The Corpus Christi, Texas hospitals have decreased the amount of malpractice liability insurance that the physicians need to be on staff. With the growing crisis in the ability to get adequate insurance at a reasonable cost, the hospitals did not want to see their physicians leaving. The requirement is now $100,000/$300,000, half of what it was. Humana also lowered its requirements to match the hospital's. The physicians also believe that if the insurance is lower, the attorneys will not sue as readily. That may or may not be true. I certainly would recommend that the physicians protect their personal assets by incorporating.
Physicians in Jackson County, Mississippi have joined forces with the labor unions to form a consortium for tort reform. They intend to use informational pickets to promote the state crisis. Last year Mississippi lost 10% of its physicians.
The Nevada Medical Association states that the number of physicians in the state who will be leaving or otherwise closing their practice is now 117. The problem is that the medical association only represents about 23% of the state's physicians.
Another trauma surgeon, the third, has quit in Las Vegas due to malpractice payments. In June six of the remaining 10 trauma surgeons expect to lose their medical malpractice insurance. The University Medical Center trauma service will have to close if they can not get the support of the surgical specialists.
The Nevada Governor realizes there is a problem in his state. He continues to attempt to lower the costs of malpractice insurance for the physicians. He is now offering to cover the physician's tail insurance that needed to be paid to the prior insurance company. He is doing this by a process as buying your nose. The doctor pays a higher than normal fee to the new carrier which will cover past acts. He also supports the $250,000 cap on pain and suffering. He also, when asked who he blames for the crisis, stated he blames the managed care insurers for keeping fees too low and St. Paul Insurance who by leaving the state (and the nation) precipitated the crisis. He has ordered the state to sue St. Paul for unfair business practices. The Governor also has changed the new state insurance to have all OBs pay the same rate. Originally it was a tiered rate depending on how many babies one delivered.
Thomas Jefferson University is dropping 270 positions due to the high malpractice rates. They received a bill for a $16 million increase this year and expect to go to $50 million next year for the hospital and physicians. They will also stop delivering babies and having pre-natal care at one of their hospitals.
Memorial, South Broward County, Florida's county hospital, will stop requiring malpractice insurance for its physicians. This is a one year moratorium and requires in lieu of insurance the ability to cover a $250,000 judgment. This was the last hospital in the county to require malpractice insurance.
The largest malpractice insurer in West Virginia requests a 22% raise. The major question is what will happen if they do not get it.
I believe by now most legislators not funded by the Trial Lawyers and the physicians understand that California has the best tort reform in the nation. A consumer rights group that believes in plaintiffs getting alot of money has issued a study that California tort reform has not decreased the amount of malpractice insurance. They state that the premium has grown 3.5% over the ten years from 1991 to 2000. Of course the group does not mention the $40,000 less premium that specialists pay in Los Angeles than in Dade County, Long Island or Wayne County. The way the group figured out the amount was to take the number of licensed physicians in California and divide by the total amount paid to insurance companies. This came to an average of $7200. How many physicians in the US would love to pay only that much and not over $100,000 for insurance? Watch out for the lackeys of the Trail Lawyers!
The town of Ocean Springs, Mississippi is losing their OBs. The physician's malpractice carrier is pulling out of the state and leaving them with a large tail to pay plus finding new and probably more expensive coverage. This would close the new OB wing at the local hospital where the four doctors admit about 60 cases per month.
There is a God! Blue Cross of North Carolina has dropped the health insurance for professional associations which include ministers, architects and of course attorneys. This means 5000 attorneys will be without insurance. Blue Cross was the only insurer in the state for these groups. The associations will be switched to the more costly small group plans with less benefits. The ministers are upset about the raise in fees and less benefits. It was a rude awakening for them to actually be confronted with what is happening in their community. Top
Who says rationing doesn't pay? Kaiser paid more money to those call center clerks who make the fewest physician appointments and spent the fewest time per call. From January 2000 to December 2001 those clerks that only did appointments of 15-35% of the calls and spent less than an average of three minutes 45 seconds on a call could earn bonuses of up to 10%. Kaiser has since dropped the program since it found significant frustration of its members in not being able to get timely appointments. Kaiser stated that this wasn't a bonus for rationing care but only to reward good service. I doubt if anyone believes the spin doctor on that one. The California Nurses Union believes that clerks should not be evaluating the symptoms and making decisions on when to make appointments. The Department of Managed Care is now investigating the practice. The Kaiser spin person states Kaiser does not know of any state investigation.
