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The Board of Trustees at the embattled Community Hospital in Ventura California is finally taking positive action to resolve its medical staff problems. The Board has fired the CEO. This is a good first step in the normalizing the relations with the staff. The hospital attorney still must be replaced as does the Vice President of Medical Affairs. The Board must also rescind all the onerous resolutions passed, involve the staff in the choosing of the radiologists and return the money stolen by them to the rightful owner, the medical staff. Until all the above is done the physicians will continue to practice at other hospitals. The longer they go to the other hospital, the less likely they will return. They currently have a significant amount of their ORs closed daily. The law suit against the hospital should continue until the issues are resolved.
Not only should the law suit continue but the judge ruled it may. For the second time in several months the judge ruled the medical staff's case against the hospital may proceed. He states that under California law the medical staff is a separate entity from the hospital unlike the erroneous decision a year ago in the East. The hospital immediately authorized its attorneys to settle the case.
Now that some of the contention at the hospital has eased Santa Paula Hospital a financially troubled public hospital is in talks with Community Hospital regarding some type of affiliation. Community had broached this earlier in the year but Santa Paula had not considered it due to the contentious nature at Community Hospital. The city of Santa Paula is attempting to force Santa Paula Memorial into an affiliation with the County health system.
For those of you who are interested in knowing more about the subject of economic credentialing I recommend the recent article in the September Health Lawyer News by Cindy Reise. Top
Thar's a fight in the Tennessee hills. A new HCA hospital is opening next month in Rutherford County. The other hospital in the county wants to put a outpatient surgical center across the road from the new hospital. For some reason HCA is objecting to the move.
In Dayton, Ohio, the Dayton Heart Center is now four years old. It is a joint venture between MedCath and physicians. It has an ED. The other hospitals of the city continue to have increased revenues and profits. The other area hospitals actually send their patients to the Dayton Heart Hospital. The naysayers continue by stating maybe one hospital doesn't make a difference but what if others come in. They state this despite their own increase in profits, but maybe not enough for them.
In Ohio there is a race to get all the potential specialty hospitals registered with an intent to build prior to the taking place of the new moratorium on specialty hospital building. There are 56 new hospitals that to date have applied for permission under the old law and only require local approval. The legislature passed the moratorium as of September 15, thereby forcing all that were considering the idea to file prior to that date. Any hospital that did not file a notice of intent by that date were required to wait another two years to file.
In Norwood, Ohio, the city council has given the green light for a new specialty heart hospital. The suburb of Cincinnati is to be the place for the building of the hospital and medical office buildings by the Ohio Heart Health Center. The hospital is asking for tax breaks as incentive to build the hospital in Norwood.
A week after Norwood acted, the town of Sharonville agreed to a 10 year tax abatement and a $2.7 million land acquisition for the Ohio Heart to move there.
Colorado has a problem in Durango between the general hospital and a surgical center that has applied for a mini hospital status. The hospital is using the same tired arguments that they need the money to offset their money losing services. They do not address the reason for the money losing services is their own inability to negotiate better rates with insurers. Since they can not do their own best, the hospital is asking the legislature to do their dirty work for them. The physicians who own the current surgical center believe as do most physicians that specialty hospitals can deliver care faster, cheaper and with better quality than general hospitals. The hospital wants to shut down the new player since they can make more money due to lack of regulations but the new hospitals state the old hospitals want to run a monopoly. The new Durango hospital will offer ED services just as the old hospital does. The AHA is attempting to look for instances of skimming of patients but to date have been unsuccessful. They have found one area in the entire country that a hospital has been hurt by competition, not a major problem in the US.
The AHA continues it fight in the US Congress to stop allowing physicians to refer to hospitals where they own a piece of the action. They are paying their Democratic friends a bunch of money to attempt to get this through. There are two sides; one is that it may not be ethical to refer to something you own and the other is free trade and competition leads to better care. In this case since most physicians only hold about 2% of the hospital investment the ethical portion pales compared to the potential good for the patient. The hospitals continue to argue the specialty hospitals will only take insured patients but have no data to back up the claim. It is strictly a scare tactic.
