuclide production should be improved, and it encouraged interdisciplinary collaboration.

The National Research Council’s committee, who wrote the report, received $700,000 in funding from the Department of Energy and the National Institutes of Health.