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Dallas Regional Hospital in Texas, is receiving terrible publicity due to its firing of three nurses who complained about the poor quality of patient care. During a recent night shift in the hospital's ICU, each of the nurses refused to take on a third patient. Almost all hospitals use either a 1:1 or at most a 1:2 ratio in this high intensity area. The hospital is trying to justify its actions but to date has been unsuccessful in overcoming the perception or reality of money over quality. The nurses are gathering support from the community.
Carilion Clinic in Roanoke, Virginia, is having a major problem. The Clinic is attempting to open a new medical school and have its five hospitals staffed by faculty. They are recruiting specialists at the expense of the independent physicians. The hospital radiologists have left to go to the competition as did a major eye group. A third group (internists) have also now received privileges at the competitor but to date have not left Carillon. More defections are either complete or in the offing. Now that the problems are becoming public, the hospital will be under more political and consumer pressure. The hospital states that it will remain an open staff hospital but all Department Chairs will be the hospital's paid physicians. The independent physicians have not believed the hospital's claims that it will be open and the hospital could end up with no independent staff or their patients.
Some hospitals are using computers to get money either in advance of elective admissions or immediately post treatment. What the hospitals are after are usually the copays.
Atlanta may be in for some medical problems. Grady Hospital, a political hospital in the city is in desperate financial distress. If it closes the other hospitals in the city will get the uninsured and Medicaid patients that now go to Grady. It is expected to lose $197 million this year. It has lost money in every year since 2000. The hospital will probably not be able to raise the necessary money to stay in business as the money people will not lend to government agencies. They need to consider moving to a different form of governance to get fees as well as loans.
The Southwestern Vermont Medical Center in Bennington, Vermont had to shut its OB service on weekends. The hospital lacks the necessary pediatricians to cover the hospital in case of a emergency birth. This shortage will last until at least September or October when a new pediatrician is expected and be able to be licensed.
Kaiser is again in the news for its not being forthright with anyone. The IT department still has problems being up and running only slightly over 95% of the time. The CEO Halverson states his pet peeve is people who are duplicit. He is the worst offender. It is he who continues to praise the terrible EMR system at the HMO. He is and was in charge of the organization that continues to not care about complaints by the members which will lead to more fines by the Department of Managed Health. It is his leadership that stonewalled at all phases of of the transplant investigation. Top
TO ALL PHYSICIANS: BE CAREFUL
A company recently had a telephone conference attended by hospital personnel
entitled "Disruptive Physicians and How to Deal with it." The
"expert" giving the conference defined disruptive behavior broadly to
the extreme. He included such things as unwillingness to adhere to
practice policies; constant tardiness, disorganized and unable to maintain a
schedule; unprofessional appearance (whatever that is) or demeanor or poor
bedside manner; unwillingness to see a full patient load, help in a pinch
or assume responsibility; clinical "laziness"-not interested in
keeping up on advances in the field, stubborn, inflexible; argumentative;
complaining to patients, staff physicians outside of the group about internal
matters; using critical derogatory or crude language; inappropriate expressions
of anger resentment moodiness or irritability; threats of legal action directed
at staff partners or patients; unethical behavior. These are so vague as
to invalid on their face. However there will always be someone who will
believe people who espouse their own beliefs, even if wrong. I would
advise anyone in a position of power in a medical staff or practice to look at
their bylaws with an attorney not affiliated with the hospital or practice to
make sure the individual's rights are protected.
The Country's Community Health Centers are having major problems with staffing. Almost all Centers are short physicians, nurses and especially dentists. The typical physician who works at one of these Centers is either foreign (allowing then to stay for an extra three years) or just out of training (repayment of loans), so inexperienced. Throwing more money may help some but a more creative solution may be in utilizing part time physicians and dentists that are either near or at retirement. Top
A study has shown that the vets returning from Iraq or Afghanistan lack VA benefits or health insurance. This is about 1.8 million vets under age 65. The study was done by a Harvard Professor known for her advocacy of government universal health insurance. The Congress thinks that there may be a connection between her advocacy and her study. The Democrats like the idea of opening up the VA to those without service connected disabilities and the Republicans want to make sure the vets with service connected disabilities are cared for first.
A letter to the editor in the Wall Street Journal by an ex CMS physician advisor tells of the evils of fee for service Medicare treatments. His main contention is that the patient is seeing too many specialists and therefore getting fragmented care. He blames this on the way payments are made. This is nonsense. No physician refers a patient to another physician so that the other physician can make money. The referral is made because the primary care physician needs help in the management of the patient's disease process. He recommends the patient should be taken care of in the "medical home" with the help of a few trusted referral sources. I have worked in the fee for service arena as a referred to physician and as a referred out physician to other specialists or primary care physicians. I have also worked in the "medical home" setting of Kaiser. In both settings patients were referred only when necessary. The only difference was the referral went smoother and quicker in the fee for service arena. One must also remember that Medicare pays about 19% more for Medicare HMO than fee for service.
The Northeast HMO's are looking to increase their premiums by an average of 10.7% for 2008. This is what they are asking but this will be decreased via negotiations and raising co-pays. Nationally the HMOs are going for a 14% raise and hoping to get 10%. 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.