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Universal Care of Tennessee a TennCare company (one that pays for the Medicaid managed care in the state) is broke. The insurer's president stated in a letter to the physicians, hospitals and other providers that they need to take a 30% cut in the amount owed them from last July 1. If they don't agree the company will go into receivership and they will get nothing. The company is now $42 million in the hole. The providers will be paid for services rendered after April 12 since that is when the state took over the program. I believe the physicians should agree to the terms and then quit the program. TennCare has been chronically underfunded since its inception and the providers are always left holding the bag. Stop seeing the patients and avoid the mess.
Kaiser reported a 90% net income increase due to "cost cutting and higher premiums". They increased membership by 126,000 to 8.3 million people. The profit is from operating income and not the reserves.
If the physicians of Atlanta can prove they are giving quality care, they will get paid more. Promina Health System has concocted a three tier scheme to pay more for "quality care." To date the standards that will be arbitrarily set have not been. The standards will be set by Promina and Cigna with no apparent input from physicians. The problem may be this is just another way to lower costs. I believe that everyone knows by now that as employers pay more that does not translate into more money for the physicians but into more profits for the middlemen HMO and IPA.
Texas has placed AmCare Health Plan under administrative oversight due to its poor financial condition. The HMO covers Houston Medicare patients. This means the plan must come up with ways to become financially solvent.
A new study has shown that Texans who appeal HMO decisions to independent panels are successful in 70%, especially in mental health, eating disorders and substance abuse. This is touted by the HMOs as a system working. This is truly a system broken when one looks at the time value of money.
New Jersey Insurance Department looked at Cigna and found a bad company. The insurer, if that's what it is, failed to claims timely in 84,000 cases and had a 26% error rate in 2000. Cigna states it intends to adopt all recommendations of the report. When pigs fly. Top
Nevada just released the results of a new survey. It showed 70 Las Vegas physicians have either left or are actively looking to leave due to malpractice rates. The Governor's plan to help pay the costs will not work since the physicians will still need to pay over $100,000 to pay up their tail coverage. Of course, this would be needed if they stay or leave, unless they could buy their nose over time. One of the physicians who has left stated his insurance went from $19,000 to $100,000 per year.
The exodus has begun. Las Vegas OBs have begun to turn away new OB patients due to the malpractice situation. This includes existing patients who have become pregnant. Most of the physicians are insured with American Assurance who bases malpractice premiums on the number of deliveries. They currently pay $40,000. The new rates are $80,000 for less than 125 deliveries per year and over $100,000 for those that deliver between 125-175 babies per year. The physicians may lose their managed care contracts but so be it. The patients have a choice of moving elsewhere than Clark County (Las Vegas), going elsewhere for delivery such as California or going without prenatal care and delivering via a local ED. See Legislative News.
The trial lawyers have now been heard from. They state the refusal of the OBs to take new patients is a "grotesque exploitation of women and children".
Washington state OBs have begun to leave the baby delivery business. The physicians can save $30,000 in malpractice expense by stopping deliveries. This will help since the increase costs can not be passed on to patients due to contracts.
West Virginia physicians are being actively courted by out of state opportunities. A large physician recruiting agency stated that they are seeing a large increase in physician inquiries for out of state positions and also from West Virginia clients wanting to replace the leaving physicians.
Give the West Virginia physicians credit! They have eight doctors running for the legislature to attempt to get the laws changed.
Pennsylvania hospitals are paying $180 million more this year than last for equivalents malpractice insurance. They continue to push for more tort reform which is unlikely in Pennsylvania.
Texas believes that about 6000 physicians will be without malpractice insurance in the next year. This is 1/6 of the Texas physicians. In the Rio Grande area the amount of claims filed is growing 60% per year. The plaintiff's bar is attacking managed care as the culprit. The Governor supports the $250,000 limit on pain and suffering and creating special malpractice courts.
The US Chamber of Commerce for the first time is warning businesses not to do business in Mississippi due to the legal climate. The Chamber is spending big bucks to advertise in the Mississippi press asking the citizens to have lawmakers change their tort system. The Governor is not a happy camper calling the action "outrageous". The state ranks last in judicial competence, jury fairness and overall tort and contract litigation. The Governor seems to be a big part of the problem as he states he would call a special meeting of the legislature for tort reform only if the legislators state meaningful civil justice will be considered. Good luck.