The GAO has recently released a report that shows specialty hospitals do serve a smaller percentage of Medicaid patients and are less likely to have emergency rooms than traditional hospitals. The timing of the report is suspect since the House Senate conference committee on Medicare reform is considering stopping the ability of physicians to refer to hospitals they have a financial interest in. The report does show that the specialty hospitals are taking those with no insurance and Medicaid.
Some small hospitals are so spooked with the ideal of specialty hospitals that they are putting pressure on their city councils to forbid the building of specialty surgical centers or hospitals even though none are being thought of for their area.
Seattle is gearing up to either embrace or hate a new specialty specialty hospital. A group of 17 physicians want approval to build a new 15 bed orthopedic and neurological surgical hospital. For the usual reasons the Washington Hospital Association is against the idea. They have no data to support their allegations that the new hospital will cherry pick the patients. They also state that the hospital will have no ED and therefore will not treat their share of indigent patients. The hospital agrees that it would be foolhardy to put a full service ED in a 15 bed facility. A consultant has stated that if the specialty hospital goes up it will cost each of the area's hospitals about 1.8% in revenue loss. It take about 15% loss to jeopardize any hospital services. Top
California hospitals will have to pay about $900 million more for nurses. The cause is the ill thought out proposal for absolute nurse patient ratios based on where the unit is and not on need. The state is now 5000 nurses short of the number needed to come up to the required number. If they don't get them, the hospitals will either have to pay a fine or close parts of the hospital.
The elite Massachusetts hospitals have in the past three years increased their medical errors by over 30%. The most frequent preventable injury was patient falls. They also still have wrong side surgery and foreign objects left in patients. Is this better reporting or truly more errors nobody knows. The nurses unions state that nurses are caring for up to six or eight patients when they should only be caring for four. It sounds like they want the California ratio model but with less patients per nurse.
Simi Hospital in California has removed its ED physicians immediately and replaced them with another medical service. The reason for quick departure was due to a report to the DHS that the hospital refused admittance to six uninsured psychiatric patients even though the hospital had available beds. The hospital had to submit a plan of correction. This may lead to a law suit of retaliation and wrongful termination even though the contract had expired.
In Pennsylvania's Abington Hospital the administrator disciplined several nursing supervisors who followed a patient's request to keep all Black employees out of her room and that only white staffers help in the delivery of her baby. The hospital wanted to avoid a conflict with the patient's husband who was adamant regarding no Blacks being allowed. What they did instead was to anger their own employees and the whole community.
In Kentucky's Norton Audubon Hospital 14 nurses were fired and nine others were disciplined for giving sedation medication without a physician order. The nurses gave Diprivan, a short duration and fast acting sedative to those with respirators. The nurses did it on their own so as not to bother the physicians on call. They were working outside the scope of their licenses and have been reported to the Nursing Board.
Using two year old data Palm Beach Garden's Med Center has been accused of having higher cardiovascular complications than its rivals. This was the basis for over 100 malpractice suits following open heart surgery at the hospital and the potential loss of its accreditation. The hospital has now been deemed clean by regulators. Top
The Chicago Tribune has another piece on physicians making money. The first one was about physicians now starting to charge like business people. This one is about the boutique practice of medicine. The story states that there are now about 150 of these practices in the US, definitely not a land swell. The criers state that this will not give health care to the poor. Do these people believe we do not have a two or three tiered system now. The high tier is for those willing to pay extra for either boutique care or better insurance, the second rationed care for HMOs and the third for uninsured and county hospital care. Even England, with its socialized system, has an opt out feature. The other European countries with their socialized medicine have an informal opt out called "money under the table". Only Canada does not have an opt out feature except for those who can afford to come to the US for their needed care. Many of the physicians who now do Boutique Medicine also keep some of their old patients as well but not all. This is the right of the physician to see who they wish to see as long as they do not do it on racial or other discriminatory patterns. Big clinics have also begun to do the concierge practices, including Palo Alto Clinic and Tufts.
