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Physicians to Get Antitrust Exemption
New Jersey is to be the third state to grant physicians immunity from antitrust. The final vote and the governor signature is all that remains. The state health plan organization is using the usual scare tactics (they're scared). They believe it is un-American for physicians to do this dastardly thing at a time of recession and increasing health costs. They don't say the exemption is needed due to their own negligence of over assertion of their power. The plans do not allow any bargaining with physicians by using "take it or leave it" contracts. The bill would allow physicians to discuss fees, group and hire negotiators for fees and other non-economic terms. The problem is the insurers have the right not to participate in the negotiations but the physicians have no right to combine to reduce or not provide services. The other two states, Texas and Washington, that have the law have seen almost no negotiations due to the insurers refusal to bargain. The difference in this law is there are no fixed percentage of physicians that can get together. In Texas the maximum is 10% of an areas physicians may get together to negotiate. This may be a hollow victory, but time will tell. Top
The French general practitioners called a four day strike over Christmas that sent hundreds to the country's emergency rooms. They want higher wages. Another strike happened over New Year's. In a typical bureaucratic response the Labor Minster has said the grievances should be discussed with administrators of the country's health system. If the United States ever gets national health I can see this happening frequently. I remember many years ago as a resident and member of the resident's committee at Cook County Hospital the Board of Supervisors would not discuss grievances with the residents. The residents refused to discharge anyone and after the hospital filled, all patients had to go to private hospitals. The Board listened and responded within one week. Top
The Los Angeles Times editorializes that HMOs are in a blitz to undermine the California Department of Managed Care's authority. Their modus is to sue the Department and it's leader. This, they hope will keep them busy and off the HMOs backs. The newest suit is to stop the independent medical review by the department. It is the paper's view that these independent reviews help the patient by having an unbiased opinion and help the HMOs by cutting back on law suits and shield them from future suits due to following the prior decisions. It should be noted that Governor Davis has announced that since the creation of the Department last year about 20,000 patients were helped. This includes all the people who called an the problem was handled on the phone. The state has actually conducted 549 independent reviews and upheld the plan almost 2/3 of the time.
In an OP/ED piece Jamie Court, the director, of the Foundation for Taxpayer and Consumer Rights believes the non-HMO players in the healthcare equation should consider clear government oversight of the process, not the current four separate agencies. The next idea of Court is to push preventive care and not be pennywise and pound foolish, which HMOs are currently. The third idea of Court is to have the state approve any changes of healthcare premiums as they do with auto and home insurance. Court's last point is to have employers as the true payors to become much more involved in system reform.
Aetna and Tomball Hospital in Houston have gone their separate ways. This affects over 300,000 people. Aetna states the decision was mutual but the hospital states it was due to the HMO bundling charges and then deciding unilaterally which claims to pay.
Ohio HMOs dropped almost 200,000 from their roles in the past 18 months,45% from the commercial side. They also lost $66 million in the same 18 months. This has led to two years of double digit rate hikes. The number of HMOs in Ohio taking Medicare has dropped from 19 two years ago to almost none today.
Florida is starting to look at whether the state's 24 HMOs are paying in a timely manner. The Florida law is to pay clean claims within 35 days. The Department of Insurance took 100 claims from each HMO not paid in the 35 day period and asked for a written report as to the cause of the tardiness. These reports from the HMOs were due on January 8, 2002. The current law also requires a 10% per annum interest on all late payments.
A recent article has stated that Kansas is now facing the loss of Medicare HMOs due to funding. Two of the largest Medicare HMOs in the state have stopped their coverage at the end of 2001. One of the executives for one one of the exiting HMOs state that the seniors still can go to Medicare with a Medigap policy, but this is not as good for seniors. What he did not state is that HMO medicine is not a right and not an entitlement. If the Congress deems not to increase payment to continue to give items not covered by Medicare that is their prerogative. It should be noted that many Medicare Medigap policies do provide some or all pharmacy benefits.
