PPM/MSO News

Birman Managed Care (Cookeville, TN) has implemented substantial overhead and cost reductions that are intended to spur a rapid return of profitability. These latest measures, totaling in excess of $200,000 per month, represent about 25% of the company’s total expenses. Additional smaller expense cuts have been identified and are expected to be implemented by the end of February. With these economies, the company expects to record a profit from continuing operations in February and March of this year. It is also anticipated that the company will incur a small, one-time charge for severance expenses in 3Q99.

• Sierra Health Services (Las Vegas) is voluntarily adopting a policy requiring its HMOs to provide external, independent reviews of coverage decisions regarding medical necessity and experimental treatment, effective June 1. External reviews by independent medical experts are currently available only to Medicare beneficiaries, although all members may appeal coverage decisions before an internal panel of affiliated physicians and members. The new policy extends the external review process to the non-Medicare members of Health Plan of Nevada and Texas Health Choice, who receive healthcare benefits through employers, unions, or individually. Under the new policy, non-Medicare members or their doctors will be able to request an external review after the internal appeals process is completed.