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Dr. Debi Thomas, the prior skating world champion and now orthopedic surgeon, was a booster of Drew/King has now gone after the LA County Board of Stupes and the hospital administrators. She stated that there are policies in place that cause the delivery of bad care. She blasted the administrative policy for cutting ORs to two and the number of overnight anesthesiologists to one. This creates dangerous backlogs for patients. The hospital administrator stated Dr. Thomas was not committed and was glad she was leaving. Dr. Thomas is not the only one who doesn't like the administrators at the countries worst hospital. Dr. Roberta Bruni quit her post recently over the administrations "witch hunt" to silence critics who are considered "enemies of progress." With administrators like this, is it any wonder that some hospitals and medical staffs can not get along?
The national United Network for Organ Sharing said they would not lift the sanctions against LA's St. Vincent Hospital but did agree with the plan to fix problems in their liver transplant program. This is the program that sold a liver to a Saudi national ahead of those on the list. The program is currently closed.
A new problem in California with transplants has come to light. The University of Southern California (USC) has been found to have one of the highest post liver transplant death rates in the country. Their death rate is about twice the expected number. The low rate of success puts the program at odds with the potential for funding by Medicare or Medicaid.
In Pennsylvania and Wisconsin, there seems to be a major shift in the hospital population from the city to the suburbs. This is causing the urban hospitals to want more money from Medicaid since they can't cost shift to other payors as easily as they did in the past. This has some of the same sound as the community hospitals being jealous of their specialty hospital competitors.
The AHA publication Trendwatch's July edition spotlights the change from the antiquated hospital to the more modern outpatient setting and the AHA's concern that regulation has not kept up. This is really a call to arms to get the regulators to do what hospitals can't, stop the competition. The article starts with the fact that procedures done outside the hospital setting in less expensive and nicer surrounding is on the increase. The total volume of surgery has increased and so has the outpatient side with a lessening in the hospital side. It also states accurately that physician offices are doing more diagnostic testing. The article then shifts to the old hat of physician self referral instead of looking at itself as the culprit. It then talks about Medicare expressing concern about the amount it is paying to the outpatient centers. It leaves off how much more it would cost if the same procedures were done in the hospital setting. The article then discusses the lack of CON for ASCs. When one looks at their map, almost all the US except for the southeast has given up on CONs and let supply and demand take over. It then goes again into the physician self referral argument, as if owning a 1-3% share of a ASC would make any difference where a physician sent his/her patient. It does not discuss in detail the new paradigm of physicians having a life and wanting to do things on a timely basis. It shows a chart where Orthopods did a certain volume of surgery at a hospital and then in the first month after an ASC was opened the surgical volume went to almost zero. Would anyone be surprised that the physician and patient would want an outpatient procedure in a nice facility and done on time. It has been shown that the patient also has better recuperation when the procedure is done in a non-hospital setting. The article then goes on to complain about the quality and safety standards are different in ASC versus hospital outpatient departments. The reason is simple it is expected that some of the more complicated outpatient procedures are done in the hospital outpatient setting and they need higher standards. The article is even harder on surgeries done in physician's offices. This I agree with as there are some ersatz plastic surgeons that do their procedures without any emergency preparation thought and have harmed patients. The physician office surgery for those patients that require anything more than local anesthesia should be inspected and monitored as are ASCs. The article next addresses the poor full service hospital who is no longer able to provide on call support. The hospital does not need to provide on call support for specialties no longer practicing at the hospital such as plastic surgery. They can have transfer agreements but that would mean giving up revenue. If they really want that coverage, they can pay for it. Finally it tells the hospital constituents their marching orders as to what to tell legislators. It is a shame that the hospital never look to themselves as to the cause of the migration and what they can do to help their physicians work efficiently.
Interestingly, on July 11 CMS put out a memo regarding Medicare spending. It showed part A (hospital) spending was up a modest 3%. In Part B spending the physician component was up 7% in 2005. Much of the increase was the tossing out of the annual physician reduction in fees. The hospital outpatient component of Part B was up 8% and equaled the total physician component of the premium increase. This tosses water on hospital arguments that physicians are taking their patients.
In a move that may get him in trouble again, Dr. Irvin Krukenkamp, an associate professor of CV surgery at Stony Brook University Hospital, blew the whistle on patient safety at the institution. He believes there are safety concerns and he also believes in voicing them. He did the same thing several years ago after a child died and the University attempted to retaliate. He sued the University and won a $3.3 million verdict. Now he spoke out again after two more children died in the past several months. The hospital has been visited by the State and are correcting their deficiencies but refuse to acknowledge any errors and state that their outcomes are successful. This is typical for many university settings to deny, deny, deny. Look at the transplant fiascos. Top
Not only is the most expensive medical care in the People's Republic with their ivy tower medicine as detailed in the last issue but also Boston is the most expensive for pharmaceuticals for the uninsured. Top
In the People's Republic of Massachusetts, the hospitals are having a problem recruiting primary care physicians. The reason is that the insurance companies don't pay well for this service unless you are fortunately involved with a good pay for performance program. The other side is that the area is very high priced. To make matters worse, medical students have caught on and are not signing up for primary care specialties.
The worst medical board in the country continues to foster it's reputation. Texas has no statute of limitations for complaints to the Board so someone may wait many years before making a complaint. The Board then starts what it considers to be an investigation process but is nothing more than a kangaroo court. In the past year the Board has increased investigations by 500 and disciplinary action by almost double with the same amount of complaints. The Board got more money in 2003 to enforce standard of care violations. This is a self full filling prophecy. As there are more investigators, more unworthy complaints will be investigated and then the Board will need more money for more investigators to investigate more nonsensical complaints.
North Carolina has been criticized for being lax on physicians. A new bill passed by the legislature and needs to be signed allows punishment of the physician without the consent of the physician. There can be multiple different levels of punishment from fines to removal. The prior law only allowed suspension or removal of the license if the physician consented or a lengthy trial. That trial will still take place but after the Board has acted.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.