March 1, 2008 Recent News





Medical Malpractice


What does the public think of socialized medicine?  The first is what is socialized medicine.  About 80% said it was government making sure that all people were covered by insurance. 73% believe that government would pay the cost of the care.  32% believe it means government tells the physicians how to practice medicine.  About 45% felt that socialized medicine would improve health care but 40% said it would worsen health care with the remainder stating it would not help or worsen health care.  70% of Democrats believe socialized medicine would improve health care and an equal amount of Republicans believe the opposite.  The split was also equal among Independents with 40% believing it would worsen and 40% believing it would improve care.  The only ones that found overwhelmingly that socialized medicine would improve healthcare were the uninsured.

CMS has just released a report that the pace of healthcare expenditure will increase 6.7 per cent per year for the next ten years. This will far out way the pace of inflation.

The British citizens are becoming more sophisticated in regard to the vast shortcomings of the National Health Service.  The patients who can afford to pay outside the program are being told they can not do so for medications that are given at the same appointments as NHS funded drugs.  The patients can still get private MRIs and other tests along with second opinions where the wait may be too long under the government plan or not covered at all. This continues the two tier approach that has always been the English way. 

The Fraser Institute has studied and found the Canadian healthcare system to be worse in 2007 than 2006.  The waits between seeing a GP and a specialist has increased from 17.8 weeks to 18.2 weeks.  This was mostly in the large provinces but there were slightly better (less) waiting times in BC, New Brunswick, Saskatchewan and Prince Edward Island.  The spread was the best being 15 weeks in Ontario and the worst was New Brunswick at 25.2 weeks.  As the Canadian Supreme Court stated, "the national healthcare only allowed one access to a list, not care".

The physicians of the Dominican Republic have gone on strike in their public hospitals for better wages and working conditions.  This is a 24 hour stoppage but if they do not get any help the next one will be for a week.  About 10,000 physicians are participating in the labor strife.  

The Chicago Tribune reports on the Russian healthcare system showing the usual graft and terrible service of government healthcare.  In all hospitals one must pay under the table for any care.  This includes speaking to physicians as well as having a patient in a room instead of a hallway.  The usual age of death in the country is 59 compared to 79 in the US.  In one hospital they ran out of syringes and asked the patients to bring their own.  Those with money could purchase medicines but those without died.  I wonder why Mike didn't feature this country on his unbiased movie on healthcare (Sicko).   

Here in the US of A, physician and patient pressure occasionally works.  Aetna has backed off its East Coast disallowance of propofol with colonoscopy.  This may change later this year.  In my last newsletter I agreed with the insurer.  I have not changed my mind.   

Kaiser did not do as well financially in the 4th quarter as they lost $233 million but for the year they did very well.  They made $2.2 Billion this year up from $1.6 Billion last year.  Maybe part of the money made was on the back of its patients as the Fresno Kaiser is finding out.  The Fresno organization failed on its first attempt to fix the way it handles high risk pregnancies and must submit a second plan to the government in order to continue to receive funds.  This stems from the complaints ignored by the hospital administration about the care by a physician.  The criticism was of the lack of an effective Board and the lack of any significant medical staff organization which is typical in Kaiser facilities.  

The People's Republic of Massachusetts Blues will require CPOE by 2012 for all organizations and physicians who want to be paid.        

When the US Senate Finance Committee comes together to talk about the 10% cut imposed on the nations physicians that was then delayed, the AMA will be excluded from the discussion.  This is punishment for the AMA blabbing secrets last year.  

The Palm Beach, Florida, area has many problems with hospital call and now has a second problem.  The Cleveland Clinic and Johns Hopkins have both opened 9-5 clinics in the area.  The name is drawing insured patients from the community hospitals who have to see the patients in the ED after the clinics are closed.  The clinics are also sending patients who need more care than they can offer back to the home hospitals instead of utilizing the local hospitals. The physicians at the clinics have not joined the staffs of any of the local hospitals.  This sounds like the physician owned hospitals but there is no hospital association up in arms about the practice.  Could there be a double standard?  No, not the unbiased AHA.

