Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Jottings: Re: AMA


According to the AMA socioeconomic monitoring system the average reimbursement in 1986 was 73% of charges form Medicare, 47% from Medicaid, 86% for PPO's, 83% for IPA-HMO's, and 92% for private insurance. Divided by region, there was very little difference between the payors except for the northeastern section of the United States where both Medicaid and both the northeastern section of the United States where both Medicaid and both PPO's paid approximately 20% less of the charges than the other regions of the country.

In addition, state Medicaid programs only cover the lowest 40% of persons who meet the federal definition of the poverty level. With few exceptions, it would increase by 50% the present Medicaid budget of any state to extend full eligibility for Medicaid to those who meet the 100% poverty level.

Because of the linkage between Medicaid eligibility and program of Aid for Dependent Children, the Medicaid load in hospitals is greatest in those which have a large number of children or a large amount of obstetrics. On the other hand, fewer of these two groups can be found among those who are totally dependent on charity contributions, because the states are making at least some contribution.

Lay Oversight of Physician's Orders in Intermediate Care Facilities

WHEREAS, federal regulations concerning intermediate care facilities (440.150)specify (E), (2) that drugs for the control of inappropriate behavior must be approved by the interdisciplinary team.

AND WHEREAS, regulations (483.440) specify that (c), (1) each "client" must have an individual program plan developed by an interdisciplinary team which represents the "professions, disciplines or services e areas which area which is relevant".

AND WHEREAS, the statute and regulations (1801) declare that "Federal interference with the practice of medicine is prohibited".

THEREFORE BE IT RESOLVED that the AMA study all sections of the Social Security act which utilize the word "client" in a medical setting where the term "patient" might equally apply, seeking to determine whether some regulatory provisions promote interference with the practice of medicine.

Originally published: Tuesday, October 30, 2018; most-recently modified: Wednesday, May 22, 2019