The USA Today has a story regarding giving the people the right to choose the type of medical care they wish. This type plan gives the patient (no longer a consumer) the choice of deductibles. These are called "consumer-driven plans." They are akin to MSAs (Medical Savings Accounts). Some will even allow as MSAs do, the roll-over to the following year of any unused money. MSAs allow these moneys if not used to be invested into equities or bonds. The major insurers have seen the writing on the wall and are now starting to bring out their own plans in competition with those currently on the market. These plans will take the place of the fixed fee co-payment that devalues the amount of an medical encounter. Now the patient will again know how much they are paying, as they did in the pre-HMO days. This goes back to the argument of whether medical insurance is a right or a privilege and should all be equal. Top
Malpractice Insurance Premiums
Missouri is starting to feel the pain. Malpractice premiums have increased 400% in the past four years. For the coming year increases will be between 15 and 30%. Two companies with 13% of the business dropped out. They have no meaningful tort reform.
Arizona is to feel the pinch as St. Paul's exits that state. This will put more pressure on MICA which now insures 74% of the physicians and 38% of the hospitals in Arizona. The CEO of the physician's MICA states that some of the hikes are due to the under pricing in the past and the September 11 tragedy. The company is planning a single digit increase for the physicians and more for the hospitals.
In Pennsylvania, a crisis was averted due to a screw-up by a carrier. The carrier neglected to give the required two month notification of insurance cancellation. This means the crisis for these physicians will be delayed until March 1. For others the crisis will become acute on July 1 when their current emergency six month insurance with the expensive JUA expires. The Trial Lawyers believe the problem is with the carriers and not them. The physicians don't care who's problem is the cause. They do know the result. The Governor and legislature in this trial lawyer dominated state continue to sit on their hands. The Attorney General, however, has asked the Supreme Court to re-think their prior rulings on the subject. The Supreme Court of this state has twice struck down legislative tort reform. This included a strict limitation of non-economic awards, which is against the Pennsylvania Constitution. The court for some unexplained reason also turned down a requirement for certification of expert witnesses. The Court now has a Republican 4-3 majority, which makes it somewhat more unfriendly to the trial attorneys who support the Democrats. The private malpractice insurance carriers have been asked to refrain from collecting an insurance surcharge. The State fund has agreed to the delay.
West Virginia is back in the news. Commonwealth Medical Liability of Washington, DC, has been insuring more physicians in the state since St. Paul has dropped their entire malpractice line. They were, until the State Insurance Commission only allowed them a 20% increase in fees instead of the 40% they requested. Will they continue in the state? Time will tell.
Now Ohio is feeling the pinch. Depending on the area and specialty malpractice premiums have risen between 20% to 100%. My Gawd, some lobbyists are looking for tort reform! How novel!! This had passed several years ago but the State Supreme Court in 1999 declared jury judgment limits unconstitutional. Twenty seven companies write medical malpractice insurance in the state but 70% is in five companies. One of those, St. Paul, is getting out of the business.
Florida physicians are smarter than most. They are hosting an fund raiser for Gov. Bush. During the party, they will bend his ear regarding needed tort reform to decrease malpractice rates. Last year they were successful in obtaining a prohibition against forcing physicians to sign all products. These physicians are now learning to be politically active with their money. Hopefully, they can teach their brethren above how to do the same. Top
In Memorial Hospital of Maryville, Ohio, patients may order their own blood limited number of tests. These include glucose, cholesterol, pregnancy and drug use. It excludes HIV and venereal disease. The payment is when the test is requested and no insurance is billed. The problem is the patient choosing and interpreting the tests. Top
Palomar Medical Center in Escondido, CA, has multiple problems. There were two foreign bodies left in patients post-operatively which caused a state inspection. The inspection found over 40 problems with the hospital including unsterile conditions, patient confidentiality problems and physician recordkeeping. They will keep their Medicare licensure since all problems have either been corrected or have a plan of correction.