The Federal Government has collected $2.2 Billion last year from hospitals and providers who have overcharged the Feds for services or have done other illegal activities.  The Medicare trust fund received about $1.5 Billion of the money.  

I hope no one paid too much for a study that showed more people with strokes dying during the night shifts and on weekends in hospitals.  Where are the least experienced people placed, on night and weekends where those with more experience and seniority are not seen.  The crews are also smaller during those time  periods.   

It's no wonder hospitals are crying wolf.  They are losing procedures that were once totally in their domain.  Just in Cardiology in the years between 2000 and 2005 the percentage of ICD implants have gone from 20% to 30% outpatient.  EP ablations have gone from 35% to 43% and PCI outpatient procedures have increased from 10% to 17%.  The hospital is becoming more obsolete and these statistics show why physicians should have privileges at various facilities. 

The California insurers that have been hit hard by their illegal tactics in insurance rescissions are attempting a new end around.  They are proposing that those whose policies are rescinded can appeal to a state external appeals board whose judgment would be final.  Some insurers are not happy with that and want to make it their own external appeals board, picked by the insurer.  Nobody is answering the question as to what happens to the patient during the time it takes to have the hearings.  

The GAO has come out with a report that Medicare HMOs may cost patients more that traditional fee for service.  CMS does not agree with the report stating that the average out of pocket costs were less for HMO patients.  The GAO stated that particular people may not match the average so they may pay much more.  The GAO continued with 19% of HMO patients were in plans that cost higher share of cost for home health and 16% were in plans that they owed more for inpatient services.  The GAO also stated that some HMOs exclude payments for chemo, mental health or home care.  The plans allot about 87% for care, 4% for profit and 9% for administration including salaries.  It seems inevitable that if there is a Democratic President, Medicare HMOs will be dismantled.    

The AHA is pressuring Congress with testimony and money to get rid of the Medicare recovery audit contractor program (RAC) since the drive up costs.  However, hospitals paid in over 90% of the $357 million that had been recovered by RAC due to unnecessary procedures and over coding.  RACs, in my opinion, are good but they should not be bounty hunters and paid a percentage of the take whether proved true or not.   Top


Tenet has notified 37,000 patients that it compromised their privacy since a former employee pled guilty of identity theft. There were actual breaches in 90 patients and Tenet will pay for credit checks for those ninety people only.  The rest will be on credit alert. 

Liveblood, a Memphis, Tennessee, blood bank has had two laptops stolen.  They contained patient identification including social security numbers of 320,000 people.  The information was double password protected.  The organization is not doing anything to protect the patients except to tell the patients what to do.   

Google has partnered with The Cleveland Clinic for a test of putting about 2000 patient records on line.  Microsoft started this about a year ago.  Interesting is that HIPAA does not cover this and therefore marketing may be used. 

A new study at the recent annual meeting of the Healthcare Information Management System Society showed no significant improvement in quality using EMR.  More studies are needed to draw the conclusion that EMR improves quality.     

New York City is pushing EMR.  The Mayor wants the city's physicians to switch to EMR from paper but isn't willing to chip in money where his mouth is.  The city has a model for EMR that now has 200 of the 70,000 city physicians enrolled. 

Kaiser has started its EMR in ten hospitals and an additional 14 are supposed to be operational by the end of this year. 

The latest study has shown that under 10% of the nations hospitals have instituted CPOE.  The pace of adoption due to costs and hospital with physician dislikes is not likely to increase in the near future.  

Hospitals aren't the only ones in left field when it comes to competition.  The EMR field is equal.  At the latest HIMSS convention, the IT people were not happy that Microsoft and Google were getting into the EMR business.  They were outright jealous and petty.  

Health Net screwed up again.  This time it was in publishing over 100,000 physician social security numbers on the web.  The physicians were in multiple mid-west and eastern states as well as California.  The company will pay for a years credit monitoring for the physicians.  Health Net may now not use social security numbers for physician identification.      Top


Lehigh Valley Hospital in Pennsylvania has bit the hand that feeds them.  Three hand surgeons have lost their membership and privileges at the hospital for rightfully refusing to take general all comers from outside hospitals.  The hospital already lost a group of neurosurgeons in 1999 and a group of ophthalmologists in 2004.  The hospital would not pay for call and the physicians would not take call without it.  The surgeons who lost privileges in the past found other hospital anxious for their services very quickly.  This group does 16,000 surgeries a year and will be a major asset to any hospital.  