A new state is being heard from. New Jersey malpractice insurer MHX, which insures 40% of the stat's physicians is shutting down their malpractice business. The insurance commissioner has been attempting to find other insurers to pick up the slack by offering incentives. So far, one taker. Top
California has adopted the nursing ratio standards without taking into account the number of nurses available. Kaiser went a step further and created their own nursing standards that are even smaller ratios than the state. Kaiser is now learning that the ratio will be hard to attain and will cost them money. They are now paying a bonus of $5000 to their employees who refer nurses that are hired. The bonus will be in three installments with the last one on the nurses one year anniversary. Kaiser needs 500 nurses to meet the state requirement but needs 2000 nurses to meet its contract with the nurses union. Most hospitals also pay significant signing bonuses to nurses.
In Denver there are empty hospital beds because hospitals will not hire temporary nurses at the high prices. The temps are paid almost double of a staff nurse. The University of Colorado Hospital has many empty beds and overflowing EDs since there are no beds in which to put the patients. The hospital believes that it is a community and state problem and paying high premiums to lose money on patients is not the answer. Top
First Coast Service, the Medicare arm of Blue Cross/Shield of Florida has reversed its stance on medication. Originally they wanted all dialysis patients to try oral vitamin D medications for 90 days. If they did not respond then IV meds would be given. This was protested by the patients and physicians stating the current IV meds have already been proven effective. Now if the physician states that there is no effective oral medication the least expensive intravenous drug will be used. This also gives pause since the decision is on cost and not efficacy. Top
Concierge Practices
The May 5, 2002 New York Times has an article entitled Dr. Levine's Dilemma. It is one of the best written pieces regarding the frustrations of the current practice of medicine and the temptation to go to a concierge practice. I highly recommend it to all physicians and all who are interested in the current managed care and payment arenas. Top
The junior senator from California, Barbara Boxer, has written an op-ed piece in the San Diego Union Tribune. In this piece she espouses half truths mixed with fact. She states the Congress has passed bills in the past to protect the privacy of the consumer in various areas. This is true, but she wasn't there. She states that the final medical privacy rules that were enacted in December 2000 by a lame duck administration were good. They were good in general but many parts were not workable for the people that need to care for patients. She implies that Congress passed these rules which is not true. Congress was given years to pass the rules and if Congress failed, and they did fail while the Senator was there, the rules were to be promulgated by the HHS. The lame duck administration forgot the due process of allowing enough time for public comments. After the current HHS allowed the time, it became clear to all that the prior rules could be improved. This improvement process is continuing in concept but as yet none of the original rules have been changed. She complains that the new
contemplated rules allow the marketing but does not state it was her own party and the original rules that allowed the marketing to patients followed by an opt out rather than the current proposal to allow the person to opt in or out prior to prior to receiving marketing information. She states that she plans to make the truth known. She could start by looking at her own article.
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Colorado has a boot camp for wayward physicians. Physicians from around the country are being referred to the Center for retraining to reenter medicine after their medical licenses have been put in jeopardy. The doctors take assessment tests of communication skills and clinical skills. The cost for this is $7500 for the assessment and an additional $5000 for a remedial plan that is forwarded to the state licensing board. The new center believes it will get 200 referrals over the next year. They hope the referrals are done prior to any final action by the states and believe that early intervention will prevent injury. Of course Public Action believes that all that go to the Center should be reported to the public. This is not a great incentive to participate. Top
The University Hospitals in Cleveland have upheld the suspension of a thoracic surgeon due to disruptive behavior over "the past years". He was removed a chair of cardiothoracic surgery in February and suspended in April. His suspension also suspended the lung transplant program as he was the chief transplant physician. This happened after the newspaper got word of the poor results at University Hospitals in their cardiac surgery program. He has a hearing in the courts for reinstatement until the hearing process is complete. The only probably really valid reason for summary suspension is his alleged violation of supervising medical residents. This was a reported but not yet proven allegation. Top
Texas Medical Society Screws Up
The Texas Medical Society has rankled its members by endorsing the challenger in the race for governor. This endorsement came after a poll showed a 14 point differential in favor of the incumbent. The problem with the poll is less than 2% of the physicians responded. This may cost the Association members. 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.