In the northeast some physicians are waking up to the fact that their incomes are lower than their counterparts in other areas of the country. The rationale is high malpractice rates and low reimbursements. Some are now moving to other areas either physically or just their practices across state lines. Top
As all know by now, the Feds have clarified the EMTALA rules. The clarification states that inpatients are no longer covered under EMTALA except under very narrow circumstances. Also hospital owned ambulances are not covered if they are transporting patients to hospitals other than the owning hospital. The end of EMTALA is now after the MSE and stabilization of the acute condition so physicians are now off the hook for follow-up care under EMTALA but still may be under restrictive hospital generated by-laws. Physicians may now take call at more than one hospital at a time and may do elective surgery while on ED call. There never was a rule of three and when the hospital does not have a physician of a specialty on call they must make arrangements for the ED care of patients including transfers. There also is no more need to have off site clinics do MSE and stabilizations. They may just call 911.
As a corollary to EMTALA, insurers and treating physicians may be contacted during the MSE for information as long as the MSE is not being held up waiting for a reply. In New York there is a law that require insurers to pay for ED visits for patients depending on symptoms , not final diagnosis. A study showed that 40% of HMOs still put up roadblock to their patients obtaining ED care. The HMO group disputed the findings. Top
In a scathing editorial the Wall Street Journal blasted the past FDA head Kessler for being too political and not relying enough on evidence. The opinion came from the new FDA considering strongly the allowing of Silicone breast implants back on the market. There was never evidence that it caused any of the harms that the evil trial lawyers (consumer advocates) attributed to it. They cost the jobs of thousands and the collection of millions of dollars into their coffers before the debacle was finally stopped. The piece ends with the following statement "The real lesson here is that the robber barons who make up Trial Lawyers, Inc. are often far more toxic than the industries they purport to protect us from."
The New Jersey physicians are tired of strikes and instead are going door to door to encourage the voters to throw out the Democrats who are not voting for their tort reform. The program is being done in five districts. The Trial Lawyers state that the physicians will make house calls for votes but not for medical care. The State Senate voted for a $300,000 cap on non-economic damages but the Assembly has not acted on it and probably will not unless the composition is changed. In the past year 25% of the OB/GYNs in the state have either retired, left or altered their practice.
In Florida since the law was signed to stabilize malpractice decisions the insurance companies are attempting to look at their costs and determine next years premiums. Three new insurers either have or have applied to open offices in Florida. The trial lawyers are contemplating a law suit (what else?) to overturn the law.
Two groups of anesthesiologists in southern Illinois are losing their malpractice coverage. This was done by two different insurance companies. The hospitals the anesthesiologists cover will lose surgeries. In one of the hospitals a group of cardiologists also lost their malpractice insurance. This will come to head soon.
The only neurosurgeon in Independence, Missouri, is leaving town when his malpractice policy ends on October 31. This will essentially close the only trauma center in the county. They can technically remain open as a trauma center as long as they are actively recruiting another neurosurgeon but in reality they will not be one. This is the fourth trauma center to lose services in the past year. The neurosurgeon is moving to Billings, Montana.
About 200 Missouri physicians went to Kansas to rally for changes in the Missouri tort system. The legislature had passed a tort reform measure but the Governor vetoed it. Top
In western Pennsylvania HMOs apparently want out of the business. They are raising premiums between 30-55%. This will still only be $56 per month without prescriptions. If one wants drug benefits the premium will go to either $129 or $138 per month. This is almost what I pay for the most expensive Medigap plan and I have free access to any physician. This is the way insurers are getting out of the business of HMOs without formally dropping the program.
Aetna is proposing a tiered specialist system. It is based strictly on money and has no quality components. There is no incentive given to the physicians with no increase in pay to continue to hold down costs. They would hope to get more patients do to a lower co-pay. The specialists affected are OB/GYN, cardiology, cardiothoracic surgery, Gastroenterology, general surgery, and orthopedics. Aetna is going to use its own internal program to determine who would get the referrals. Of course, those with the most cost efficiency get lower co-pays and therefore lower payments. The incentive seems to be backwards.
Anthem Health of Connecticut is getting rid of approval for specialists. The members will have open access to all specialists for a two year period. They will still need approval from the PCP for out of network specialist exams.