Palomar also is having a mutiny regarding its orthopedic surgeons participating in the trauma call. This has necessitated the closure of the trauma center on January 1, 2002. The Orthopods want a no gag clause, a guarantee by the hospital that they would pay any fine against any orthopedic physician for an EMTALA violation of not showing up on time and necessitating a transfer, a hospital clinic where follow-up care would be done and a higher per diem stipend. They have been offered $1,900 for weekdays and $2,700 per weekend day. The hospital is planning on putting a new contract on the table soon.
In San Jose, California the power and the back up generators failed at Good Samaritan Hospital. Workers eventually fixed the backup generator but not until a baby was delivered romantically, by flashlight.
It seems Kindred Hospital in Minnesota is having a problem. It is a long-term care hospital that takes patients that fall between acute hospital and nursing home care. A recent investigation found unlicensed personnel caring for patients and compromised patient's rights. The Medicare funding was to be removed but a recent plan of correction was submitted. This institution had problems in the past and is already under scrutiny by the feds. In September the feds found the last plan of correction not credible after three patient deaths. A rash of resignations of respiratory therapists resulted in the hiring of unlicensed therapists. JCAHO is also investigating the hospital. It does not seem to be the type of place I would want me or my family to be.
A medical student took old records from the Rapid City Hospital in South Dakota and put them in a trash can in convenience store in Wisconsin. They were spotted there by a newspaper editor who turned them over to the Associated Press who is planning to return the records of 125 psychiatric patients to the hospital. A faculty committee is working on any punishment for the student and the hospital is working on its obvious problems with privacy, which was the sentinel event.
Albany, New York area hospitals are hurting. Many have had to begin or continue to re-design their missions. If a program is good but is not making or losing money a decision needs to be made whether to continue to to drop the program. Some hospitals are even hiring private physicians to work and manage their in-house departments such as radiology or pathology. Some, such as Albany Medical Center, have dropped 100 physicians from its ranks of employed. They are starting to learn what other hospitals have learned; owning physicians is usually a money losing proposition. Top
An article in the LA Times showed that there is a problem with the reporting of malpractice claims to the Board. The State law states that only judgments need be reported. That means that all settlements and arbitrations do not need to be reported. The reporting is to be done by either the Clerk of the Court or the insurance company who pays out money on behalf of the physician. There was an editorial in the San Francisco Chronicle roiling over the fact that about 1/3 of the complaints against physicians are not on the web site. They do not differentiate between claims and final decisions. The paper is still on the kick of the public's right to know and the right of the accused and exonerated physician be damned. Top
The New York Times ran an article about paying advocates to make sure patients get the care they deserve. There are several companies in the country that focus on patient rights and advocacy. These companies work with patients for a set fee or percentage of the reimbursement amount. These companies are taking the place of the usual role of the over-worked physician as a patient advocate. These organizations should be the court of last result before suing the company. The patient should do most of the work first by going to their employer HR Departments and also the organization patient advocate, if one exists. Some of the private companies are founded by patients who got the managed care run around themselves. This type of advocacy does not need an attorney but it does need someone to empower the patient and who knows the correct steps to take. If this does not work then an attorney for patient advocacy should be contacted. Yes, I do that. Top
Government Not Collecting Money Owed
The GAO has chastised CMS for not collecting over all the money due them for fines and fraud settlements. The amount is in the hundreds of millions of dollars. Does this surprise anyone? The GAO also stated that the accounting of the moneys owed was in such a shambles that they could not tell if any of the money went to other agencies instead of CMS. The CMS stated that the OIG and Justice do not give them an accounting. This is another good example of how everyone knows everything at all times, right hand-left hand scenarios. Top
JCAHO Accreditation Meaningless
In an article the Wall Street Journal states that accreditation is a poor predictor of good quality. This is something that all those who have undergone JCAHO scrutiny for their own non-patient care standards have known. The JCAHO for some reason (monetary?) disagrees with the study by the University of Michigan School of Public Health that appears in the Journal Quality Management in Health Care. In 1999 the OIG has questioned the JCAHO's inability to detect substandard care. Isn't it time that those hospitals that truly want to break free do so by going to either the free State Department of Health or the less intrusive American Osteopathic Association reviews. 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.