Together at Last.
The Charlotte NC Business Journal has reported that physician groups have gotten stronger and can negotiate better resulting in better fees. Could that happen with you and your organization? Where is your drop dead fee?
An article in the San Jose Business Times talks about the looming lack of physicians in the Bay area. The article discusses the inability of private practice to pay the same starting salary as Kaiser and the high cost of living. The high cost of living along with the average $90,000 loan debt facing new physician is too much for them to consider this area for practice. Kaiser also has difficulty but not as much as the private sector. This is bad as the population ages and grows. As an example, Kaiser Santa Teresa had a hiring freeze in 1996 and now has 20 unfilled positions. The potential problem is the aging of the physicians and the planned retirement of 44% of the private practice and 50% of the Kaiser physicians in the next five years. The financials show the average OB/GYN makes $120,000 a year in California compared with $140,000 in the Midwest. An orthopedic surgeon recently turned down an offer for $180,000 a year and stated the start needed to be closer to $300,000 per year. Making matters worse are some hospital bylaws that state physicians need to live within thirty minutes of the hospital for EMTALA reasons. EMTALA does not state this. Some hospitals are offering signing bonuses in the $50K to $75K range, not enough for a down payment on homes in part of the Bay area. Sutter is helping on some home purchases. Kaiser is now adding a non- recourse note of 10% of the purchase price of a home, up to $100,000. The doctor needs to stay more than 10 years. Single physicians without a working partner leave rather quickly.
We're Not Alone
Boston has the same problems as the Bay Area of high costs and low reimbursement leading to a lack of physicians. This include problems in recruiting departmental chairs.
A Philadelphia Inquirer article states that the trend of hospitals leaving the practice of employing physicians continues. The Jefferson Health Main Line hospitals are rewriting or dissolving their physician contracts. They want the physicians which all have at least a year left in their contracts to either going into practice on their own or continuing but without base salaries. They would be paid the difference between gross receipts and cost. Some physicians are suing other hospitals for breach of contract when they have done the same thing. Around the country this trend continues. There was no mention in this article whether the hospitals were requiring the physician buy back their contracts. This has been an issue in other locales.
Physicians in Pennsylvania closed their offices this week to go to the Capitol. They are lobbying for malpractice payment relief by putting caps on verdicts for pain & suffering. The Trial Lawyers state this is only a scare tactic. Currently OB are paying $84,000, neurosurgeons are paying $111,000. Does anyone remember the 1975 California insurance crisis. The effort forced the passage of MICRA.
In a similar rally, California physicians, organized by the CMA, went to Sacramento to attempt to get more Medi-Cal funding. Top
The San Francisco Business Times has a story about the high profits of HMOs. They state the HMOs spent fewer dollars on medical care and administrative expenses in fiscal 2000. The top six HMOs went from 1.5% profit to 3.5% in the past year. The rate increases to payors were in the 8-12%. The decrease in administrative expenses were about 12% and the decrease in medical expenses were 1%. This should be no surprise to any payee ( used to be physician) who are being paid less and slower.
In numerous studies that the HMO industry are attempting to be suppressed show traditional Medicare payments are less than Medicare+Choice. The statistics show approximately 3-8% more money spent per patient in HMOs than in traditional Medicare. This was because, as HCFA published, those in managed care were healthier than those in traditional Medicare. Top
There is a central site that collects articles from medical journals and organizes them by specialties. The site www.MDLinx.com gets its revenue by high advertising charges and free viewing for physicians. Top
A recent Reuter's article stated that mammograms raise the cost of health care. Since there is a high false positive rate of 10%-16% there is a need for unneeded tests. Also the article states that woman with false positive mammograms utilize three times more services unrelated to the mammogram than those women with a normal mammogram. This may be because these women sense they are more vulnerable which may prompt more physician visits or use the result as a wakeup call to take care of other deferred medical conditions. This is bad? Isn't it always better to take care of medical conditions early? The higher costs now will prevent much higher costs and potentially save lives in the future. The same argument is made by MCOs for PSA. Top
The San Diego Medical Society is going against capitation. The main thrust of the article is capitation rewards for rationing medical care. As the US Supreme Court stated this rationing is what Congress intended when they enacted the law and the HMOs can not be sued for their rationing of care. In California more physicians, groups and hospitals are in the words of Mrs. Reagan "Just say no". Not all are against capitation, only the low fees paid in California.
The creditors of Heritage Southwest Medical Group IPA have allowed the suspension of the Chapter 7 bankruptcy proceedings of the IPA so arbitration may be instituted. The IPA had given scripts to their employees as to what to tell physicians why they are not being paid. These scripts were not true and did not state the financial condition of the IPA was such that they could not pay. The IPA has admitted the script was just a script to delay the truth.
PHYCor, the much ballyhooed physician practice management company of yesteryear, has declared in it's SEC filing that it may be necessary for the company to seek protection from its creditors. This is the step prior to bankruptcy. Top
The FBI has raided five Florida hospitals and two pathologist's home looking for medical records. The pathologists are not employees of the hospital but do work at one of the raided hospitals. The search was for criminal fraud material. The source may be an ongoing feud and law suits between the two pathologists. Top
In Maryland a hospital closed its old hospital and opened a new one in an affluent and growing area of the county. They are losing money and the more patients it attracts, the more they lose. Maryland has a governmental rate setting committee. At the same time the hospital asked for more money the regulators said they have been charging too much and ordered a rate cut so the hospital would reach its cost targets. They did not take into account the targets were set five years ago when labor costs, use rate, emergency service utilization and health inflation were different than today. The hospital has lost $2.8 million in the first 4 months. With the help of the rate setters they will lose a projected $16 million for the year. Of course, if this hospital gets special consideration, what about all the other new ones built? Is it any wonder why only people with experience in the health business should be involved in the regulation of the industry? Anybody remember the fatally flawed H. Clinton plan where she refused to have anyone on her committee with healthcare experience? Top
With due apologies to Angela, a story of potentially 20 murders at Nacona General Hospital in Texas has been reported. In this small town there is suspicion that there has been foul play and they are exhuming bodies for autopsies. The authorities are looking for traces of mivacurium chloride, a short acting paralytic that can cause death if used in large enough doses. A night LPN is being investigated. Top
Norway has more patients than their medical system can handle. Germany has an abundance of medical facilities. The combination makes for a perfect solution. Norway has budgeted $111 million this year to send 10,000 patients waiting for surgical procedures to Germany, Britain or Denmark. This includes travel and related expenses for the family. Norway believes their situation will not be resolved for about 10 years. 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.