Florida continues to be a mess. In central Florida there are very few neurosurgeons and more are changing their practice patterns to back surgery. The reason is the malpractice premiums. Apparently, a neurosurgeon will be sued every 1-2 years in the state and with the new propositions that just passed where after the third judgment (not settlement) , the person may lose their license. This means not many people are willing to take chances and even fewer are willing to come into the state. In the past year, 1/6 of the neurosurgeons in the greater Orlando area have quit. Many of the others have significantly changed their practices. More than half of the state's counties have no neurosurgeon and none on the way. There are about 350 neurosurgeons retiring in the country per year and only 100 being trained. The law of supply and demand is not working due to the external forces.
In a story the New York Times has stated that it's not the totality of the awards nor the number of claims that has caused the massive rise in med mal premiums but the problem of the insurances companies playing catch-up when their investments went down the tubes. The story ends with the California experience of lower premiums is a combination of the tort reform of 1975 plus the law passed in 1988 that prohibits raising of premiums over 15% without public hearings. I know that from the time of 1975 when I joined one of the new physician med mal companies I had minimal increases in my premiums. From 1975 until I quit my practice in 1997 my premiums had about doubled. Not bad for 22 years. Top
I can't believe they are smart enough. The Drew/King Hospital finally passed an inspection by the feds on how to handle psychiatric patients without Tasers. This inspection will allow the hospital to continue to receive federal funds even though it had it's JCAHO status removed. I bet if they had a surprise inspection next month, they would not pass.
How do you resolve the dilemma? A 82 year old woman with no viable home who is competent to make decisions was discharged from Kaiser San Rafael, California. That was about one year ago. She refuses to leave. She has sued the nursing home she was at prior to being in the hospital and as such will not go back to it. Also, the nursing home no longer accepts Kaiser patients. She is on no meds and requires no medical care. The hospital is not getting reimbursed for any of their inflated $1 million in "costs". She has no money so, although they have sued her, they will collect nothing. They have gotten an eviction notice but since the patient is bed bound, they will not enforce it. The patient refuses to leave Marin County where she has lived her whole life. The hospital has removed he television set and does not provide her with newspapers as it does the other patients. The patient spends her days in bed reading and looking out the window.
The President of the North Carolina Hospital Association wants all the in-house attorneys to drop out of the voluntary North Carolina bar. This came after the Bar Association stated that malpractice was not a problem in the state. This is not the mandated State Bar Association.
In a study funded by the AHA, it should come as no surprise that specialty hospitals are harming community hospitals. The AHA will present these biased findings to Congress to attempt to persuade them to continue the moratorium on specialty hospitals with which community hospitals cannot compete in quality. Remember who funded the project and it is a good rule to remember that whoever pays the bill gets what they want in the report.
In Wisconsin, the legislature is having a hearing on March 1 on a moratorium on hospital construction. This is for all hospitals and not specialty hospitals. The reason is the possibility that more hospitals mean higher costs.
In Oregon the Providence St. Peter Hospital in Olympia has sold its outpatient surgery business to its physicians. The real estate would remain with the hospital. The reason for it is that the hospital outpatient business is fallen because of not doing this sooner and the physicians building their own centers. In one of the good things, the union employees of the hospital surgery center will now have to compete for the non union jobs at the physician owned facility.
Taking a page out of the book of CalPERS, a coalition of healthcare unions are also looking at hospitals to reduce costs and increase quality. Of course, no one believes that they really care about quality, only costs. The coalition is going after Sutter as the poster child for cost cutting. I wonder if it's just a coincidence that Sutter will not sign a contract with the labor unions. Sutter is in the ballpark with other hospitals and below the costs at Tenet.
In Florida, a small hospital has been banned by the state from accepting any more patients. The Gulf Pines Hospital is a 45 bed hospital now with six patients. There are three physicians and no radiologist.
