February 15, 2006 News


Healthcare Insurance and Costs



A myth uncovered.  Hospitals have banned cell phones due to the risk of interference with equipment.  That is not true.  As a matter of fact, cell phones may increase safety by improving communications.  It seems like the only equipment that may be interfered with is ventilators and that can be avoided if turned over in the vicinity of the ventilator.

Grossmont Hospital in San Diego really likes Sharp Healthcare.  Sharp is currently running the hospital and the current lease is up in 2021.  The district board wants to get a bond measure passed to bring the hospital up to seismic retrofit. They need Sharp to commit to an additional 30 years in order to attempt to get 2/3 of the voters to approve the measure.

The University of California at Irvine has been in the news alot recently for the scandal of rejecting liver and kidney transplants which were needed for the patients registered at their hospital.  They then lost their Head who resigned over the problems.  Now a new problem has arisen.  They have the Chief of Cardiology and the Assistant Chief who have no medical license nor are they certified by any Board.  They could practice in California under a special law that allows them to practice without a license for as long as five years.  Both cardiologists are Pennsylvania licensed.  Their positions at the University was not according to the State medical board rules.  There have been numerous complaints about the two and five cardiologists have left because of them.  

Some of the UCI transplant scandal has fallen over to UC 
San Diego.  The director of the abdominal transplant program has been removed from his administrative duties for misleading regulators about the UCI program.  He stated to regulators that he would work full time at UCI to care for their liver transplant program which had no surgeon.  The problem was he never left UC San Diego and the liver transplant patients died. 

Now there is the charge of nepotism at UCI.  The families of the CEO who just resigned have jobs there or have sold art to the hospital.  The perception of conflict of interest is all that is needed.  There may have been some hanky panky by the head of cardiology in the hiring of the CEO's son.

The troubles keep coming.  UCI is now going to be investigated by JCAHO.  Not only that but a recent story in the LA Times detailed problems with the anesthesia department.  The department has lost a string of physicians and there have been faculty complaints regarding patient care.  There have also been potential sanctions against the pain management program.  Guess who looked into the allegations of poor patient care, the hospital.  They found, not surprisingly, no evidence of faulty care. The anesthesia pain program has been under scrutiny since 1997 by the ACGME.  It continues to be under probation.  The University will not comment on anything stating confidentiality. This may be true but they are guilty until proven innocent. 

Don't you love academia.  There are two stories regarding the Cleveland Clinic.  The first is the resignation of the Cardiology Chairman Dr. Eric Topol after his public fight with the chief executive Dr. Delos Cosgrove.  Dr. Topol is going to Case Western Reserve.  Dr. Topol is been in the news due to his comments regarding heart disease and Vioxx.  Dr. Cosgrove has been in the news for testing devices on patients without consent.

The second story is regarding the conflict of interest policies at the Clinic.  An investigation showed the Clinic was not "transparent" enough in their conflict policies.    

Providence Hospitals in Oregon lost the medical information on 366,000 patients.  The first class action suit against them has already been filed.  There have been unconfirmed reports of identity theft from six patients.  Providence is now proposing to credit monitor for all the patients for a period of years and then deal with any identity theft problems that arise.  This could cost a bundle.  Providence is now being investigated by Oregon as well as  been reported to the feds for HIPAA violations.

Trying to cath up with Providence is Brigham and Women's Hospital in the People's Republic.  They have been sending private medical information to an investment bank for about six months, even after being told repeatedly about the error.  The bank continues to shred the material which included sexual transmitted disease information. The hospital will notify the patients involved and then be sued for their gross negligence.  They will also be investigated by the feds for HIPAA violations.

In yet another screw-up, Prudential Financial has been sending hundreds of financial records to a company in Canada.  They like the bank above have contacted the offending party and the told them of the mistake.  No action has been taken by Prudential.

There seems to be an epidemic of negligence.  Blue Cross an Shield of North Carolina has disclosed the social security numbers of over 600 people who applied for HSAs. 

In the field of specialty hospitals, the feds have mandated another six month moratorium on building the hospitals.  In the meantime, in Montana a specialty hospital is attempting to be purchased by other hospitals and the surrounding community hospitals are suing to block the sale.  They can't stand the competition of another full time hospital in their area.  Purely a turf battle over money. The main question is whether or not the entity is a single service hospital or a surgical center.          Top