A pediatrician in the Charlotte area was fired from the clinic she worked at.  The patients found out when they came in for their appointments.  This caused a furor and a patient started a blog asking patients to go to other clinics.  In the first day 25 patients got their records and left.  The clinic could not discuss the reason for letting her go but the physician's husband stated she was not given a cause.  The clinic should lose many more patients as the action becomes more widely known due to the newspaper story. 

Northern California's Sutter Health has formed a virtual physician group.  It has multiple physician groups throughout the area that are stand alone and have formed an umbrella so that the transfer of a patient between groups would be easier but possibly less convenient for the patient than going outside the system.

Northwest Physicians Insurance in Oregon, and Idaho which is a division of The Doctors Company, a med mal insurance company in Napa, California, has offered discounts in med mal insurance to physicians that use computerized records and email to communicate with patients.  The discounts range from $375 to $2250 per year depending on the specialty. 

A new report shows that the shortsighted medical schools in the 1980s and 1990s put a cap on their specialty programs due to their unreasonable belief in a flawed HMO system.  Medicine today is paying the price for this mistake.  There are not enough specialists and even general surgeons to go around, especially in rural areas.  From 1980 to 2005 the medical school enrollments were flat while the population has grown by over 70 million.  Last year medical schools finally started to accept more students.  Another part of the problem is that surgeons now get about 50% of what they made per procedure 20 years ago.  This is during the same time as inflation and medical school loan debt has dramatically increased.   

As a corollary to the above story, physicians in Milwaukee are shunning the county's three year old program to take new indigent patients into their practices.  The actual program started about a month ago and only 3% of the physicians have volunteered for the program.  They now have three patients enrolled in the program.  If a patient is enrolled with a primary care physician they still need to pay to see a specialist or get any tests.  MilwaukeeCare has not been able to get labs, x-ray or specialists to join.  To date there are no hospitals in the program either.  I wish the program well in the future, if there is one. 

California physicians got $10 million more this year in bonuses via the Integrated Healthcare Assn.  The total amount given is about $65 million which seems like a major sum until it is shown that it is under 2% of the annual reimbursements to the medical groups.        Top


The disagreement between Detroit Medical Center and Wayne State University over how much to pay physicians now has an agreement to hire an expert consultant.  The two institutions have already paid a consultant over $200,000 in the past year to help mediate the dispute.  This mediation has never been signed.  Recently DMC has reduced by $12 million the amount it is paying WSU after a consultation with Foley & Lardner law firm that seems like it gave wrong advice as determined by the state.  

DMC has made some concillitory moves in the dispute.  They have agreed to hire an outside expert to determine the validity or invalidity of the Lardner opinion.  They have agreed to place money into an escrow account that may be used to pay WSU.  They have also gone on record to take care of those patients dropped by WSU due to the money issue.  The extra pay that was negotiated several months ago was helped by the Michigan Governor's intervention.  This is the pay that is now under dispute.  

Although not a hospital, The Endoscopy Clinic Center of Nevada in Clark County, was using the same syringe to give medications to patients.  This has caused at least six cases of Hepatitis C.  The Department of Health has sent letters to many thousands of patients of the clinic warning them of the potential for the virus.  

The Bayfront Medical Center in Tampa, Florida, is having trauma problems since they do not have enough neurosurgeons to take call.  They have to close their trauma center periodically due to the lack of neurosurgeons. Two of its four neurosurgeons stopped taking call so they are in deep trouble.  The hospital is looking but not finding other neurosurgeons due to the Florida med mal laws.       Top 

Medical Malpractice

The AMANews has an article on the impact of noneconomic med mal caps.  Its conclusion is that the caps are good for lowering the costs of med mal premiums and the art of practicing defensive medicine.  On states that have enacted reasonable caps they have more specialists per capita to see patients than those states like Florida which has the highest med mal premiums in the country.        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.