January 12, 2005 News






Blue Cross of New York is to start offering tiered hospital plans starting next year.  They have not done this before in this state but in other states they have substituted the word "quality" for "cheap". I assume this will occur here as well.

The December, 2004 HealthLeaders Magazine has a story on tiered hospitals that is summarized by even in the longest running tiered system, Blue Shield of California, the has been a negligible shift in the use of the less quality (expensive) hospitals.  In Florida there is so much politics that there are no hospitals in the most expensive (less quality) category.

The ED physicians at Virginia's Mary Washington Hospital have severed their ties with Anthem Blue Cross over fees.  This means the hospital will put pressure on the physicians or get a new group of ED physicians as about 20% of their ED patients come from Anthem.  This is the only major hospital in about a 30 minute range.  This will be settled quickly with Anthem giving more money and the ED physicians demanding less.  The employers will insist upon it.  

In Florida, the HMOs are doing very very well.  They have had a collective 26% increase in profits for the first nine months of 2004.  That is a profit margin of 4.4%, a 400% increase of recent years.  The HMOs have seen this and are reducing their rate increases.  

Tennessee Governor Bredsesn has eliminated half of the TennCare enrollees.  He stated that this is the only way to save the program mandated by socialist law suits to cover more and more care. Those that filed the suits got what they wished for more care for less people.  The do-gooders are considering more legal action which will dismantle the program entirely and the state will go back to standard Medicaid.     Top


They're back.  The worst hospital in the country, Drew/King in LA, continues to garner their rightful share of press.  The hospital consultants state that just to make the hospital average will take years and millions of dollars due to ingrained culture of ineptness.  There are about 1000 items listed for change. The report criticizes the County Health Department for their management since they took over at the end of 2003.  The report also stated that the hospital will never get better as long as it is controlled by the Board of Supervisors and their political appointees. Many of the staff are incompetent and need to reevaluated and fired even if physicians with ties to the community.  The report goes on to say that it is possible the hospital needs to be shut down, a real possibility if they lose their federal funding in several weeks. 

Following the report one of the members of the Board of Supervisors has taken the challenge.  He has called for the county officials to create an independent health authority to run all the county's five  hospitals. The authority would have the purse strings and would not come to the Board yearly for money. 

The lead editorial in the January 4, 2005 Wall Street Journal argues for the continuation of competition in the hospital industry with the moratorium against specialty hospitals being dropped.  The Journal states that the hospitals that are up and running provide better care than the community hospitals and although they initially take money from the community hospital, that shortfall is not long standing.  These folk are alot smarter than the AHA which is only after a turf war. 

The December, 2004, HealthLeaders Magazine has an interesting article on specialty hospitals with MedCath now wanting to partner with some community hospitals.  The article also states that some of the specialty hospitals are thumbing their noses at Medicare and going ahead with building.  This will give them the highest paying patients and leave the Medicare DRGs to the community hospitals.  A fitting fit.  One shouldn't wish for something they might get. 

Modernphysician has an article on the physicians buying whole hospitals that have gone defunct and making them into full service institutions.  This does not run afoul of the specialty moratorium.  There are 4-5 hospitals in the Southern California and hospitals in Texas, Pennsylvania and Oregon that have recently been purchased.          

Six month after voluntarily stopping heart transplants due to poor volume, Westchester Medical Center in Valhalla, New York, has paid two high price and qualified cardiac transplant surgeons from Mt. Sinai in New York City to do the transplants at their hospital.  The hospital is paying for their myopia.

In Methodist Hospital in St. Louis Park, Minnesota, the hospital had fired the 21 ED physicians en masse and hired a group out of Texas for their ED.  The ED nurses are now complaining that there are only 10 physicians and wait times have increased.  There are now 5 physicians covering the Ed in a day instead of six and the regular physicians are covering the gaps, a poor choice.  The old ED group has filed suit since for profits are not allowed to practice medicine in the state.  The new group is part of a for profit company. 

The OIG has in a ruling allowed for the second time a hospital to pay part of a on staff physician's malpractice payment.  In the first case it was an OB in a rural area.  This one is two neurosurgeons who were told they had two weeks to come up with a huge increase in their claims made med mal premium.  These were the only two neurosurgeons on the staff and for a 45 mile radius.  The neurosurgeons were going to retire and have their tail insurance paid by the company.  The hospital paid the tail premium and 75% of the increase in the premium for the first year.  The hospitals paid nothing the second and last year of the contract.  What this shows is if there is real need it is not inurnment nor anti-Stark to do what is necessary and get permission later.          Top


The Maryland physicians are between a rock and a hard place.  Their malpractice premiums were late as of January 1.  The Legislature has passed a bill to help their cause and the Governor may veto it because it includes a tax and he ran on a platform of no new taxes.  Some have decided to take vacation for several weeks to see what happens.  Others have either paid the premium or retired from their practice. 

The employers of Maryland state that if the new tax is passed on to them, they will have to reduce jobs and pay less of health coverage.

The employers don't have to worry since the Governor vetoed the plan as too weak on reform and too expensive a tax that will be passed on to consumers.  The legislature will now consider overriding the veto.        

In the New York City area med mal premiums to hospitals have gone up 150% since 1999. The hospital association will attempt to use the figure to lobby the legislature to bring about med mal tort reform.  

The Atlanta Business Journal has   multiple stories on the state of malpractice reform in the state.  One article is by the trial attorneys stating that reform would take the attorneys out of the med mal business, a highly unlikely scenario.  The trial attorneys are mobilizing for paying alot of money to the legislators to make sure there is no reform.  They have a problem since this is the first time the Republicans have control of the Legislature in quite a while.  The physicians have used their old and true argument that without reform more physicians will close up shop or reduce their scope of practice.  About 100 OBs in the state will soon stop their practices according tot he Georgia OB GYN Society.     Top


See "Hospitals" for an article on physician ownership of hospitals.

Most physician in the country have increased their patient load but only 1/3 have increased their revenue. 1/3 said even though they increased their patients their revenue decreased. Most physicians state they need more training in finances.  

In a fascinating study the VHA stated that disruptive behavior in nurses was commonplace.  About 68% of nurses and 47% of physicians have witnessed disruptive behavior among nurses and by nurses directed at other hospital staff.  This study did not include physician disruptive behavior as defined by inappropriate behavior, confrontation or conflict, ranging from verbal abuse to physical and sexual harassment.        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.