A well meaning community of patients is attempting to raise $40,000 to help pay the malpractice premium of an oncologist. Dr. Romeo Ruiz of Westlake, Ohio had is rate doubled with one month notice. He is 60 years old and plans to retire rather than pay the increase. The patients don't realize that this is not a one time event. They will continue to raise money every year. The solution is not to raise the money but to elect officials that will pass meaningful tort reform that will stand up to the Ohio Supreme Court scrutiny. This court has blocked tort reform in the past and some members that voted against tort reform are up for election this year.
In Gulfport, Mississippi, the Medical Oncology Group as well as the nephrologists and two pediatric cardiologists who all work at Memorial Hospital will go on leave of absence due to lack of malpractice insurance. That shouldn't pose much of a problem for the hospital and the patients.
In Kansas City the insurance companies raised rates more than double. This is obviously posing a major problem for the physicians and eventually for the access to care. The physicians insurance reach huge proportions but the reimbursements continue to be low. A bad combination. Kansas and Missouri both have some tort reform but may need more to stabilize the malpractice rates.
San Antonio's University Health System is running short of neurosurgeons and needs to close on a periodic basis. The other large level 1 trauma center, Brooke Army Hospital, has lost it's level 1 certification. The reason for the demise of Brooke is unknown but it will be re-inspected by the American College of surgeons this year and may then regain its certification from the state. Wilford Hall remains a Level 1 trauma center and will need to pick up some of the slack for the civilian traumas.
A large group surgical practice in Central Florida has lost its malpractice coverage and stopped doing emergency cases. It is attempting to get replacement but will either need to pay a large premium ( double) or go uninsured, which is allowed in Florida. Some of the physicians of the group will leave since they do not want to pay the large amount of money nor risk their assets by going bare. The hospital stated that they will have to divert patients because of the loss of the group but had the one remaining general surgeon cover all emergencies and did not have to close or divert. After a week of no coverage the group did find coverage with another carrier. The group paid $180,000 last year and is paying substantially more this year, possibly almost double.
Nevada passed its tort reform (see New Legislation News). Now the physician owned Nevada Mutual Insurance Company will decrease rates of possibly up to 10%. If the Supreme Court does not approve the changes, the rates will go back up and Nevada will lose its physicians. Six other states controlled by the Democratic Trial Lawyers contributions have already lost Supreme Court battles. These are Illinois, Ohio, Oregon, Washington, Kansas and New Hampshire.
West Virginia is one of the worst states in the nation for physician's malpractice rates. The Governor doesn't believe a special session to deal with the issue is called for. The Governor is wrong. His lack of direction is a call to the state's physicians that they should consider leaving for greener pastures. The special session last fall was a step in the right direction but the state needs to go farther (see story below).
The Charleston Medical Center in West Virginia is having difficulty finding enough orthopedic surgeons to keep their trauma unit functioning on a full time basis. They are also coming near the breaking point with plastic surgeons, neurosurgeons and some other specialists. The reason is in the recruiting and retaining of specialists. The Center does pay the physicians for the extra call but the liability issue remains (see above story).
A 42 year old died after suffering brain death during a face lift at the Hollywood, Florida Cosmetic Surgery Center. This is the third death there in the past three years. All from brain death. The surgeon does not carry malpractice insurance and did go bankrupt last year. There have been other suits or threatened suits for malpractice that led to the bankruptcy. Top
The People's Republic of Massachusetts passed a rule to decrease the amount paid for Medicaid pharmaceuticals and to have the pharmacies also pay a tax on the non-Medicaid pharmaceuticals sold. The largest pharmacy chain in the state, CVS, stated they were pulling out of the Medicaid market. Now the other major chains followed. Walgreens and Brook Pharmacy both pulled the plug. Between the three they have about 60% of the pharmacies in the state. The new fees put the state at the bottom of the rung for payment. The acting not too well Governor Jane Swift was looking to legal options to force the pharmacies into her not well thought out scheme. One can not lose money on each item sold and make it up on volume.
The red faced Governor Swift did an about face and overrode the plain meaning of the law to delay its implementation until October. The pharmacies then agreed to continue to fill prescriptions. She also made an unlawful decree of requiring a 30 day notice to withdraw from the Medicaid program.
While Governor not so Swift backpedaled as fast as she could, Walgreens is now heading out of Washington. That state also has Medicaid pharmacy reductions and they rank lowest in the nation in pay next to the People's Republic in Medicaid pharmacy payment. Walgreens has 48 stores in the state. The Republic also wants but may not receive detailed information on prescription costs. The legislators do not realize the pharmacies are private and can set their hours and decide which prescriptions they will fill. The Board requesting the above information has no authority to compel the pharmacies to give it except for taking away their ability to prescribe for state patients, which is what the idiot legislators prompted in the first place. I guess they will find out the hard way.
