May 15, 2005 News





Right to Life



There has been a substantial rise in actions against physicians nationwide.  Approximately 20% more physicians have been disciplined between 2003 and 2004.  One of the reasons is that there are more physicians practicing.  there has been a 200,000 increase in the past ten years.  There is no reason why the Medical Boards should not regulate the profession as well as the state Bar regulates their profession. However the rule in Missouri that a doctor will be disciplined if he/she fails to pay state income tax is ridiculous.  If a physician is not paying tax because of business losses in outside interests, that is no reason to have his medical license touched.  

About 2% of Florida's physicians have gone before the Board.  Most of the actions were for not keeping up on their CME units, a problem which is inexcusable.  The remedy is minor, do the CMEs and pay a fine.  About 16% of the actions were for real problems and cost the physicians their license or put restrictions on them.  

The physician Dr. Upton, of Boston who left one patient in the OR to go to another hospital to operate on another elective patient has been placed on probation by the state.  He can not schedule surgeries in more than one hospital in a day and must have a monitor looking in to make sure he does not leave.  Beth Israel Hospital, the one he left to perform the surgery at Children's, reinstated him.  He is a very high utilizer of the OR there.          Top


I always like starting this with stories about the worst hospital in the country, Drew/King of Los Angeles.  After it came to light that the hospital was paying people for working over 20 hours a day seven days a week, three physician were fired and three other ones were suspended.  The fired three are the head of the geriatric program Dr. Eugene Christian Jr., an internist Dr. Anthony Kingsley and his wife Dr. Rita Ogbo who works at a health center.  The suspended physicians are Dr. Harry Ward, a moonlighting nephrologist, Dr. Carlos Rosario a neurologist and neurosurgeon Dr. Daniel Le May.  They are on non paid suspension while moonlighting charges are investigated.  All the physicians refute the charges.

The county of LA is withholding about $350,000 from Drew Medical School since they paid out so much money without checking on the recipients to see if they were actually working.  The county may try to recoup the remaining 3/4 million dollars.

After doing the above the County debated about closing the ill fated hospital.  Instead they decided to throw more money to the hospital and get a completely new running of the med school.

Physicians in Andover, Kansas are planning to build a full service hospital of 70 beds.  Part of the investors are the physicians of the area.  The city is also behind the effort.  Any guesses who isn't.  Could the other and only hospital in town be for this?  No.  They are looking at a lesser bottom line and are afraid that their "mission" will be hurt.  

Kaiser is retuning its advertisements.  They currently are using the "Thrive" theme and are going to add Bob Dylan's song "The Times they are a Changin".  It is fitting that Kaiser is adding Bob Dylan since very few people can understand what either are saying.

In a more positive vein, Kaiser has partnered with Weight Watchers to give their employees and members a 20% discount.  This will include a 12 week meeting membership, a subscription to the online magazine and an at-home weight loss kit.  It's nice to see the fat cats losing weight. 

Specialty hospitals are not good but community hospitals are.  This is the message that MGH is sending by opening a specialty hospital (surgical center) in a nearby community. If a physician owned center would have opened there would have been a cry of stealing our patients from the two faced hospitals. 

The American Blood Centers, which depend on the community hospitals for their business, have come out in favor of an extension of the specialty hospital moratorium.  This is a prime example of political clout that the community hospitals have and the specialty hospitals nor their physician owners don't have.

Two Senators have caved to the AHA bribes (Lobbying) and authored a bill to ban new specialty hospitals and restrict the money paid to the current ones.  At the same time the community hospitals would get more money.  The bill will be a tough sell with all the money going to the community hospitals.

Following that announcement several members of the House subcommittee including the Chair stated that they opposed the extension of the moratorium and would not let any bill be heard that would extend it. 

CMS thought they would change the payment structure for the specialty hospitals and this would take six months.  They have no legal right to delay the end of the moratorium for that.  The CMS also found better satisfaction in all specialty hospitals and better outcomes in cardiac specialty hospitals.  There was not enough data to look at outcomes in ortho or surgical specialty hospitals.

Norton Hospital in Louisville has had a precipitous drop in deliveries.  They have decided to keep their OB Department open to attract new physicians to the hospital.  The reason for the drop was that the physicians left the hospital.  They are now, albeit late, studying why the physicians left and what they can do to remedy the situation.  They will look at how to make deliveries at the hospital more efficient.  That won't do it.  They need to upgrade their suites and do other things to entice physicians to come to the inner city hospital.  

The major hospital chain in central Contra Costa County, 30 miles from San Francisco, has negotiated a contract with National Surgical Hospitals for a joint venture that includes physicians for several surgical centers and a possible specialty hospital.  The physicians are all for an outside party to run the surgical centers since the one that the hospitals run now is inefficient. The positive part is the combining of a non profit hospital with its physicians via an outside company instead of always being competitive.

The federal government is assuming a small part of the care of illegal immigrants in the healthcare system.  They have allowed $1 billion over four years to be paid to hospitals that care for the people.  Physicians are notably absent from the payments, which is why many physicians want to be paid for on call work.     Top  


The Board of Directors and the physician members of the American
Association of Neurological Surgeons expelled Dr. L. David Rutberg, a
neurosurgeon in San Diego.  The cause was his testimony in several malpractice trials that were not in keeping with the state of the art.  This discredits the physician and will keep him off the witness stand.  It would be wonderful if more societies would follow the lead of the AANS.   