Kaiser was fined $1 million by the California Department of Managed Care for systematic poor emergency room care that led to several deaths. The fine was appealed to an administrative law judge who stated the Department had no jurisdiction over physician care but only health care finances. The Department overrode the decision, which was its right. Kaiser now has the choice of paying the fine or appealing it to the court system where the decision can not be overruled by the Department. If they do and lose, the HMO industry would be bound by the decision.
Enrollment in Florida HMOs continues the national decline. The HMOs went from 32% to 29% of the state's population. This is a drop of almost 10%. This statistic is misleading since it represents a fast growth of population and not a decrease in actual numbers of people enrolled in HMOs. The actual numbers enrolled increased by 200,000.
Blue Cross of California has dropped its controversial tiered hospital policy. The policy is still present with PacifiCare and Blue Shield. This, of course, has to do with wanting to keep contracts and the lack of quality involved in the decision making policy. What Blue Cross will do is to place icons in their directory to tell the public how expensive each hospital is compared to Blue Cross' standard. Since a PPO consumer will pay 20% of charges, this may make a difference as to what hospital they pick. Of course, the physicians may have some say as to what hospital the patient goes.
God love the People's Republic of Massachusetts. The HMO industry certainly doesn't. In the past six months the legislature has passed five new insurance mandates. There are an additional 44 pending in the legislature. Recently, a mandate was passed to pay for chiropractic services. That will add 4% to the premiums. Prior, a law was passed to require a developmental educator for coordination of services. The legislature did not look at that this was already being done in the Special Ed classes. There can be only so much social programs enacted by the People's republic before their social agenda folds in on itself.
The LA Times has reported on the increasing demise of medical IPAs in California. Nobody is sure how many medical groups are left with HMO contracts. The issue is if there were too many medical groups and this is the survival of the fittest. If so, then it is good. If the lessening of the groups is one that will continue because of meager reimbursements, then it is bad. If the lessening of the groups means stronger negotiating power by the remaining groups with the HMOs, then it is good. If the lessening of the medical groups means the culling of physicians, then it is bad. The HMOs are beginning to deal directly with the physicians in order to bypass the administrative IPA overhead. That is good for the physician and patient who can now keep their own primary physician, but what will happen in the future? Will the HMOs begin to shove the administrat9ve burden onto the individual physician? What will happen to the clinical pathways?
In another LA Times article, the paper reports the California Department of Managed Care is about to publish new HMO requirements. One of the new rules will be for the HMOs to disclose their fee rates for individual procedures or services. The Department is also attempting to stop the lying by the HMOs regarding incomplete information and illegal bundling in order to stall a claim or pay less than due. This will give the provider an easier opportunity to challenge the HMO ruling. The new rules will have a comment period and will go into effect in the fall. I might suggest the Department offer a rule like Texas, the HMO pays 85% of the rate billed until the dispute is settled.
Lifeguard, a HMO that only pays on a fee for service basis, based in San Jose, California will become an independent subsidiary of Blue Shield of California. Interestingly, CalPERS dropped Lifeguard several years ago and now has made a deal with Blue Shield to be one of their insurers of choice. What goes around comes around.
The Mayo Clinic is quitting the HMO business. It has already dropped its Minnesota and Florida HMOs. One month after unequivocally stating it will not pull out of Arizona, it is.
