Practice Management

President Bush has kicked off his second term in office by asking Congress to impose limits this year on medical malpractice litigation, according to The New York Times (1/5/05).

Venous thromboembolism (VTE), a leading cause of death and disability in women, principally manifests as deep vein thrombosis (DVT) and acute pulmonary embolism (PE). Every year, as many as 600,000 patients develop a PE in the United States, resulting in up to 200,000 deaths.

Last May, it was my privilege to address fellows of the American College of Obstetricians and Gynecologists and guests at the annual ACOG convocation in Philadelphia. I proposed a Women's Health Bill of Rights. Most of these 10 "rights" related to equity and equality in access to, coverage of, and treatment in our health-care system. The tenth item on my list was quite different and reflects thoughts on a paradigm shift in health care.

Last night you were on call and delivered three babies, managed a patient with severe preeclampsia, treated a case of uterine atony, and readmitted a woman with a post-hysterectomy wound infection. Yesterday you covered the hospital's Women's Health Clinic; it's a twice-monthly pro bono service you provide to the community. And this morning, you're facing a waiting room full of patients and two assistant U.S. attorneys. The grave-looking men in dark suits say they are investigating you for up-coding of Medicare and Medicaid claims and private insurance reimbursement. You're facing possible federal criminal prosecution, but you're not alone because the hospital also is being investigated.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

Imagine practicing gynecology and performing the most challenging surgeries day and night without worrying about malpractice suits, managed-care pre-authorization, or CPT and ICD-9 codes. Wouldn't it be wonderful to have no concerns about being paid and patients who are grateful for care even when the outcome isn't perfect? That would never happen in this country but it's a scenario experienced by health-care professionals affiliated with PRN Relief International. These dedicated individuals minister to some of the planet's most needy-and grateful-patients. I was fortunate to be able to serve with them recently in Jamaica and it's an experience I'll never forget.

As described in the first half of this roundtable (see Contemporary OB/GYN, November 2004), the professional liability insurance crisis has had a broad and pernicious impact on the country's obstetrician/ gynecologists. As they conclude the discussion, the panelists move from reflecting on how the crisis came about to speculating about the prospects for reforming--or even completely replacing--the current tort system.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

These experts offer a common sense approach to reduce pregnancy-linked deaths.

We may have seen the first glimmer of light in the otherwise dark tunnel of the professional liability insurance crisis. On July 12, during a speech at the National Press Club, U.S. Senate Majority Leader Bill Frist proposed "an expert medical court system with transparent decisions, limits on punitive damages, and scheduled compensatory damages to provide rapid relief to truly injured patients (instead of trial lawyers)" while holding negligent doctors accountable.

Ending months of speculation, Democratic Presidential candidate Sen. John Kerry (D-MA) has picked Sen. John Edwards (D-NC) as his running mate. Kerry's choice offers insights into his administration's likely health-care priorities. And unfortunately for ob/gyns, it also raises profound concerns about the prospects for federal tort reform during a Kerry-Edwards administration.

Delay in aggressively treating out-of-control, unremitting vomiting in pregnancy can dehydrate, deplete, and nearly starve a woman and her fetus. This expert's approach tells you how to quickly distinguish developing hyperemesis gravidarum from something more benign.

The only way for women's health care as we know it to survive is if young ob/gyns lead the way in saying NO. Let's stop taking the horrible contracts offered by insurance companies, HMOs, and managed-care organizations and take back control of our futures.

Advanstar Communications Inc., a leading worldwide provider of B-to-B marketing and business information products and services, reported its 2003 operating results.

Case Studies in Coding--Practical advice on reimbursement.

Your patient has CIN, a precursor to cervical cancer. How do you manage her pregnancy? An expert pathologist provides algorithms and a step-by-step guide for safely biopsying a pregnant cervix-when appropriate.

Antibiotics can prove invaluable in the treatment of mastitis, but before you prescribe them, it's important to distinguish breast engorgement from infectious mastitis.

Does maternal epilepsy increase the risk of congenital malformations, or are the antiepileptic drugs to blame? Either way, the primary goal of therapy during pregnancy is to control a woman's seizures while minimizing fetal exposure to anticonvulsive drugs.