The first but not the last boutique medical practice has opened in Delaware. The upfront fees are several hundred dollars per patient. Critics fret that this is a luxury, which of course it is a legal one. They are afraid that if too many physicians do this there will be less physicians for the care of the others including the 43 million without insurance. This is pure folly. All patients may see a physician, with or without insurance. They just need to pay. Insurance is not a right. The left wing socialists who are for the government paying for all are aghast at the idea of people actually paying money for an item. Boutique practice is the antithesis of managed care where more patients and less time per patient is better. Top
Judge Moreno in Florida has agreed with the physicians against the mean HMOs. The Judge agreed to allow the RICO charges to remain to force the change of business practices. This also allows for triple damages. While this is going on, the 11th Circuit is deciding whether or not the physicians can even be a class. The case goes to trial next summer.
The California Department of Managed Care is without a leader. The last one left when the Governor Davis fiasco developed. Governor Schwarzenegger has not yet appointed a new chief. The Democrats want a patient friendly person chosen. The specialty interest HMO groups want one that is business friendly and will not bother them. While I am almost always on the side of business, the HMOs are so flagrant in their disregard for their own rules that I favor a patient friendly leader of the Department. This should be a department that deals fairly with consumers and is their advocate against the larger more powerful mangled care industry. All the special interest groups are lining up. The CHA wants someone who will give them more money. The CMA wants someone who will give the physicians more money. The IPAs want someone who will protect them. Isn't lobbying wonderful?
Excellus Blue Cross has lost its bid to the New York Supreme Court to hear its case. It will now have to pay over $18 million to its 2500 physicians. The insurer stated the court didn't take the case not based on the merits. I bet it doesn't snow in Rochester in the winter, either. Top
The North Carolina Senate Malpractice reform bill is an equal opportunity hater. There is no malpractice non-economic caps, the insurance commissioner will say shat the allotted amount for insurance is and it will be harder to bring a case to trial with less recompense for the plaintiff attorney. The bill will allow for recovery of legal costs from the loser and will allow payments to be structured over a long time. The bill also sets up a state pool for malpractice payments and the pool is funded by the physicians. The bill puts in place a three member pre screening panel which would recommend settlement or dropping the case. If anyone goes against the panel's recommendation and loses, they have to pay the other sides costs. The bill also opens up to scrutiny those physicians who have had several malpractice suits and also removes the privacy aspect from peer review hearings.
The Washington Medical Association is planning to target those state lawmakers who killed the tort reform bill in the Democratic controlled House committee. The Republicans are planning on making tort reform a central theme of the next election.
In Oregon the physicians have ponied up over $500,000 for a ballot measure on tort reform. They need about $4 million. A different bill was defeated three years ago. The problem is already acute in the state as the largest insurer has stopped insuring new OBs.
Missouri insurance carriers in 2002 paid out $135 million for 524 closed claims. Self Insured entities paid out an additional $6.6 million for another 42 claims. The average claim paid was up $500,000 for both death or permanent disability. In the 2001-02 era 57% of insurers stopped writing in the state.
Maryland is beginning to mobilize the lobbying forces on both sides for the upcoming legislative session that will discuss tort reforms. It will turn out to be politics as usual as the Republican Governor will push for the reforms but the Democratic Senate will not allow them to pass. Top
Catholic healthcare West has decided to infuse money into a new Sequoia Hospital in Redwood City, California. However, like most large organizations, they are not mobile and quick. Their slowness has cost them dearly. The cardiologists, cardiac surgeons and the entire support team of the cardiac care unit from the hospital are leaving for a new hospital a few miles away. This team won an award for one of the best in quality of care and brings in about 40% of the hospital revenue. The new hospital will not be built for about 5-7 years so watch for a bidding war or kicking the people off the staff now for dealing with an economic competitor, Sutter Health.
Hospitals are upset at Medicare. They are not getting paid enough when they do really well in treating patients quickly and efficiently. The hospitals do not get paid anything extra if they work to improve care. What they don't state is that they get paid a fixed amount per diagnosis and if they have good processes in place the patient may get out of the hospital earlier and not utilize hospital recourses. This gives more money to the bottom line. The hospitals want a payment program that is tied somehow to quality of care, whatever that is.
