A study just released by two Pennsylvania judges
showed a decrease in the amount of $1 million verdicts. The
problem is there is still a large discrepancy (about double) between
Philadelphia and the remainder of the state as well as the surrounding
states. The tort reforms that passed the House and are now in the
Senate are aimed at reducing the non-economic damages. The trial
lawyers are still in their old theme that the liability would be borne
be the victims. What they are really saying is we make our living
on the insurance money and do not want the golden calf killed.
In Florida, the medical association is thinking about
placing a proposition on the November ballot that would limit punitive
damages. Many states do not allow these damages in negligence
cases only in those with intent. Again the trial lawyers would be
vehemently opposed. They state, not believe, that the high awards
keep the physicians accountable. Such hooey! The
proposition route was tried in 1988 and failed mainly due to the lawyers
heavily outspending the physicians.
The Florida physicians are going to march on Feb.
20th at the state capitol against the high malpractice rates.
Since the legislature is in the pocket of the trial lawyers, it won't
make much of a difference. There needs to be a much more decisive
action such as not doing elective surgery or seeing elective patients.
This may hurt the pocketbook for several weeks but the rates will hurt
it more and for a longer time. The march needs to be coordinated with a
state proposition for the November ballot and this time but your money
where your mouth is. Don't be overspent by the lawyers. Hire
a good PR firm.
In two stories in the Corpus Christi, Texas Caller
the malpractice woes of the state are detailed. The first story
discusses the legislature again looking at the problem. However,
the state does not enforce the $5000 bond requirement to file a case.
The law states the bond may be waived for poor patients but if waived
they need an expert to agree that each defendant named committed
malpractice. This expense comes out of the contingency fee
attorney's pocket, so they try to talk the judge out of it. The
attorneys also complain that the nasty insurance companies take the
premium money and don't want to pay claims. The one thing I
believe all doctor's agree upon is that their premiums should not be
raised just because they get a notice to sue that never comes to
The other story is how lawsuits hurt not better
patient care. The article states how the Corpus Christi physicians
are sending patients to San Antonio or Houston for care.
Managed Care Demise
A new study by the Commonwealth Fund showed that out
of pocket costs for Medicare HMO patients rose by about 50% over three
years. The sicker patients spent $2,088 last year in drug bills.
Approximately 14% of seniors are enrolled in these plans. The average
recipient in an HMO has an out of pocket expense for drugs at $1438 as
opposed to the regular Medicare at $3142 per year. Could this
be cherry picking with or without rationing of care? I
truly do not understand why any are enrolled. If one looks at
regular Medicare supplements there are 10 plans that go from A to J.
The top layer have up to $3000 matched coverage for the recipients.
Yes they are over $200 per month but the patient can get care in any
hospital and with any physician in the United States, as well as
emergency overseas coverage. Now that the HMOs have cut back their
payments and benefits there is even less reason to join one of these
Hospital trauma Systems
The San Diego Trauma Centers will be examined.
Palomar Hospital, part of the system, closed its trauma doors for
several weeks due to a contract dispute with its physicians. The
has led to the County re-evaluating the system as to the necessary
funding necessary. The project will be complete in six months.
That's better than the over ten years it has taken from the fall of the
San Francisco Bay bridge after an earthquake to the groundbreaking for a
new span. This is longer than it took to build 3000 miles of the
Great Wall of China in 621 CE.
Tacoma, Washington's Mary Bridge Children's Hospital
Orthopedic surgeons refused to cover the ED. They did this by dropping
off the hospital staff. CMS threatened the hospital with loss of
Medicare certification for EMTALA violations. The hospital began
to pay the Orthopods for call and the CMS dropped its case. The
hospital is paying for on-call and more if the Orthopod actually has to
show up. Top
HMOs & Hospitals
Blue Shield is playing follow the leader. They
have copied PacifiCare in using a two tier system of hospitals for their
insured. Health Net is soon to follow. The two tiers are only
based on cost and not quality. They have dropped the only
hospitals in Vallejo and Fairfield California to the second tier.
The hospitals are now dropping Blue Shield entirely, so they will not
have to go after the patient for the extra per diem payment. This
could add up to over $700 per stay depending on length of stay and
diagnosis. The only two hospitals in central Contra Costa, just
across the river from Vallejo are also dropping Blue Shield. Blue
Shield just sent me a letter stating that instead of the hospital one
mile from my house or the one five miles away which are both on the best
hospital in California list, I can go to one twenty miles away where it
is a for profit and I have no physicians. It is easier to drop
Blue Shield, and I will.
PacifiCare has changed the rules in midstream.
In Texas, they have began charging patients for hospitalization and
chemotherapy medication, even though they were already on the medication
when they switched policies. Not playing nice!