Healthcare Insurance and Costs

I am an ardent proponent of the private practice of medicine without insurer interference.  I am against the single payor systems since I have seen how this works in Canada to the detriment of all the citizens.  I have seen the arrogance the system allows in England which would never be allowed in the US.  I have seen the patients from Jolly Olde who have come here due to the lines for treatment for cancer in their system.  I have finally read a decent and reasonable discourse on the single payor system.  In an article in Hospitals & Health Networks, Joe Flowers wrote nine reasons that hospitals should embrace single payors.  The article was based on economics and not pie in the sky reasons like the People's Republic of Massachusetts or San Francisco use.  The first was transaction costs can be saved which would rid us of the petty bureaucracies of the insurers.  The second is it would help the US become more competitive in the world markets since their would be no business contributions to health care.  The third is the spreading of risk.  The fourth is value.  This is one that has yet to be proven to me.  The fifth is cost of receivables which means payees would be paid and the consumers would not need to be bankrupt.  The sixth is the one that made me like his article.  Single payor does not mean the opposite of private, market driven or consumer choice.  He uses the HSA as an example.  He states that we are already in a "Soviet style" of health care where all are forced to conform to rules.  The seventh shouldn't be here but he just states rightly that the use of EDs for colds is stupid.  His eighth reason is patriotism.  What he means is that people need not choose between medical care versus shelter or warmth or food.  His ninth and last reason is addressed to the hospitals that he works for.  He states that nobody cares about them except themselves.  All try to get a cheaper price.  

Looking at a system that has no value, President Bush has just approved emergency funding for the VA system.  As I have said in the past, this is a boondoggle and the vets should be mainstreamed at no cost to the men and women who have sacrificed for us.  The care would be better and at a lesser cost.

At the University of North Carolina patients are being asked to pay prior to care.  This is for non-emergency medical appointments and procedures.  Both WakeMed and Duke are following suit.  The problem is that UNC is a state institution and as such is supposed to take all comers.  This would be equivalent of a county hospital not seeing the patients in the clinic if they are using the patients in their teaching program.  That is a tradeoff.

To no one's surprise, the People's Republic of Massachusetts is paying a lot more for the care of their constituents in the past year.  The people have no reason to get health insurance since the state covers all under Medicaid.  The people at the state level want to push the cost to the employers and not take the blame themselves.  The state has 160,000 people on it's Medicaid rolls who are working.  The largest employer in the state, Wal-Mart, has only 2600 of these on the Medicaid roll.  Even the large hospitals in the state have people on Medicaid.  

In San Francisco, the Stupes came out with their proposal for employers to pay for the healthcare of their employees even if they did not work or get healthcare in the city.  Not to be outdone, the man who elected President Bush, Mayor Newsom proposed his own program to pay for the employers, recipients and taxpayors.  There was no cost placed on the program but guesstimates were about $50-$100 per person per month.  The problem is no one know how many are uninsured in the city.  Some state 85,000.  Others state 150,000.  Participation by the uninsured would be voluntary but not for the employers.  In order to have the plan work the Mayor is going to have the city clinics stay open longer in the evenings and weekends.  The details are still to come and may break the plan in two.  

A study by the Center for Studying Health System Change (HSC) showed that in those communities that have specialty hospitals there has been no decrease in costs.  There has been an increase in patient convenience and better amenities.  The issue of quality is still up for grabs.  It is interesting that the reason for the lack of price competition is due to the community hospitals now finding they need to compete at are building their own specialty hospitals, either free standing or with in the present facility.  The study stated that the community hospitals are building for the lucrative specialties and not toward quality or efficiency.  

Speaking of lucrative, the HMO industry continues to lose patients but continues to gain money.  In the first six months of 2005 the industry made $7 billion, a 21% increase over the same period in 2004.  This was due to increased premiums and will now be with cost containment.  

In western Pennsylvania the hospitals had a contract with a group of anesthesiologists and their nurse anesthetists.  The contract broke up when their was no meeting about the pay.  This has caused turmoil in the whole region since many people are now moving to different hospital for much more money and signing bonuses.  The cost to the hospitals will go up measurably or they will be left with no gas passers.  Top


Massachusetts is now posting surgeons volume on line for 10 inpatient surgeries.  There were no accuracy of the numbers performed prior to the listing.  The rationale for the posting was that increased volume equals quality.  That has not been proven in 7 or the 10 procedures listed. 

An executive of Aetnahealth has stated that insurance companies are transparent except when it comes to their payment practices which are opaque.  They continue to short physicians and at best it is negligence and at worst malfeasance.  One of the worst examples is bundling of claims by insurance companies.  They then pay one claim and zero pay the rest.  This usually does not comply with the contract.   

California physicians are now being paid according to patient satisfaction and effective treatment.  Originally this went only to physician groups and now to individual physicians as well.  This will be 10% of physician income in five years.  This will be mandatory for all internists who recertify.  

There have been several articles recently regarding concierge medical practices.  Those that oppose them do so for jealousy masked as social reform.  They forget that the county has a two tier system at present. Those with Medicaid usually can not find a private physician and use either the mills or EDs for their physician.  There will never be enough people with th type of money needed for concierge medicine to interfere with the vast majority of patients seeing their physician.  Socialized medicine does not work but entrepreneurial medicine does.

An attorney for a hospital law firm was asked the question about employed physicians and conflict of interest policies.  He answered the question by stating the hospital should require a conflict of interest statement upon hire and annually thereafter.  Also there should be something stating that if anything changes the hospital should be notified.  He then goes on to state this is due to the Stark and Anti-Kickback rule but it really is to make sure the physician or a family member does not compete with the all powerful hospital.         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.