April 15, 2009 Recent News



Assisted Suicide

Electronic Med Records


The MGMA has come out with a report that almost 2/3 of physicians are paid to take call.  Some are paid an hourly wage and others are paid a stipend.  About 70% of hospital owned group practices are paid extra to take call. This is higher than those physicians not owned by hospitals.  They report only 58% are paid to take call.  The highest pay was for neurosurgeons at $2000 per day.  Urologists got $900 and peds got $500 a day.    

The New York Times reports that primary care physicians are dropping out of Medicare or not accepting new Medicare patients.  Those that opt out can charge their usual and customary fee but can not bill either Medicare or any secondary insurance.  The entire bill is the patient's to pay.  Of the 93 internists at New York Presbyterian Hospital only 37 accept Medicare.  The growing physician sector accepting Medicare patients are Urgent Care Centers and private pay physicians.   

Most physicians are not ready for the new ICD-10 diagnostic codes.  They are in conjunction with the new HIPAA regs that start on January 1, 2012.  The new ICD-10 codes start October 1,2013.  This means that physicians and hospitals will go from the current 13,000 codes to 68,000 and a new HIPAA "5010" claim form.  This will be very expensive for all concerned.  If the physician outsource their billing they should expect to pay considerably more. At present vendors are not upgrading and if you do not have the latest updates the plans will not accept the data.  Watch for the insurers to stop paying claims as not complete if all their required information is not on the form and their required information will not be uniform.   

Self insured companies have hired a new firm Health Research Insights (HRI) to go after physician repayments.  The problems are there is a convoluted statute of limitations and the company is presuming the physician is guilty.  They are taking those physicians that they believe are upcoding and sending letters requesting either money or chart notes justifying the charges.  If the physician does not comply HRI threatens to go to the feds.  In reality, the company has no teeth.  Ask for what authority they have.  You probably will not get an answer. You should also contact your attorney if the money is significant.

In California, the hiring of physicians directly by hospitals is forbidden.  The California Hospital Assn.  is pushing the legislature to allow hospitals to hire physicians especially in the rural areas, which makes up about 75% of California.  The reason the law is in place is so administrators can not influence healthcare decisions as do insurers.         Top


The LA Times reports that some healthcare planner are looking to the Kaiser model for healthcare reform.  They point to their preventative programs and electronics.  However, they lost money last year due to investments and also lost membership leading to layoffs. They have cancelled almost 3000 posted job openings in the past six months.   It should also be pointed out that their electronics cost $4 billion dollars and works only ok but is the best there is in the country.  That is a sad commentary.  They have been voted the best HMO in California, Colorado, Pacific Northwest and the Virginia area. That is a sadder commentary.

In an interesting turn of events, the nursing field is now becoming overcrowded.  The recession has come to healthcare with hospitals becoming smaller with fewer workers. Patients are deferring elective and semi-urgent procedures that cost them significant co-pays or other out of pocket costs.  The Wall Street Journal highlighted a graduating nurse from West Virginia with a BN who is looking for a job in either the ED or ICU in the Pittsburgh area.  She can not find one maybe because she is looking only for a short term position so she can move on to be an anesthesiology nurse.  The recession has come to this profession as well reducing the openings in the field where there were supposed to be huge need.  This problem is nationwide.  

The Dems in Congress say all should have health insurance and employers should help pay for it.  They also want a public plan as an alternative.  Of course the public plan will be cheaper but will not be the same as the Congressmen and Senators receive.  It would only be fair if they received the same as the public.  You will never see that happen.  They also do not mention that a public plan would not allow providers to negotiate fees due to antitrust.  The NY Times states that they have not thought about the state insurance commissioners who regulate issues within the state.  There have been some negotiation with the insurance industry stating they will accept all with no preconditions providing that all have to have insurance.  There is however no transparency in the behind the scenes areas of the Board of Directors of the workhorse group reminiscent of Clintoncare.  The pols also can not reconcile the payment for their plans which is not unusual for either party. 

The Republic of Massachusetts continues to pay big bucks for their coverage for all system.  The employers are allowing their employees to be covered by the state system instead of paying for the coverage themselves.  This number has jumped 24% in one year and the cost is now $794 million for the small state.  The generous republic gives many more benefits in their plan than does the employers.

The wonderful medicine in the Republic is coming under fire.  The Boston Globe reports that in 2008 there were over 300 problems in the small state's hospitals.  Some of the hospitals had 25 errors. Of course there is alot of leeway in what to report.  For example only 12 pressure sores were reported for all of last year and that many have been reported already this year.  Most incidents were preventable patient falls.