Don't cry for me Harvard!! Harvard has
lost their top cardiac surgeons to Mt. Sinai in New York City. The
surgeons were paid a good salary and also promised research and
operating room space. Harvard is worried and well they should be.
They pay their physicians below the median for salaries but when the
cost of living is taken into account it is at the 25 percentile level.
They blame the low salaries on the low reimbursement but are not
willing to have the guts to drop out of managed care to force increased
New Medical Insurance?
Cigna is following the Aetna model of a new insurance
plan that allows employers to fund a certain amount of money into an
account that is to be used for medical payments. After the fund is
used up the employee will be responsible for possibly 20% of the
remainder and Cigna would provide the other 80%. This gives the
employee some control over the expenditures. If there is any money
left at the end of the year it may be rolled over to the next year.
If this sounds familiar , it is because it has been in existence for
about five years but called a Medical Savings Account by the Feds.
I have had one for years and love it. I get a IRA type tax deduction for
the contribution and then pay a small amount for al large deductible
policy as a safety net.
Patient Physician Haggle
The Wall Street Journal is reporting an increase in
patients trying to haggle the cost of their medical care with their
physicians. The patients have been doing this for years for
cosmetic surgery and other conditions not covered by insurance. In
the era of insurance will pay for all this has fallen off. It now
returns but the patient needs to pay a significant, if not all, the bill
upfront to get a significant discount. This is especially true
with those patients who et a fixed amount each year to spend on health
Knee Surgery Deaths
The three deaths in Minnesota following knee
replacement surgery were not related. One was indeed from an
infection in the prosthesis but the other two were heart attacks.
This was when the State reasonably prohibited all knee surgery for one
week until the cause could be probed.
HIV in Blood
A Texas man is the first identified blood recipient
in several years to have been infected with the AIDS virus via a
transfusion. The patient had an emergency bypass surgery and
required transfusions. One of the units was from a donor that had
donated four times that year. The first three times his test was
negative but the fourth was positive for HIV. The Bank retested
the other three units and found no HIV but notified the hospitals and
recommended the patients who received the donor's blood be tested.
This one recipient was positive. The test being used is sensitive
enough to tell if a donor had been infected 7-10 days earlier. The
Bank believes this one did not have a high enough count to be detected.
Golden State Physicians, a Sacramento IPA, had its
radiologists refuse to do any more for the group. They haven't
been paid. The IPA has hired two prior management companies that
did not do what they stated they would-pay bills on time. The IPA
has now hired a third management company and in all probability will be
out of business in a short time. The Department of Managed Care
has them on its watch list but has no power to de-certify them.
MGMA has released the first comprehensive report on
the comparison between salaried and independent physicians.
Salaried physicians are losing about $89,000 per full time physician.
Independent multi-specialist practices are making about $1000 per full
time physician. This does not take into account the difference
between salaried and productivity physicians. Those on straight
salary are bringing in about $300,000 and those on productivity about
$416,000 per year. The flip side is that hospital owned practices
had about $58,000 less expenses per full time physician than their
independent counterpart. This was due to group purchasing
The California Foundation has released a report
stating that 46% of California physicians, primary and specialists, do
not treat Medicaid (MediCal) beneficiaries. For those that did see the
Medicaid patients half, only had 5% of their patients in the program.
The study showed that most of the physicians taking the patients were
either foreign medical graduates or non-board certified. Again, of
those accepting the patients, 94% said the pay was inadequate and have
more complex medical problems. The other major problem are the
administrative hassles. I remember when I started practice I
took all patients. As the physicians in my specialty took less
MediCal patients, I ended up with more. This with the decreased payment
and the increased paperwork required to take care of patients led me to
drop the program after about ten years. I also refused to see
those MediCal patients from physicians who never sent me anything but
the MediCal patient. If they sent me some better paying patients I
would see some of the MediCal patients for them. Now, there are no
primary physicians or specialists or hospitals in my community who take
Pharmacy Error Kills Patient
CVS Pharmacy mistakenly gave a 51 year old patient
with diarrhea an opium tincture instead of camphorated tincture of
opium, Paregoric. The pharmacy is blaming the physician for not
using that name on the prescription. This was found on an autopsy
toxicology test. The pharmacist is on administrative leave and a
civil suit is in the works.
The Feds raided a San Francisco medicinal marijuana
club and confiscated a whole pound of the nasty weed and 630 plants.
In other coincided raids a total of 6300 plants were taken.
Medicinal marijuana is legal under California law but not under federal
law. It is only the Feds that do the busts. It is
understandable since there is nothing else going on of national
importance. At the same time San Diego approved the
implementation of a marijuana identification card to allow the
possession of one ounce for medical purposes. Is this schizophrenic,
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