Although not really hospitals there are less mammography clinics available to women now and there will be less facilities in the future. The reason is the small reimbursements to those reading the films and the high malpractice rate for the same physicians. Also there are fewer that are taking the necessary specialization necessary to read the mammograms. This leads to very long wait times for routine screening mammograms, up to six months. Top
In an extremely controversial report in the Annals of Internal Medicine the authors from Harvard Pilgrim Health Care state that younger physicians provide better healthcare than older physicians (over 40). This premise is based on the younger clinicians practicing protocol based medicine more frequently than the older physician. The older physician, the authors state, are less accepting of protocols. This is reasonable since as we all know, the "evidence based protocols" seem to change on a routine basis as those who make up these protocols get more experience. It is the experience that the younger physician does not have and so needs to follow the protocol. I will acknowledge that the younger physician is more knowledgeable of the newer medications than the older physician. I will also acknowledge that while the new medications may be better, they also seem to be the cause of product recalls and major law suits. The studies state that the older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care and may also have poorer patient outcomes. They state that as one ages there is a negative association between knowledge and experience. I believe this study needs to be studied in an non-academic environment where 99% of the medicine in the United States is practiced.
A study by the AMGA has shown in the major medical groups of over 50 physicians have an turnover rate of about 9% per annum. The cost of recruiting a new physician is about $3000 per year. Since physicians are becoming a scarce commodity in several specialties, this is a cause of concern. One of the main ways to retain physicians is to be honest with them upfront regarding income and other like factors.
Nine pediatric gastroenterologists have left Tufts for greener pastures for Mass. General. this is after Mass. general lost to Tufts in acquiring Children's Hospital. Tufts is thinking about but won't file suit to keep the physicians. They won't since that would set up a war where all the other hospitals will do the same against the weak Tufts.
The infertility physicians in Seattle are leaving their hospitals and opening up their own facilities. This will leave the lucrative market to the physicians who wish to control their own finances and services and to profit for their abilities. This change has occurred due the much greater odds of fertility now with IVF than in prior times. The hospitals are recruiting new fertility physicians but will have to go against the established physicians. Top
A twenty-eight year old man who needed a kidney transplant was rejected from a compatible volunteer donor. It turns out he was too smart for his own good. He originally lived in New York and was near the bottom of the transplant list. He found out his chances for a transplant were greater in the South East so moved to Florida. He met and made friends with someone who turned out to be a compatible donor and who was willing to donate one of his kidneys. The transplant was set up and ready to go. Then the organization found out about a web site the man had set up looking for transplants. This was a no no for the organization and they stopped the transplant. The web site had nothing to do with the friendship nor the meeting of the prospective donor and the recipient. The man now remains at the bottom of the list and the potential kidney will not be donated. This is a lose-lose situation. Top
The Advisory Board to the FDA on the Cox-2 agents had 32 people. Of the thirty, ten had some prior experience with the industry as consultants. These ten voted 9-1 in favor of allowing Vioxx back on the market and the keeping of Bextra on the market. If they would not have voted both of those measures would not have passed. The Committee voted 31-1 for allowing Celebrex to remain. There has been criticism for allowing those people with prior ties to the industry to partake in the discussions and voting on medications. In reality, almost all the people with the knowledge of the drugs have had prior business dealings with Pharma. It would be impossible to get a knowledgeable committee together without there being some conflicts. However, those with conflicts should be recognized as such. Top
In Illinois, as in the rest of the country, the HMO experiment is either dying or moribund. In 2003 HMO enrollment in Illinois dropped 6.8% and an additional 2.7% in the first half of 2004. There are now under 15% of the Illinois population covered by the onerous HMOs. Any prior differences between the HMOs and other types of insurance have dissipated so there is less reason to force people into the rationing cattle car.
United Health has put out a tiered physician program with no input from physicians and not based, according to United, on quality. It is purely on economics. Some physicians get a star after their name which means they are more economical than others. This non performance based program also includes primary care physicians, which others have not done. To date the physicians, patients and employers have all complained about the program mechanics.
In Kansas City, they are taking a page from the Cincinnati physicians and suing the local insurers for inadequate pay. This inadequate pay leads to the inability to recruit new physicians into the area. The physicians state that they are being paid 16%-25% less than other area cities. They also claim the insurance companies are paying their employees bonuses to deny a percentage or absolute number of claims. 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.