January 15, 2007 Recent News



Peer Review


Starting in 2007, about 300 physicians belonging to Northeast Health System in suburban Boston found themselves without the patients in the largest network, Partners Healthcare) in the area.  The reason for the break is the Northeast physicians sending some patient away from Partners.  Northeast has signed contracts with the major insurers in the area.  The physicians are owned by the various systems.  Too bad for the physicians.

In Washington, D.C., the council has legislated that all providers will be required to report "adverse medical events" to a centralized database.  Physician will have to report any malpractice judgments or settlements from malpractice as well as disciplinary actions within 60 days.  Healthcare providers will have to do the same for any providers that they employ.  The main problem for hospitals is the definition of "adverse events".  The law states that this means the anything that involves a death or an unanticipated injury to a patient.  This happens to be the same definition as Jayco has.  Public Citizen doesn't care about quality or anything except raw numbers of physicians disciplined, is for the new law.  That alone is a good reason to be against the law. 

JAMA has an article regarding hospital performance measures for heart failure.  The authors reiterate what many have already stated, performance measures do not reflect quality of care.  There are five performance measures developed by the American College of Cardiology and the American Heart Association.  These did not include the use of beta blockers.  The study by UCLA found that the four had no influence on death rates or hospital readmission within 90 days.  Beta blocker use, not included in the performance measures, was highly predictive of death or readmission in that time frame. 

Medicare has decided to treat radiology as they do surgery.  If you do multiple procedures at the same time you will get less for the additional procedures.  Now Highmark blue Cross blue Shield has decided to follow suit.  I hope the physicians and hospitals are prepared for the decrease in the technical component of the procedures.

Speaking of radiology, the HMOs of Minnesota are now requiring second opinions prior to the ordering of the expensive CT or MRI scans.  The reason for this is the proliferation of radiology owned scanners.  The second opinion must be from the hired gun of the HMO who will probably be paid a bonus for the scans disallowed.  In the HMO Medica the hired gun does not have to be a physician.  It is back to the clerk evaluating the physician. The other HMOs at least have the consultant be a physician and the treating physician still has the final say.  In a Medica trial they found that physicians did not order MRIs for back pain and instead treated the patients with anti inflammatory drugs.  This only means that the tests will be delayed but will still be done.   

Oregon has a shortage of physicians to take call.  About half of all EDs in the state have no 24/7/365 coverage in at least one specialty.  At least 13% of the trauma centers have been downgraded due to lack of physicians.  Even paying a small stipend has not helped.  Maybe paying a larger one would.   

Oregon is not alone.  In the Jefferson and Shelby counties of Alabama there are about 30 neurosurgeons in practice.  On weekends there are only three or four. This area includes about one million people and the city of Birmingham.  Many of the neurosurgeons have limited their practices due to liability concerns.  In the Birmingham area there are some weekends when there is no one on duty that does craniotomies.  The other reason is some hospitals do not do trauma and some do not do emergency stroke care.  Some hospitals have attempted to pay but even that does no good.  If the physicians are not doing brain surgery as part of their privileges or liability coverage, they will not do it after hours.       Top


Kaiser has spoken through the side of its mouth again.  An article in the LA Times states that Kaiser is working with state regulators to develop standards to protect individuals from unfair retro cancellations of insurance.  Kaiser, along with the Blues, have already been chastised for this practice.  Kaiser was fined $100,000 for its shabby treatment of a member.  Kaiser now wants insurers to check with the insureds before deciding to rescind a health policy.  This is the policy recommended by consumer advocates.  The Blues are fighting a losing battle against the thought of being consumer friendly.  

CMS reports that health spending was slower in 2005. This includes all aspects of spending for all services and by all payors.  the only ones with the same or greater rate of spending was hospitals.  

California health insurers are refusing to cover some individual patients because they are either in the wrong occupation or are taking the wrong medicines.  Those that take expensive meds like Celebrex or Allegra may be rejected.  Also rejected are those in pro sports, roofers, dock workers migrant workers or firefighters.  The insurers are Blue Shield, PacifiCare and Health Net. Kaiser is also in the same pond.  The reason is that these people utilize more services or expensive meds and raise premiums for all.  If the premium goes up too far the Department will look at he reason and might find out the salaries of the executives are keeping pace with the premiums.  The insurers cherry picking days may be over as the Governor's new requested health plan prohibits it at least for the employers or those in the proposed new health plan.

If you aren't influential you are nothing.  The Massachusetts' Hospital Association fired its president for not having enough clout with the legislature.  They compared the anemic effort of the MHA to the pull of the Partners Healthcare Chairperson.   

USC had significant problems with its liver transplant program.  They now have changed how they select recipients for a new liver.  The reason for the change was the poor percentage of survivors when they took all comers.  By only taking "good" patients the percentage of survivors should increase. 

In the 35 years since I left Cook County Hospital it has not changed.  It is still run by inefficient political hacks.  The hospital is in financial trouble due to the negligence of these hacks.  They have not billed patients for about $250 million in the past year.  This means that the new budget by the county will remove over $180 million from the healthcare budget.  The major political Chicago hacks like Jesse and Obama don't want to take on the Cook County political hacks.  They need the machine.          Top

Peer Review

The AAPS reports that a new type of peer review has occurred.  A community has peer reviewed a hospital.  In Beeville, Texas, the community looked at Christus Spohn System.  The reason was the system's inability to recruit and retain physicians.  The only general surgeon at the hospital left after 20 years stating he was afraid of being labeled a disruptive physician for raising patient care issues.  One of the hospital advisory board members stated that "sham peer review" was indicated in certain instances.  The COO of the hospital was forced to resign. 

In a fascinating article on Medscape on 1/9/07, a pharmacist tells his story of sham peer review for whistleblowing on the VA system.  He eventually won but not without significant expense both monetarily and emotionally. The VA was using their patients as guinea pigs without consent. It took many years to change the system due to the money involved.        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.