The dispute between Detroit Medical Center and Wayne State's School of Medicine is beginning to have severe consequences for the people for the area. Some physicians are leaving and others are not coming. There is a contract dispute regarding the residency programs. The ACGME may close the programs and send the students elsewhere or place the program on probation which would lessen its appeal to physicians. The dispute is over money and control. Wayne State wants to be paid for their people going to Detroit and the separate issue is allowing the physicians to participate in ventures that may compete with Detroit.
The problem was resolved by a new 3 1/2 year contract between the two institutions. A small number of residencies will be now only for each institution and the vast majority will be combined. After 2009, the joint core residencies are free game for either institution. There is no mention in the press release about the Wayne physicians going elsewhere for more lucrative procedures.
In yet another blow to universal health care America seems set on canning HMOs. The costs are far greater than the benefits. More people are switching to the less restrictive PPO. In reality what do HMOs do? The true answer is nothing. They are middle men who take vast amounts of money from healthcare needs and divert the money to their own needs. Why the change from a decade ago? People want control of who they see and what services they can utilize. People want the best in healthcare and if hospital A has it but is not in a network, the consumer will put pressure on its company to switch networks.
Ah yes, HMOs. The Commonwealth Fund has reported that Medicare spends more money on the Medicare HMO patients than on the regular Medicare patient. The amount is about 12% more and the report recommends a reduction in payments to the insurers. The Insurance Plans call the report flawed. What else could they say?
DoctorCare, a Miami physician run HMO is about to close. The physicians state they are nincompoops who did not know how to run a business or that high quality healthcare is not possible today. The physicians recognize that it may be some of both.
The healthcare advocates continue to beat their collective heads on a brick wall. They want the medical profession to switch to electronic medical records. There are several problems with EMRs. The first one is cost. No physicians who is caught in a war of decreasing reimbursement and increasing costs is going to spring for an electronic gizmo that costs five figures and needs continued spending on maintenance. The hospitals that have the device are also finding complaints that nurses are spending so much time with the computer that they can not see the patients. Physicians in their offices are talking to patients and typing at the same time in order to save time. This leaves an impression that the physician cares more about the writing than the patient. Fortunately, the feds have come to some rescue on the cost element. They now allow hospitals to give systems to physicians. The new laws state the system may not be proprietary. It must be able to talk to other systems around the country. The physician must pay at least 15% of the cost. The donation must be for software and maintenance, not hardware.
The non-profits are worried that if they follow the above their non-profit status may be compromised. The IRS will be issuing a letter on this in the near future.
The story about the Kaiser employee who sent a mass email regarding the stupidity of Kaiser's Epic, the new EHR system will not die. Now Kaiser has sent an email to the other Epic customers stating it remains an Epic supporter. The original email said that Epic was the unilateral decision of Haverson, the CEO. This is plausible for those that know the Kaiser mentality. Epic states that the decision involved hundreds of people and took six months. That really is not a long time. The original stated that Epic was having a difficult time tailoring to the vastness of Kaiser and that it was down a fair amount. Epic states that it is scalable and able to accommodate 26,500 users at the same time. Epic states that was down time but the problem was power not the software.
Kaiser continues to state that its electronic medical records are on target even though the price has risen to over $4 Billion and it is several years behind in implementation. How many group physician practices could spend anywhere close to Kaiser's massive expense? None!
An article in the Archives of Internal Medicine the VA system was shown to have good colorectal cancer screening by the less effective and cheaper fecal occult blood test. The amount of the effective and more expensive colonoscopy is not up to standards especially in the 55-64 year range. The article believes that the lack of effective colonoscopy may be a combination of patient preference, lack of endoscopic capacity and cost.
Believe it or not, there are still some California physicians who want to treat Medicaid patients under a contract with the state. Those fools are being stymied by the State. California makes it difficult to get the required number for billing even for those who just move their office. One physician clinic took over one year for a new number due to the gross inefficiencies of the state. The problem is the legislator's laws regarding fraud control. Top
Another California hospital has been accused of dumping but this is for inappropriate transfers. Contra Costa Medical Center has had its federal money threatened for three cases of inappropriate psychiatric transfers. This one is refreshing in that the hospital CEO states the policy is in place but the hospital goofed by not following it. The CEO is a MD who does not stonewall.
St. Vincent Hospital in LA has closed its cardiac transplant unit. This is the same hospital that moved a Saudi national to the top of its liver transplant list and causing a stoppage of that program. After the liver problem insurers stopped referring transplants to the hospital. The hospital's kidney and pancreas transplant programs will continue.
The LA Board of Stupes has just learned that the budget of the downsizing of the notorious Drew/King hospital would run 25% higher that originally thought ( if that is the right word for this organization). The cost over three years would go to $81 million from $65 million over three years. This does not include any overhaul of the left behind hospital. The major cost is the transfer of jobs. This money is a small enough amount for the Board which spend no time or money overseeing the hospital until the LA Times broke the story about the fiasco there.
The County has allowed the health department to negotiate about $199 million in contracts to overhaul the infamous King institution. This includes hiring true ED physicians to staff the ED instead of residents who are now gone. Drew University has ended its medical program for about 250 residents.
The two most successful hospital groups in California are Kaiser and Sutter. There is intense competition between them so when Kaiser wanted to rent space at Sutter facilities, Sutter just said no. The idea was to rent space so that Kaiser could compete in the non-HMO world. Kaiser has started a PPO sector that would be in direct competition with Sutter. There are some medical groups that also are discontinuing working with Kaiser for the same reason. It will be hard for Kaiser to compete without the outside physicians and hospitals.
In Florida, two hospitals have started charging higher prices for use of their emergency rooms by people that do not have emergencies. The two hospitals are both for profit HCA facilities. The patients are seen by both a physician and a nurse and if they fall into a mild cold or dental problem they are given names of outside clinics to go to and are not treated at the ED. If they choose to stay they are billed a surcharge. If they leave no charge is given. This is legal since it is done after an adequate medical screening and all EMTALA rules are off. 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.