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I just returned from a one week trip to British Columbia, Canada. In the week I was there several articles appeared in The Globe and Mail newspaper on healthcare in Canada. There was an article on a high outbreak of C. Diff in Ontario's Joseph Brant Memorial Hospital. They said that 91 of 177 patients with the disease died and the bug was the cause in 62 cases. This is over a 20 month period. In Canada, as in the US, the release of this type of information is voluntary and almost no hospital reports their statistics. The Ontario Health Minister states that this will be mandatory reporting by years end. Also in BC they are now beginning to give Gardisil to girls in grades 6 and 9.
There is also a problem with Canadian pathology. In Manitoba, a pathologist misread radical prostectectomy specimens and underreported capsular extension that may be treated with radiation therapy. The health authority has suspended the senior unnamed pathologist. In Newfoundland and New Brunswick there were much worse problems with pathology, so much so that a class action law suit has been initiated. Canada also has severe pathology personnel problems with only 30 per year coming out of training.
In the last Medicalaw.net Updates I had a story regarding HSAs. A new story has shown that HSAs are increasing. The interesting thing is how each side looks at the data. The Democrats who do not like entrepreneurship state that the people who are using HSAs are the wealthy. They define wealthy here as those making $139,000 versus $57,000 for those with other insurances. The leftists Waxman and Stark say that this proves the program is elitist. The usual that one puts into the program is $2500 and the usual that one removes is $1000. I doubt that the extra average $1500 will make anyone very wealthy when they have to wait until they are 65 to use it for anything other than healthcare. It should also be known that employers that use HSAs had their health insurance costs go up 3.4% versus 7% for those without the plans. The fees for these plans are lower and people look at the costs before spending giving some control back to the patient.
Medicare and Medicaid are still rife with fraud. The government is getting better at catching the crooks. In New York, the Attorney General has doubled the amount it has collected in 2007 over 2006. The State collected $112.5 million in 2007 and $59.4 million in 2006. About $41 million came from the home health industry.
San Francisco has a law that may or may not be legal. The courts have heard the case but have not ruled as yet. The law has businesses either putting money into the Healthy San Francisco program or putting money into an insurance for the employees. To date 6000 of the cities employed are in the program and the San Francisco restaurants are adding surcharges to the bills to cover the extra costs. Top
Hospitals have for the last at least 38 years that I have been involved with medicine continued to use urinary catheters for nursing convenience. Woe be the physician that attempts to say no when the nurse calls for a catheter order. This has caused multiple infections and other more severe problems. Now the hospitals will not be paid for the infections due to catheters. The Advisory Board released statistics that about 20% of catheterizations in the hospital setting are not needed. This could end up to be very expensive for the hospital and very good for the patients. Top
The Prime Hospital chain is playing tough with Kaiser patients. The hospitals take in the patients due to EMTALA and then have to take less than their costs for the care provided. The California law is that patients can be billed for care not paid by the patient's HMO but are not financially liable. The provider and the insurer must work it out. The insurer never pays and the provider is always stuck. Prime is now billing the patient for the difference between what Kaiser pays and the usual and customary charges. Kaiser has called patients and told them not to pay. Kaiser had been sued by Tenet for their low payments and reached a 50% settlement where Kaiser paid an additional $8 million.
The road to hell is paved by good intentions. An attorney do gooder filed a request in Connecticut to find out how often HMOs denied pharmacy requests to fill Medicaid prescriptions. Several HMOs refused to comply with the order to turn over the information and when pressed quit the state. The State has now signing up two other HMOs to take their place and who will abide by the state transparency rules. Slight problem. The HMOs have no infrastructure or providers. The State is now having to run the programs with the usual inability to do so. Since there are few HMOs the Medicaid patients will now be fee for service. The do gooder attorney has won. He did not want private sector involved in Medicaid and now there won't be.
The East Bay Business Journal reported that Kaiser Hospitals and Health Plan saw a 64% drop in net income in the first quarter this year due t investment losses. They had a $250 million net income this year versus almost $700 milli0n last year. They did have a small increase in operating income from $521 million last year to $546 million this year. They also had 25,000 new enrollees, not necessarily more members.
The East Bay Business Journal had another story regarding Kaiser. This one is on Kaiser adding self funding insurance to its arsenal. Large employers pay the bills of their own employees and only pay an insurer a fee for administering the claims. Kaiser is entering the market slowly for national accounts with over 500 employees such as Safeway. This goes with the switch nationally away from the HMO concept to a more user friendly product. The major problem with the idea from Kaiser's standpoint is its lack of national presence. Top
For those of you who love electronics, the news of identity theft should make you shudder. An article in the USA Today tells of those who are after financial information are working with those in hospitals and physician offices to get the needed information. In a recent survey of 263 providers, 13% had had a breach but only half of the providers had notified the people whose records were involved. California and Arkansas are the only two states that require patient notification if medical information is improperly accessed.
The UCLA privacy fiasco continues. California has now investigated and found many more breaches of privacy by the UCLA staff. Four of the 68 people named to date are physicians. UCLA has relooked at the policies, promised to retrain the staff and pledged to update security on the computer system. I feel sorry for Dave Feinberg who was recently hired for the computer job and then got the mess dropped on him.
Kaiser has completed its EHR for nationwide outpatients. This only cost about $4 Billion for installation plus an additional $1 Billion for maintenance. To date 13 of 36 inpatient programs have installed the costly system. Top
In a confusing article that attempts to make the case for single payor insurance by the use of the terrible med mal situation in New York state the only thing that comes through loud and strong is New York is imposing a $50,000 surcharge on all physicians to fund the state med mal insurance fund. This is on top of the regular premiums which are increasing 15 to 25% next year. Watch for a glut of early retirements in New York in the next several months.
Nest door to New York, the People's Republic of Massachusetts believes that physicians are in good shape with their med mal insurance. This shows what can be done with statistics and an evil mind. The Republic is fourth in the country in money outlay for med mal settlements due to their Democratic legislature refusing to do anything but the bidding of the Trial Lawyers. Now they have come out with the statistic that the physicians are paying less than they did in 1990 after adjusting for inflation. The article does not mention that fees have not only not kept up with inflation but dropped to the era of the 1970s making expenses much more dear. The state physicians do not believe it since they can not keep the physicians they train in the state. 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.