Georgia continues to fine errant insurers. The Insurance Commissioner fined Prudential $100,000, Blue Cross/Shield $91,000, Cigna $80,000, Blue Cross/Shield HMO $44,000, Aetna $50,000 and Coventry $10,000. These were for non-compliance with the state's prompt payment law. Top
Several weeks ago a law suit was filed regarding the matching program. Now, Yale has been stripped of its surgical program unless it changes residents conditions of employment. Yale promises to spend $1 million for resident support staff. Boston hospitals have also seen the light and are beginning to plan for a decrease in the hours residents work. New York has a law limiting residents working hours.
As a corollary to the above, a recent article in the Cincinnati Business Courier states residents are gravitating to those areas that allow more planned family time, like Emergency Medicine. The trend is for more anesthesiology, physical medicine and radiology and away from surgery and other primary care specialties. Top
Several months ago there was an article involving the Cincinnati area physicians leaving or not coming to the area. This was due to the low reimbursements in the area. The insurers now refute this since they have not seen complaints from subscribers not being able to obtain care. The insurers state that whatever problem exists are part of a national problem and not their low payment schedule in the area. However, they have just increased payments to specialists. Top
In a recent study about 40% of responding hospitals reported that at least some specialists were refusing to to be on-call for ED coverage. The study by the Governance Institute stated that most hospitals rely on voluntary back-up and that 43% pay a daily stipend of between $400-$1,120. I happen to know of one hospital that pays $1500 per day to the neurosurgeons for call. Top
The US Preventative Task Force has requested that physicians screen all patients for depression. This entails two questions (1) Over the past two weeks, have you felt down, depressed or hopeless and (2) Over the past two weeks, have you felt little interest or pleasure in doing things? If the reply is yes then the doctors are asked to follow u with written or oral questionnaires. There then needs to be medication and/or therapy with a follow-up in two weeks if the patient doesn't show up. With managed care and the need to see a patient every few minutes how is this to happen? How are the physicians expected to answer their own questionnaire? Do you know many physicians who are not depressed and should be on medication using the above definitions? Top
Medical Service Accounts (MSA) are health insurance plans enacted by Congress as a alternative to the other current health plans available. What this does is allows an individual self employed or working for a company with less than 50 workers to deposit 75% of the deductible into a tax deferred account. If the person needs the money during the first year he/she may withdraw it tax free to pay the bill. If not used, it is allowed to ride and build up equity which can be invested. One also has a large deductible insurance policy above the plan money. You know it has to have merit if Sen. Kennedy is against it. I have had this for several years and have had no complaints. I have used some of the money and tax deducted and invested the remainder. The large deductible policy is also income tax deductible. By allowing the individual to determine how the money is spent, it empowers the person to look at the health care expenditures. Top
In a great program, the medical societies of two counties have started a Physician Preceptor Program. They invite the legislators and the regulators to see first hand what happens to the physicians when they pass a new law or regulation. There are currently a half dozen of these around the country. Top
The People's Republic of Massachusetts employers are pushing for a web site to rank hospitals in quality. There is a push for a release of quality information in August. The information requested is the ordering of medication on a special computer system, the use of intensivists and referral to specialty hospitals to do the high risk procedures. The employers are asking the hospitals to voluntarily report. Some hospitals have refused to cooperate. Most of those not cooperating are the community hospitals which do not have the financial resources that the major Boston hospitals command. This all goes back to the flawed IOM report regarding medical errors. Top
The AMA continues to lose their constituents. They lost 4% of its members representing 6% of its revenue in the past year. It also lost revenue from lack of advertising by 7%. It has compensated for this by lowering costs. Hopefully, they soon will wake up to the fact that the specialty societies represent their physicians better than a central agency. Top
Washington Hospital in San Jose, California is putting in tracking devices for nurses. This means the administration will be able to see how long the nurse spends with a patient, how long it takes to answer a room call and how long the breaks are. The management thinks it will make it easier to know where a nurse is, instead of running up and down halls. Each nurse would be wearing a tracker badge. It's two o'clock, do you know where your nurse is?
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.