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the health services provided under medicare and medicaid are probably not medically necessary. . Aside from the economic impact, the committee is most concerned about the effect of overutilization on the health of the aged and the poor. Unnecessary hospitalization and unnecessary surgery are not consistent with proper health care.” IN SHORT, PSRO was passed as a means of curtailing physician abuses. It seems just possible that the “negative presumptions concerning the competence, good moral character and regularity of conduct” protested in the TMA’s suit arise more from the documented abuses than 14 The Texas Observer CLASSIFIED Classified advertising is 204 1 per word. Discounts for multiple insertions within a 12-month period; 26 times, 50%; 12 times, 25%; 6 times, 10%. BOOKPLATES. Free catalog. Many beautiful designs. Special designing too. Address: BOOKPLATES, P.O. Box 28-1, Yellow Springs, Ohio 45387. MINNIE L. HAMMETT TYPING SERVICE \(formerly associated with Marjorie Ann Reports, manuscripts, theses, dissertations, mimeographing, multilithing. Reasonable rates. Open weekends. Free refreshments. 442-7008. Austin. PLAYING THE RECORDER IS EASY. Free catalog, best recorders, recorder music. Beginner’s Pearwood Soprano Book, $11.95. Amster Music, 1624 Lavaca, Austin. GUITAR PICKERS. Buy your guitar strings from us and save 20%. Mail orders accepted. Amster Music, 1624 Lavaca, Austin. YOUR BOOK PRINTED from well-typed manuscript. Any quantity economical. BIOGRAPHY PRESS, Rt. 1, Box 745, Aransas Pass, Texas 78336. WRITERS: “UNSALEABLE” MANUSCRIPT? Try AUTHOR AID ASSOCIATES, Dept. TO, 340 Fast S2nd Street. N.Y.C. 10022. SAVE A SCHOLAR’S EYESIGHT! I am writing a book on recent Texas politics. The complete back issues of the Observer are indispensable for this task. However, I am unable to obtain early volumes except on microfilm, a major cause of blindness among academicians. \(It is not the only cause. The peculiarities of graduate education are for any printed volumes of the Observer. They need not be bound, but I would prefer them to be complete. Especially needed are volumes for 1955-1959 inclusive, and for 1961. Chandler Davidson, Department of Sociology, Rice University, Houston 77001. INTERESTED IN QUALITY TEXANA? New publisher, free brochures. Write: Madrona, Box 3750, Austin, Texas 78764. from the passage of the PSRO law. There are several views on what should be done to curtail physician rip-offs. The coalition backing the National Health Securities Act \(better known as the consumers should be given a regulatory role. But physicians get apoplectic at the very idea of lay control over the practice of medicine. PSRO was envisioned by the Senate Finance Committee as a compromise measure which would placate the AMA factions by leaving regulation in the hands of physicians. That compromise has had checkered acceptance nationally. As of May, 1974, HEW reported 118 PSRO’s in the planning or conditionally-accepted stages. At its convention in Chicago this July, the AMA gave consent to the concept of PSRO, but the organization is pressing for amendment of the law. The TMA suit, of course, documents the fact that the Texas doctors’ group is staunchly opposed to PSRO. Their charge that PSRO will require physicians to comply with “governmentally imposed” standards of care is not quite accurate. Under PSRO, regional groups of physicians must collabbrate in defining the normal procedures of care which should as a matter of course be administered for a specific complaint. The idea of having the norms developed regionally grew out of the recognition that patterns of treatment vary according to local conditions. To adjust for those differences, the federal legislation carved large states into several regional PSRO’s, and let each region develop its own definition of acceptable norms. To make sure that the public would not be locked into substandard care by adverse local conditions, the feds threw in a protective provision. The protection guarantees that regional PSRO norms must come up to standards set by a National Professional Standards Review Council. If the regionally devised norms fall short of those prescribed by the National Council, the home-bred norms might have to be modified. The complaint that PSRO denies patients the right to receive medical care from the physicians of their choice also falls into a grey area. Under PSRO, a physician who refuses to allow review of his records will not be eligible for medicare-medicaid reimbursement. Clearly, indigent patients could not afford the services of such a physician. To that extent their choice would be circumscribed. THE UNDERLYING question, of course, is whether the government has the right to regulate the delivery of services which it finances. In the health care arena, the principle of the government’s regulatory prerogative is fairly well established as a matter of practice. For several years all medicare-medicaid claims have been subject to utilization review by Blue Cross and insurance carriers, and reimbursement of certain costs have been prohibited. Therefore the idea of refusing payment for unnecessary procedures is nothing new. What is new is the idea that a physician who consistently performs unnecessary procedures or fails to comply with the prescribed standards of care may be cut off from reimbursement under medicare-medicaid. This sanction may be imposed for an indeterminate period of time by the Secretary of HEW. Or, the secretary may hit a physician with a fine of $5,000 or the full costs of any unnecessary of bite just might cure doctors of the habit of performing unnecessary surgery. The legal question raised by the TMA is whether the procedures for imposing these sanctions are in violation of due process of law. There are several things which the TMA dislikes about the process. One of the prime targets mentioned in its resolutions to the AMA House of Delegates was the “conflict of interest” provision, which requires that no physician may be involved in reviewing the care of his own patients. It further requires that physicians who work in hospitals owned by themselves or by any member of their family cannot review the procedures performed in that hospital. In testimony before the U.S. Senate Finance Committee last May, TMA spokesman Dr. Milton V. Davis of Dallas outlined further objections to PSRO procedures. His number one complaint was that existing medical societies or foundations designated by them are not eligible PSRO’s. If Texas is to have PSRO, the TMA officials want to control it. They have their machinery cranking toward that goal through a contract with the Department of Public Welfare. Under that contract, the Texas Medical Foundation \(a non-profit corporation created by the the medicaid program \(see Obs., About $110,000 of the money set forward in the DPW developmental contract will be used to develop norms for the delivery of care in Texas. In addition to the money provided in the DPW contract, the Texas Medical Foundation has cornered several other sources of funds for their work on PSRO. These include a $424,000 contract with the Department of Mental Health and Mental Retardation, a $32,000 contract with HEW funded through Texas Regional Medical Programs and about $456,000 to be raised through the a b ove-mentioned TMA membership assessment. The standards of care to be developed through those various funding sources will probably become the basis for PSRO in Texas. Ironically, those norms are labelled in the suit as the “governmentally imposed standards” that will deprive Texas physicians of their right to practice medicine “according to the highest standards.”