If one has a problem with the US hospital system, they should go to Dubai. A woman in transit through the country had to be hospitalized as an emergency for a C-section for eclapsia. he could not pay the bill and so remains in the hospital until the bill is paid. There is no mention as to whether or not she continues to build up charges while staying at the hospital.
Drew Medical Center in LA is about to lose its third residency program. It has already lost surgery and radiology. The next to go will be neonatology. The hospital is also having a surprise inspection from the Department of Health due to two recent patient deaths who were on monitors but whose failing vital signs were not caught. The inspectors blasted the nurses for giving substandard care; the physicians for allowing problems to continue and the county for poor oversight.
Tenet has worked out a deal with the Feds. They will sell Redlands Hospital and in the meantime the hospital will continue to be allowed to collect federal money. As part of any sale Tenet would need to indemnify the buyer against all law suits for the time that Tenet owned the hospital.
Regional Medical Center in San Jose, California, has to retrain the hospital staff on recognizing and treating trauma. This after a two year old died after being hit by a car. The child remained at the hospital for several hours prior to being transferred to a trauma center where she died.
Washington, DC Southeast Community Hospital is bankrupt and a high bid for the hospital is $5.75 million. This bid will not include any liabilities. The last owner purchased the hospital in bankruptcy for $22 million. In the meantime there has been a bid of $155 million for all four hospitals on the block. The high bids for each of the hospitals will then be compared to the high bid for the four hospitals in bloc. The highest will then get the hospitals. Top
OhioHealth is getting ready to take away privileges from all the physicians who have invested in the specialty hospital, New Albany Surgical. The new hospital opened December 1, 2003 and specializes in orthopedics and neurology. The OhioHealth people are using a lie that the investment is a conflict of interest. It isn't as long as the physicians do not vote in meetings in any matter that would affect both institutions. The other hospital group that has threatened to take away privileges is Mt. Carmel. Their policy is more rational. They will take privileges if physicians are steering the least medically complex and most profitable to the new hospital. If the physicians are decredentialed they will bring all their patients to the new hospital and will of course be off the on-call list. This will make those remaining take more call and probably force the hospitals to pay for that increased call. They lose business, lose referrals, lose on-call physicians and gain nothing except egg on their face. They will also be sued and this will also cost money to defend. Ohio has a separate law that does not allow economic credentialing during their own moratorium of 24 months.
In Indiana, close to Louisville, a private heart hospital won city approval at the November 18 deadline imposed by the feds in HR1. The new hospital will be owned 51% by Cardiovascular Hospitals of America and 49% by Louisville, Kentucky based physicians. It will go head to head with two other heart facilities in the area both in community hospitals. Since the moratorium is only for 18 months, it is possible to start building now and not be done by the time the moratorium is over. The problem with that line of thinking is that the AHA may bribe, read lobby, enough legislators to extend the ban for a longer time.
In Louisville, Kentucky, another fight is brewing. There is an MRI operating without a certificate of need. The unit states that since the equipment cost under the threshold, one is not needed. This flies in the face of a three month old advisory opinion by the state that all freestanding MRIs need a CON unless they are owned by doctors who practice on site. This may leave out hospitals from installing new MRI scanners. These scanners are mostly owned by non-radiologists and would run afoul of the Stark legislation. They don't since they do not take Medicare or Medicaid patients. Some feel the referring of patients to machines you own is against the AMA Code of Ethics. That may or may not be true, but it matters not a whit. The AMA has no power over anyone and their Codes are unenforceable.
The new Medicare Bill also limited payments to all outpatient ambulatory care centers. There will be a 2%-3% cut in Medicare payments starting in April 2004 and then a freeze on payments for five years staring in 2005. Top
Large employers across the US are looking to a 14% increase in premiums next year for their managed care contracts. Why is that? Could it be the intermediary is skimming to increase their bottom line for investors? Could it be the managed care industry artificially held down prices for so long that now they have to increase the rates at a large clip? The employers are only able to absorb about 9% of that increase so the patient will pay the remainder. This may not be bad as the patient needs to know how much medical care really costs so they may as be an active participant in the process, which now they are not.