Pennsylvania hospitals paid out $636 million for med mal coverage in 2004.  This is money that may have been used to purchase equipment or to help the uninsured.  This came to 2.67% of every dollar spent by the hospitals..  They paid out an additional $448 million in malpractice claims in 2004.  These costs were only for hospitals and did not include those for independent physicians and mid wives.

Nevada continues to struggle to get physicians to come to the state.  There is some improvement in the med mal premium structure.  The rates have not escalated but are still very high with OBs paying close to $150,000 per year.

Watch for med mal suits in the New York City hospitals.  One person has died to date from Legionnaire's Disease and the bacteria has now been found in a second hospital. 

Maryland had passed and then overrode the Governor's veto to get a law to help the state's physicians in their med mal premiums.  That was four months ago and to date nothing has happened.  The new med mal premiums are due again and the physicians will need to pay the high premiums. 

South Carolina physicians are still getting raises in their med mal premiums but at least they are less than last year.  They just got a cap on non economic damages and it will take some time to see any major changes.      Top 


The CMS has just released a letter stating that providers may begin applying for their NPI numbers on May 23, 2005.  You have until 2007 to begin using the numbers.  This will take the place of all random numbers you currently have to use for various health plans including Medicare.

The Oregon Medical Society has rejected a proposal to report Meth users to public health authorities.  The group stated that this was not what they wanted to do.

A new survey has shown that more physicians are being paid for on call services.  It amount of is now up to about half of hospitals pay.  Without the pay, many hospitals are having trouble recruiting specialists.  The numbers included extra pay for employed physicians as well as independent ones.  The average pay is about $30 per hour or $750 per day.  I know in my community it is about double that figure and all physicians that take call are paid. 

A different study showed that only 30% of facilities had no problems finding physicians to take call.  About half of the hospitals that currently do not pay for the extra service are now considering paying for it.

Hawaii has a shortage of orthopedic surgeons and OBs.  The reason is a combination of malpractice suits and low reimbursement.  This is especially true in the outer islands.  The Hawaiian OBs are making 17% less over five years and the Orthopods are getting 10%-20% less than their mainland counterparts. Hospitals on the outer islands need to air transport patients to Oahu for surgery many days of the month since they do not have enough specialists to cover each day.

Boutique practices are doing ok in the Portland Oregon area.  There are two regular boutique practices and one partial boutique practice.  Both the physicians and the patients were happy with the arrangements.  The non-practicing academics weren't.

A study was just released that showed to no one's surprise except the researcher that physicians are not getting IT equipment.  This lack of expensive hardware is not allowing the small practices to have data to report for quality purposes. Since the physicians don't have the systems the data is being obtained from insurers which only has codes and only a part of a physician's profile.  The other part showed that physicians are getting reimbursed for seeing more patients not for quality measures.               Top

Right to Life

Another legislator has attempted to intervene in a private matter regarding right to life.  Democratic Representative Jackson of Texas has asked a hospital in Texas not to take an infant who has terminal leukemia and has failed all treatments off life support.  The hospital wants to discontinue life support and so does the ethics committee.  The representative wants the child transferred to another hospital who has already refused the child on two occasions since they have nothing to offer the child.  The parents want the child to live but a Texas law allows hospital to stop treatment despite the wishes of the family.   The child died on May 4, 2005 without transfer. (See also Recent Legal for a Florida case)        Top


UnitedHealthcare has a program fostered by GM that refers patients to those physicians and hospitals that are the cheapest.  They claim quality but all know that is a sham.  The large St. Louis organization BJC has put its termination notice into United.  Missouri has always wanted their consumers to have a large choice of providers but as of now only about 2/3 of the providers are included. It will be interesting to see who caves first.   

Intermountain Health, the notorious insurer for going after people with outstanding bills, has changed.  They have seen a new compassionate role.  They state they will allow more access to to doctors but for more money.  All this comes after IHC was chastised by the state legislature.  Currently IHC takes about 1 in 1000 patients to court for unpaid bills.  This will hopefully change since the new policy states they will only go after those who perpetrate fraud or who can afford to pay.  Of course, the afford to pay is under their definition. 

Kaiser has announced an earnings increase of 27%.  The net income had gone up by $100 million and revenue had increased by 11%.  Kaiser also announced an increase in subscribers by almost 100,000 in the quarter as opposed to a loss of 13,000 a year earlier.  Kaiser believes that their new products of HSA and a credit card to help with deductibles fueled the advance.  The year end figures for 2004 showed a 59% increase in net income to $1,61 billion. This was due to lower costs and higher fees.  

In Tennessee, some physicians believe the rules to hold down costs will restrict their ability to treat TennCare patients.  The rules state that they would have to provide the least costly treatments that are adequate for their patients.  

In the Socialist State of Minnesota, the Blues have reversed the decision to place physicians in tiers depending on their costs.  Originally if a physicians didn't promise to only refer to a low price hospital they would be placed on a low tier list.   The Blues continue with the lie that they will use quality as the divider when all know its price.         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.