Medical Marijuana

R U N2 TMing?

If not, you are probably having trouble deciphering the previous line, which in English means, "Are you into text messaging?"

Text messaging is something often identified with teenagers incessantly punching gibberish into their cell phones. But many doctors have found texting to be an EZ (easy) way to SIT (stay in touch) with family and friends throughout the day when they are too busy to call or send an e-mail. More than that, those doctors are using it as a way to communicate with colleagues on the fly, or to communicate with patients.

And as more medical students -- who are as familiar with texting as they are with using the telephone (assuming they haven't given up the old land-line phone already) -- enter the field, text messaging is expected to become increasingly common among doctors.

With the cell phone's popularity, text messaging services can provide a convenient way for you to remind patients of appointments or send them a birthday wish. Automated systems exist, so that you don't have to remember every patients' birthday -- you can impress them not only by your apparent memory but also by your tech savviness.

But some suggest that texting has its limits for doctors because of an acronym EVRY1 (everyone) is familiar with: HIPAA. While advocates of texting say it's more private than actually talking into a cell phone, others say the tool is best used to facilitate the quick scheduling of a meeting or phone call, rather than for detailed, substantive patient issues. A quick phone consult, for example, could be arranged as fast as you can type PCM (please call me) on your keypad and hit send.

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At a January meeting between Aetna representatives and one of Atlanta's largest gastroenterology groups, about 50 doctors handed over letters of resignation, threatening to pull out of the insurers' network.

They were protesting a change in Aetna's policy regarding anesthetizing patients undergoing colonoscopies, said Steven J. Morris, MD, managing partner of Atlanta Gastroenterology Associates.

As of April 1, Aetna is ending coverage of anesthesiologist-supervised sedation in endoscopy procedures.

Physicians, including Dr. Morris, are appealing to Aetna to rethink their decision. Opponents say the move will discourage people afraid of the procedures from being screened for colon cancer. And for some, the very idea of Aetna declaring anything medically unnecessary is an affront.

"We have an insurance company telling us to change the standard of care," Dr. Morris said. "This is a ridiculous situation."

Aetna is not alone in changing policy. Humana made a similar change last year. WellPoint did the same in June 2006, though spokesman Jim Gavin said, "Our clinical guidelines can be implemented across the country at the option of our health plans," so the rule isn't enforced everywhere.

For decades, physicians have used a combination of a narcotic and a benzodiazepine, which can put a patient in a conscious sedation. Doctors differ in their opinions of that method.

"These drugs have inconsistent and unpredictable effects," said Steven J. Stryker, MD, a surgical oncologist and professor of clinical surgery at the Northwestern University Feinberg School of Medicine in Chicago.

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If you want to know why health plans are so interested in government business, check out where the growth is happening at UnitedHealth Group.

United's AmeriChoice Medicaid unit for the first nine months of 2007 saw a revenue increase of $508 million, or 19%, from the same period in 2006, to $3.2 billion of revenue. United Healthcare, which handles the bulk of the company's private-pay business, grew by $511 million on $26.8 billion of revenue, a 2% hike.

United is hardly the only plan seeing such growth. Big health plans are betting on a continued boost from government health programs to boost profits, offsetting slower growth in employer-sponsored health insurance.

"They're all under pressure to show growth, and the source of future growth is expected to be through government programs," said Richard Schnute, a health care consultant with HealthCare Options Inc., an Indianapolis firm.

For many plans, commercial business accounts for the vast majority of revenues and profits. But that growth is topping out, analysts say. After a flurry of deals the last 10 years that consolidated the commercial business by extending plans' geographic reach, insurers can't make any more big, revenue-juicing acquisitions without raising red flags with the Justice Dept.

Also, years of premium increases have driven some employer and individual customers to drop insurance altogether or make other changes in benefits, so premium hikes might not assure financial growth. And the U.S. economy itself can cause a hit. UnitedHealth Group, for example, has blamed a decline in profitability in its Uniprise unit, geared toward big businesses, on "employment attrition at continuing customers."

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Massachusetts has developed a set of guidelines for in-store clinics, becoming what is believed to be the first state to issue specific regulations for the fast-growing market.

The Massachusetts Public Health Council approved the regulations on Jan. 9, with eight members voting for them and five abstaining. The council, which develops regulations for the state's Dept. of Public Health, began its work last year when CVS Corp.-owned MinuteClinic applied for a license to open in-store clinics but asked for several waivers to the state's regulations for traditional medical clinics.

The new regulations cover sanitary conditions in the store-based clinics, as well as requiring that a clinic located in a retail store that sells tobacco products must post a sign saying it does not endorse the use of tobacco.

Many of the regulations, reflecting the concerns of council members, center around who is staffing the clinics, and how the clinic handles emergency and referral situations.

The health department's Division of Health Care Quality must review every application and will look at site plans, and also the applicant's own policies and procedures. The department will also review staff credentials.

The regulations include a requirement that retail clinics must develop policies and procedures for referring patients whose needs exceed the scope of the clinic's services. That includes keeping a roster of primary care physicians accepting new patients so an in-store clinic patient without one may be referred to one. A clinic must have a written plan for how it will deal with repeat patients without a primary doctor.

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For more than a decade, Maryland residents have been able to compare data on the state's various HMO plans. Later this year, the same feedback will be available for PPOs.

The Maryland Health Care Commission announced late last year that it will partner with four of the state's largest PPOs to provide comparative analyses of their plans, which it said would make Maryland the first state to do so.

Beginning in 1996, the state has mandated that insurers publicly report the performance of their HMO plans using two widely used data sets -- Healthcare Effectiveness Data and Information Sets and Consumer Assessment of Healthcare Providers and Systems, a standardized customer satisfaction survey. Since then, the MHCC has offered a comparison tool for consumers to evaluate HMO plans against each other.

Joyce Burton, chief of the MHCC's Health Plan Quality and Performance Division, said a feasibility study determined that HEDIS and CAHPS data also could be collected from PPO providers, through a public-private partnership between the MHCC and the insurers. A comparison tool for PPOs is scheduled to launch later in 2008.

"It's good for consumers to have this information on cost and quality," said Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade group for large insurers. "But they need it from all the sectors, including hospitals and providers."

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