Illinois non profit hospitals, especially the Catholic Chicago hospitals, are again under fire for not holding up their end of the tax deferred bargain.  They are not providing anything close to the community benefit that they are receiving in tax breaks.  The Hospital Assn. can not dispute the numbers so they are going after the methodology.  They want to add the money they don't collect from Medicaid and Medicare that they have entered contracts with as their charity care.  A spurious argument since bad debt is not charity and neither is contractual stupidity.                   

I don't understand it but nine patients have accounted for 2700 ED visits over five years.  Eight of the nine are drug abusers, three were homeless, seven had mental health issues.  There were five women and four men.  The average ages were 40 and 50 respectively.  There were also 900 frequent fliers who used the ED six or more times in three months.  That is over 2000 visits mainly for mental health problems. 

When I did my training at Cook County Hospital we took care of all the patients in the county with no health insurance.  The hospital, now called Stroger after a political hack, is finding itself the recipient of patients from the other Chicago hospitals who discharge their patients early and tell them to go to Stroger, who all hospitals identify has Cook County on the slips given to patients. Most of these hospitals are non profit and deserve to get that status removed.  This seems to be akin to legalized patient dumping since the patient is seen in the referring hospital ED and then sent to Stroger for definitive treatment. 

In an article by the AP the British method of deciding which, if any, expensive cancer treatments will be given to patients.  NICE, the organization that decides these things, has said the drug company must give a major discount if the drug doesn't work on the patient or just discount the drug upfront.  The drug would have to increase life by at least 3 months and only for a cancer that affects a limited amount of patients.  This is to make sure the government doesn't spend too much money.  The question asked is should treatment by cost efficient and what is cost efficient?  This is the argument that will come to this side of the pond if universal government medicine ever comes here.  I have already been on two committees that were to decide life and death when dialysis first came and I would not wish that on anyone. 

The same day the above article appeared, there was an article in the Wall Street Journal by two physicians on the faculty of Harvard Medical School on "Why Quality Care is Dangerous."  The article discuss why rigid protocols should not be used and how things change.  They gave examples of how rigidity in glucose controls went from the way to go to dangerous as well as other things that were in and are now out.  The article went on to lambaste the using of quality metrics to rate physicians by non physicians.  They end their argument with the "time out" taken by surgeons prior to surgery should by now taken by policy makers.        Top

Assisted Suicide

The London Times has a story about a clinic in another country that has agreed to allow assisted suicide of a Canadian man with terminal heart disease who wants to pick his time of death and his wife who has no disease but wants to die with her husband.  I am not mentioning the name of the clinic or the country it is in on purpose.  This clinic has helped people with psychiatric disease commit suicide and has had defections from its staff due to their lax standards for assisted suicide.        Top

Electronic Med Records

As most people who are not getting paid for supplying or using electronic records know, the science isn't there yet.  The records are not transferable to other systems and many can not even be fully utilized within the same system.  To bypass the transferability problem, several large companies including Google have allowed storage of medical records on the net.  The problem is the inaccuracy since the records are not the true records but made out of billing codes which are very inaccurate.  Even the wonks are saying claims data should not be used. 

Even Dr. Blumenthal, Obama's czar for EHR, realizes the potential problems with EHR.  The feds are going to put in standards and policies but no one knows what they will be and how certification will interact.  Currently many certified programs are not user friendly nor will give quality improvement but at a high price.  It appears the wonderful fed stimulus plan will only pay about 2/3 of the cost over a five year span.

Another hidden danger in EMRs has just been written up.  That is med mal risk increase.  The use of templates allows more money to be billed with a stroke of the key but more information means more that the physician must go over for accuracy and more chance at overlooking something.  When documentation doesn't match CPT codes there may be a demand for repayments.  If one doesn't use EMR and EMR might have picked up a drug incompatibility, the physician may be liable for not using EMR.  

In a potentially dangerous maneuver, Blue Cross and Blue Shield of Minnesota will offer a virtual clinic where they can log on for a doctor's visit for a flat fee.  The patient decides the type of physician in the network that he wants to see and the first available one will be on line.  They will be able to see each other with a web cam.  There are times when the physician will miss things due to not seeing the entire patient and the attorney will have a field day.  The physician gets a cool $25 for each 10 minute session.  That comes to $150 per hour with no office overhead. Is it worth it for the physician?      Top


  DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.