Both the Philadelphia and Pittsburgh Business Journals carried stories on the high cost of malpractice insurance. In the last issue I wrote about this noting that Pennsylvania’s lack of tort reform. The Philadelphia article called Philadelphia the malpractice payoff capital of America. In the first 11 months, $336 million were awarded. That amount was $12 million only four years ago. The Pennsylvania Catastrophe Loss Fund (CAT) instituted a 60% surcharge on the primary malpractice premiums paid by state healthcare providers. This is in addition to an increase in the basic malpractice premiums. In one area about 24 younger physicians have left. Physicians in Pennsylvania are required to carry $1.2 million in insurance. The private insurers underwrote $400,000 last year and the CART picked up the rest. Philadelphia has 11% of the state population but accounts for 87% of the awards in the state. The State Medical Society is now trying to work with the legislature to institute tort reforms, including length of time to trial and caps on pain and suffering.                                 Top

Anesthesiologists are leaving Massachusetts for greener pastures or staying in academia leaving a gap in the community. The loss is blamed on the fact that medical students do not see anesthesia as glamorous enough and is low paying as opposed to the perceived high price of living in the state. In a survey of 85 hospitals, 11 were forced to delay emergency surgeries, 19 for forced to delay elective surgery, 17 closed their pain clinics and 10% of all anesthesiology positions were empty. To make mattes worse, out of 286 medical students that completed anesthesia training in the past several years 162 left the state.                         Top

The parent organization of the above group who are refusing Medicare patients because of low pay, Fraud and Abuse regulations and paperwork is calling for a national health plan without any controls such as co-pays or deductibles. There would be a limit on out-of-pocket expenses and then total payment would occur. This is not intended to replace Medicare, VA or the Bureau of Indian Affairs. The states would administer the program but funds would be dispensed on a per capita basis. The article did not say where these funds would come from or how the financing would occur.                                     Top

In a new study published in the NEJM the time of physician visits have increased from 1989 by several minutes. What the article fails to emphasize is the new era of litigation, a more informed public asking more questions, and more diagnostic abilities and treatments that need to be explained. The standard visit was 18 minutes and physicals 24 minutes. This increase of time was across the board; no matter what type insurance or the seriousness of the problem. The standard British health service visit is 5-6 minutes. The study surprised both physicians and patients.                                 Top

HealthPartners, a large Minn. HMO has stopped requiring referral to specialists in most of their patients. This new rule does not apply to those patients who go out of the clinic system or out of network.            Top

Blue Cross PPO members using Sutter physicians or hospitals that have not agreed to contracts may be asked to pay higher amounts than previously. The providers of care do not have to accept Blue Cross’ payment and have the option of going after the patients for the extra money.                 Top

The FDA is looking into barring the use of any blood or blood products from any person who has spent six months or more in France, Italy or other European countries where "mad cow disease" may be present. There is currently no test available for the disease and the only thing available is the removal of potential carriers from the lists of donors. A standard question currently asked is whether or not the donor has spent six months or more in England.                         Top

To no one’s surprise California emergency rooms especially in the southern part of the state have lost a significant amount of money for uncompensated care. There is currently a law providing $100 million to physicians for uncompensated care. A new bill would add another $100 for physicians and $100 million for hospitals. Another bill in the hopper is for the health plans to pay hospitals and physicians directly for all emergency care instead of paying via an intermediary such as an IPA. Top

A group of 12 physicians have purchased the 71 bed San Clemente Hospital from NetCare Health Systems of Nashville. The new owners are planning to open a birthing center featuring midwives and not physicians.                                 Top

The Sacramento Bee had an article regarding the meddling of both health plans and physicians in case management. The El Dorado Medical Group partnered with Marshall Hospital in 1995. They went bankrupt in 2000. The doctors admit they did not change the way they practiced and costs were not contained nor care rationed. Also different payors paid differently. This scenario is being played out throughout the state with about 85% of groups either bordering on bankruptcy or heading there. Starting on May medical groups will need to report to the state their financial positions. This should be an eye-opener for the state and the groups. There is a discrepancy in the figures physicians are being paid under capitation. The CMA states the current rate is about $29 per patient per month. The California Association of Health Plans state the rates are between $35 and $45.

An Olympia, Washington 74-doctor clinic is considering bankruptcy due to low reimbursement. Several months ago the clinic switched from a fixed fee to a fee for service arrangement. The new fees are par for Washington but the clinic states the State payments are low. A separate pediatric group has not covered its payroll in 6 weeks and a clinic in Kirkland has voted to stop accepting new Medicare or Medicaid patients due to low reimbursements.

The primary care physicians and some specialists in Colorado are stopping the care of Medicare recipients. They are only taking old patients that have become Medicare recipients or have allotted only a few slots to new Medicare patients. This is not as acute in Denver as in the rest of the state. Currently only 62% of primary care physicians in Denver and 58% in the rest of the state are now taking new Medicare non-HMO patients. The numbers for HMO patients are 64 % in Denver and 46% for the remainder of the state. In Colorado Springs only 10% of primary care will take new Medicare HMO patients and 34% of non-HMO patients. HCFA isn’t impressed and wants to see more evidence of Colorado’s Medicare problem. Nobody ever claimed bureaucrats were intelligent. Top

A group of psychiatrists at Highland Park Hospital, an upscale hospital in an upscale community, are protesting closure of the 27 adult in-patient unit. They state they are "being treated as second class citizens". The 30 physicians have taken out ads in the local paper and are fighting the hospital by stating no Certificate of Need (CON) was obtained for the closure. The hospital has countered that no CON is needed since there is no true closure but only a transfer of beds from Highland Park to the sister facility Evanston Hospital. Northwestern University owns both hospitals. Top

The Eye Bank Association of America is currently banning corneal transplants from donors who have had LASIK. The group does not now know if these corneas may be transplanted safely and are currently studying the issue. Since most of the LASIK is performed in younger patients the care about later transplants is down on the "I care about" list. The fear is the reshaped corneas will give the donee a built in visual error and may weaken the cornea. Top

In an article that should surprise no one United Health of Illinois lost 7% of its enrollees when it stopped pharmacy benefits. They do not know if the loss of the money from the enrollees will be more or less than the money saved on the dropping pharmacy benefits. Humana, the only other HMO in Cook County, with pharmacy benefits has seen a slight increase in enrollment since United changed. Top

In a study published in the Archives of Internal Medicine the San Mateo County physicians working in the staff model Permanente Group were happier than their independent counterparts. They were more satisfied in their quality of practice and have less decline of income. The study suggest that working with managed care plans have a more deleterious effect on physicians than being employed in the staff model situation. Top

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