Since Jane red-faced not so Swift is not running for re-election a Democratic candidate has come up with a plan for the state's health care. He wants universal health care paid for via the state employee's plan. This he hopes will do away with mangled care. The head of the Commission under whom this scheme would be funded says enrolling the people and would be too much work and too costly. She did not endorse the idea warmly. All want to increase care and decrease costs with smoke and mirrors. God love the everything for everybody people.
While the cheap seats above are cutting the pharmacists, the San Francisco Health Plan has decided to pay pharmacists $20 for the mandatory consultation to dispense the morning after pill. The plan also pays $30 for the pill. Top
The University of California, Irvine has stopped taking indigent patients for other than emergency conditions. The hospital has not received enough funding from the Orange County supervisors. They are still owed $10.5 million for the past year and an additional $2.5 million for physician fees. They are limiting their services to those indigents who live more than five miles from the hospital or two miles from their clinics in Anaheim and Santa Ana. The patients that require care will be sent to surrounding hospitals. These private hospitals will put the political pressure on the supes to pay up. UC Irvine will also put into place a case management system for the indigent so they will not seek unnecessary services.
Even the Federal Government is getting into the act. The Veteran's Hospitals have been ordered to halt the recruitment of new patients. This halt of the outreach program may be the impetus to get rid of the un-needed and costly program. This stems from a 1996 law that opened the program to all veterans. Say thank you to Monica's boyfriend.
The practice of boutique medicine is getting slightly larger with some hospitals like Mass General, Boca Raton Community, Bethesda Memorial Hospital in Boynton Beach, Florida and Good Samaritan in West Palm Beach coming across as the biggest hypocrites of all. The hospitals have concierge floors and wings that patients pay more for but that's supposedly different than physicians charging more for being able to spend more time with their patient. One Internist was told to increase his practice from 3500 patients to over 5000 per year. He quit and now has a better life seeing a smaller amount of patients and giving them more time. There are several unanswered questions but of little relevance. The main one is are these boutique patients doing better? This is not important since as one person said its the difference between first class and coach. They both get you there but the passenger decides how they wish to travel. Top
The Health Plan of the Redwoods who went to court to stop the physician specialists to whom they owe millions of dollars from dripping out of the HMO, has now gone belly-up. The disbanding means that the physicians were right and the HMO will pay only a few cents on each dollar owed. This also gives the patients relief to go to another plan, if they can find one. Good bye and good riddance.
The 11th California IPA this year has closed its doors for the usual reason, low payments. University Affiliates in Southern California was started by University of Southern California. Top
Los Angeles County is threatening to close one of its largest and busiest hospitals, Harbor, UCLA Medical Center. The reason is, of course, money. The hospital refuses to reduce the services it offers and so will be closed piece by piece. The first to go is the psychiatric ED, followed by the general ED, surgical wards, and lastly the ICU. the hospital would then become an outpatient clinic. Not only would this leave a huge hole in the Los Angeles basin for coverage but would also deprive future physicians of the ability to train. This eventually means less well trained physicians to care for all communities. If a proposed tax to keep the Harbor trauma and other services open does not pass in November the services will be consolidated at County-USC and King-Drew Medical Center in Watts. The Olive View-UCLA Center would also become a clinic. Top
The Cincinnati Business Journal reports the slow and continuing death of the failed HMO concept. They state that Ohio and Kentucky have reached the lowest numbers in the past six years. The trend by employers is to the more flexible PPOs. Currently the HMO population is 37% in Ohio and 30% in Kentucky.
American Medical has decided, after the large amount of negative press it received, to no longer practice reunderwriting as of January 1. They used to bump up any patient's insurance fee if they made a claim. The insurance company says what they did was OK but changed anyway due to pressure from the brokers and the loss of the ability to write insurance in Florida for one year.
The People's Republic of Massachusetts is bracing for high deductible HMO plans. The deductible could be as high as $7500. The insurers are doing this to keep costs down for the employer not the employee. The Department of insurance has already given the green light to several companies for a $1000 deductible. They are considering the larger one and whether this might impact care. Duh?
Anthem Inc. has been downcoding and denying legitimate claims state the AMA and many state medical societies. The unilateral changes started 1 1/2 years ago ad continue. The physicians so far have not sued but have attempted to work via the state insurance commissions. If that does not change Anthem the should and will sue for back monies owed plus interest and attorney fees. This will eat into profits and will bring physicians out of their networks, not a good combination for a business that wants to stay afloat.
A Louisville company is attempting to become the credentialing company for insurance companies across the country. They want to collect the information on all the physicians and for each physician credentialed they chare a fee of between $45 and $125 per physician. this fee is paid by the companies or hospitals and not by the doctors. Top
The FTC is stepping up its scrutiny of the medical professions antitrust provisions. They are going to spend an additional 50% on this industry alone. The agency will go back and see if its prior allowing of mergers increased costs. If so they may ask via administrative hearings that the mergers be dissolved. They are afraid the new larger hospital chains have potentially too much clout and therefore the consumer is paying too much via increased insurance payments. The interesting aspect is the administrative hearings are held by the FTC. They therefore are the prosecutor and judge, a nice but unethical arrangement. 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.