In upstate New York, Excellus Blue Cross and Shield has increased this year their premiums by almost 15%. They are scheduled to go up an additional average of 8.3% on January 1. The average means that some are above that. The highest is a 20% raise for individuals. The other health insurers in the market will increase their fees by an average of 12.6%.
A Harvard associate professor who also works in private practice supports a single payer health system and has written an article regarding it in JAMA. He wants the government to pay for all health care for all citizens with no money out of pocket for anyone. That wouldn't cost much. That wouldn't decrease the amount of technology that the American patient and his lawyer has become used to as a right. That wouldn't cause any waiting period like there is in Canada and Europe. That wouldn't lead to the things I saw in London while on a pediatric urology rotation such as a mother coming into a clinic with her child and the professor stating that the child needs surgery and we will call you when it is scheduled. This is done without any other conversation about the procedure or any questions allowed. The American people will love it. The only parts of his thesis I can agree with is the increasing costs generated by the regulations and other administrative requirements caused by either the government or the unneeded managed care organizations and other insurers.
In California the State Compensation Insurance Fund that handles most of the state's Worker's Comp insurance has stated it will decease the amount charged to business by a whopping 2.9%. This is a far cry from the Legislature's estimate of 14.9% when they put in some minor restrictions in their reform bill. This should make it easier for Governor Schwarzenegger to get a better bill passed in the special session called on this issue.
As HMOs continue to wither and die, a legitimate question is what is gong to happen to IPAs. They are now a separate rung in the bureaucracy that needs to make money and deprive those who provide services of money they earn. It seems logical that they should go when the HMOs go. They serve no other purpose than as a negotiating instrument between the provider of care and the insurer. Top
A study in the NEJM stated that it makes no difference which hospital you go to for a procedure. The best results will be by the individual who does the most of the procedure. It is true that if one goes to a low volume hospital they are more likely to have the procedure done by a surgeon who is a low volume surgeon for that procedure.
The Florida Sun Sentinel has done an expose on physicians who have been chastised or fined in the past and the relationship with prescribing large amounts of narcotics to Medicaid recipients. After the sensationalism is done they make the point that the Medical Board is not monitoring the prescribing of narcotics by the state's physicians. They also point out the problems with physicians who don't treat pain aggressively are being taken before the Board. The paper pushes the point of lack of proper oversight by the state Medical Board of physicians whose patients have died after ingesting large doses of drugs and those who are large prescribers of drugs. Some of these may be legitimate but one doesn't know until one looks.
In St. Petersburg, Florida the chief of medicine at Bay Pines VA Medical Center has been removed. The cause is that he is under investigation of misusing money and sexual harassment. He was reassigned to cardiology. The feds have sent a preliminary report of their investigation to the hospital. There has been no hearing on the removal from the position. To make matters worse 24 physicians believe the chief of staff should also go. These physicians sent a letter to the hospital director requesting an outside investigation of the chief of staff. He is being accused of gross mismanagement and is a risk to the Veterans. He has also been accused of harassing the employees.
The Texas physicians face a 24% fee increase in their license, up to $415 per year. This is to allow the Board to increase their enforcement activities. The Texas Board is noted for their unfairness to physicians and lack of due process. This will not help the lack of due process.
JAMA has a recent article about the impending lack of non-primary care specialists in the medical pipeline. This report by the AMA goes against the reports of the past two decades that showed the opposite. Top
Governor Schwarzenegger of California has refused a request by the Los Angeles Hospitals to delay the implementation of the nurse ratios.
The American Association of Colleges of Nursing has reported an encouraging trend. There is another increase in the enrollment of nurses in baccalaureate programs. In 2003 the increase is 15%. Two years earlier the increase was 3.7% and last year the increase was 8%. The bad news is the potential is for a 40% annual increase to replace those who are retiring. This does not include those people that have enrolled in hospital programs that do not lead to degrees. 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.