Let the turf wars begin. The vascular surgeons, cardiologists and radiologists are all fighting over carotid stenting. All feel they are the most qualified. The cardiologist and radiologist are both facile in the use of catheters; more so than the usual vascular surgeon. The vascular surgeons believe they are the most qualified since they have been operating on the carotid arteries for years and are the ones that will be needed to bail out the other two when they get into trouble, and they will. Physicians charge several thousand dollars for the procedure so the war is over the color of money.
In Arkansas the physicians are able to treat any patient of any insurer as long as they accept the payment of the insurer, any willing provider. The problem is that the insurers are arbitrarily reducing the amount paid by 10%. Since they have an unlimited supply of physicians who are dumb enough to take the low payment, they have no worries.
The government has stated that the physicians seeing Medicare patients will receive 4.3% less next year. This will be true unless Congress overrides the CMS as they have in the past. It may not occur this year since the costs of Medicare have risen 14% and it is supposed to be budget neutral. The AMA predicts that if this goes through, less physicians will see Medicare patients. This is nonsense and a scare tactic that those in Washington will ignore.
The physicians in Smithville, Tennessee, is threatening a boycott of Saint Thomas Health Hospital. The reason is St. Thomas wants to reduce the number of beds so it can qualify as a rural critical access hospital and therefore get more money per patient. The physicians also have privileges at another hospital 20 miles away and will send their patients to the other hospital. This has happened before at the hospital when it barred tubal ligations after being taken over by the Catholic order. The number of births at the hospital dropped to zero.
Some hospitals are taking the idea of hospitalists and transferring it to loborists. The physicians are in house who only do deliveries. This lets physicians who want to give up the delivery portion of the practice to continue to do the pre natal work and not be o call for the delivery, a true win win situation for all but the woman delivering the baby. This may reduce the amount of women who use the community OBs since they would want them to deliver the child as well as take care of them during the prenatal period. The loborists would have their malpractice insurance paid by the hospital and be paid a stipend by the hospital. Of course, this could not occur in those states with a corporate bar to medicine act.
A new survey shows that physicians allow the patient's religious choices to come before medical advice. This is not true for children but only adult patients. The choice of religion versus treatment decision only happens about 7% of the time. Top
King/Drew again leads off this section. In the past year the patients of the area have gotten smarter. The amount of people seeking care at the facility has dropped causing the already higher than its peer group cost per patient to grow even more. Now the Department of Health has recommended a cutting of services and personnel. After cutting out the trauma center last year the personnel were kept on. The actual recommendations will be presented on August 16 to the Board. The recommendation will include the dropping of OB, Peds and neonatology. The other recommendation is to reduce neurosurgery and cardiovascular surgery since the trauma unit is not expected to reopen soon, if at all. There would also be fewer trainees at the hospital. Some of the Board of Supes are so involved in race that they can not see the hospital is not a friend but a detriment to the community.
The Board of Supes has more than just Drew/King on their plate. They also have the potential for closure of Rancho Los Amigos National Rehab Center. The Board decided on continuing the fiscally strapped hospital for three years as it looks for a private contractor to take it over. At the same time they voted to reduce the number of beds at USC by 25 beds. The decisions are in response to a suit by advocacy groups. These advocacy groups will probably also be the cause of the final demise of the Rancho Rehab Unit as very few private companies would want to take over the hospital under the conditions put on them.
Another CEO bites the dust. This time the firing was the idea of the Board at Hubbard Regional Hospital in Webster Massachusetts. The CEO was a collections attorney who was unpaid except for the money he received from the collections. He claims the Board continued to interfere with administrative decisions. He did turn the hospital around financially but was a disruptive force. He states he was given the usual 10 minutes to collect his belongings and leave.
What does a hospital do when faced with a gift of $25 million for a new wing versus the hospitals medical staff being adamant against the hospital taking the money? The donee is a trial attorney who has made his millions suing hospitals and physicians. This is the problem for St. Luke's Episcopal Hospital in Houston, Texas. The hospital has chosen, and as any good business would do, the choice is the green. They have no scruples when it comes to who gives them that much money.
In Ohio, the hospitals are figuring out how to partner with physicians. They are building more outpatient and medical office buildings with physicians as partners. One of the ways they are doing this is the hospital is selling the top floors of building to physicians as air rights for their offices. The hospital continues to own the first floor specialty area. This allows the physician to sell their office space in the future if there is someone willing to buy it. One of the ways the physician can be protected is if there is a regular office building and the physician leaves prior to the end of the lease they can have the hospital take over the lease after a six month time span.
Kona Community Hospital in Hawaii is being investigated for unethical practices. The charges were brought by the medical staff who know where the skeletons are buried. The CEO is on leave after the medical staff had a no confidence vote. About 25% of the staff have left in the last year due to having to work on call without pay. The former chair of the medicine department was removed after complaining that the care was inadequate and the hospital would not hire any new physicians. The Joint recently also had an unannounced survey due to the charges and cited the hospital but as long as the hospital correct the deficiencies they will continue to be accredited. (See story below). Top
The Washington Post had an article about the Joint and it's conflicts of interest. On one hand it inspects and accredits hospitals and on the other hand it teaches the hospitals how to pass the inspection. Recently the organization has missed problems where patients have been injured or killed. Examples given were the Redland Hospital situation in California where just after the inspection, the FBI raided the hospital for potential unnecessary cardiac procedures, Maryland General Hospital where after getting the OK, the hospital was found to be doing erroneous lab testing, Norwalk Hospital in Connecticut where one month after accreditation the hospital was found to have numerous violations in prescriptions and patient treatment, Palm Beach Hospital that got accredited in spite of significant infection problems. Some critics state there is too much coziness between the hospitals and the Joint. O'Leary, the sometimes retiring president of the organization, states rightly that they can not fine or close a hospital. They can not deem the hospital as Elaine Bennis would say "sponge worthy". Another problem is that the Board is almost all AHA or AMA members without significant consumer input. The Joint also charges about $25,000 for an accreditation and an additional $10,000 for instruction how to pass the test. The latter accounts for the majority of the $33 million in revenue. The two organizations claim a wall between them but the wall does not extend to money. Top
When PacifiCare is purchased by United Health the PacifiCare execs will get about $230 million. Most of this is from accelerated stock options. Some would also be in signing bonuses and United stock options if they stay with the new company. Some will share $15 million in change of control payments.
UnitedHealth and Aetna have begun the rating of Arizona physicians based on quality and cost. (This means cost.) Those that don't admit will get higher marks than those that do. Those that don't perform the more expensive tests will get higher marks as well.
The North Carolina state health plan for state worker, teachers, retirees and their dependents have stopped payments on all medical bills until the the state budget is passed. The budget is supposed to detail changes to benefits where the person may have to pay more and the plan less. The state has now started paying physicians as their copays are not going to change. Top
Sometimes things work as they are supposed to. West Virginia adopted new med mal laws and the amount of suits has decreased. The insurers are now asking the state for permission to decrease their premiums. 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.