In an amazing about face Kaiser Permanente is about to offer a PPO. They are pandering to their employers who are asking for more cost sharing of their employees. Kaiser will actually offer three new plans. The first is the standard HMO but with a deductible decided by the employer. The next is the PPO plan for people who don't want to use Kaiser physicians and want flexibility. The third is an MSO type plan. Blue Shield is also offering more flexible plans for the coming year.
Kaiser is also dropping brand name drugs from its formulary for Medicare patients and raise their co-payments. They will discontinue to pay for $1000 of both brand name and generic products and pay for an unlimited supply of generic only products. There will also be co-payments for the now free radiology and lab tests. Kaiser will also increase its co-pay for hospitalization from $500 per admission to $200 per day up to a cap of $3000. This means that if someone is hospitalized for more than several days the HMO would be more expensive than traditional Medicare. This is another reason why the HMO business is the worst business in the country for the consumer. Top
In one of the most blatant underpinnings of trust Oxford Health has audited hundreds of psychiatrists and other mental health professionals in the New York area. They have looked at the notes of the sessions with their patients and state that the notes do not justify the amounts charged. Psych professionals are taught not to put many aspects of the session in their notes so it may look like there was not enough justification to the bean counters. The company states that the notes were too short or did not have enough detail. The doctors state that Oxford has never told them what they expect in their notes. This may also end up in a messy court battle with the end result of therapists refusing to take Oxford patients. The company chose for the audits those therapists which have the heaviest volume of Oxford patients and therefore are the most vulnerable to coercion. Oxford wants repayment of significant amounts of money, up to $100,000, from the therapists.
Recently. the California lame duck governor signed SB 2 which mandated that employers either cover their workers for health benefits or pay into a pool (see Legislation). I recent article in the Washington Post has chronicled Hawaii's pay or play policy that has been in place for many years. The policy has led to an increase in the uninsured, the opposite of what was intended. They have gone from 2% to 10% of their population are uninsured. Prior to the 1974 law that mandated employer insurance the rate was 17%. Employers are hiring more part time employees to not pay for the required benefits. Will the same happen in California? Only the Shadow knows. Top
A woman in Connecticut has been charged with faking a nursing license for the past 15 years. She had worked in several hospitals as a LVN during that time. She was turned in by a temp nurse staffing agency who found an invalid license number. Top
For all you physicians out there, CMS has just announced a reduction in your pay by 4.5% for Medicare patients. This is only fair since your overhead is decreasing. I recommend you begin trimming your Medicare rosters or start charging for those services that have been free in the past.
In one of the dumbest proposals that has ever come out of the malpractice insurers, some are requiring physicians to fill out a three page questionnaire on communication skills in order to get renewed malpractice insurance. These exams may be the basis of premium reductions, increases or the inability to get insurance. This seems foolhardy to base the results on a self exam without other data. There is no question that communication problems is one of the main factors in determining who gets sued but this self exam is not the way to approach it. Insurance companies would do much better by attempting to have the physicians take classes is risk prevention which would include bettering of communication skills.
In the hard to believe category, the Business Journal of Jacksonville, Florida, has reported that Florida is short of cardiologists. They blame the shortage on many seniors in the state combined with the government's ill fated ten year attempt to control supply and demand by limiting the slots for cardiologists and others in residency programs. The other part of the problem is the large increase in trained general cardiologists opting for an additional year or two in training to become interventional cardiologists.
Pain management specialists rejoiced when the FDA voted to not put new restrictions on OxyContin. However, the same specialist now fear for their professional lives after the arrest of Dr. Hurwitz in Virginia on 49 counts of drug trafficking. He has also been charged in the deaths of three patients. (See Legislative Section for the new California statement on pain)
The Pittsburgh Gazette is running a series on the problems of hospitals not playing fair with their physicians. The first article on October 26, details how hospitals go after physicians with phony charges if the consider whistle blowing on the hospital. This is the reason for the recent increase in "disruptive physician" cases that have no merit. The article quotes the "large eastern firm" stating their is no problem. This firm works with hospitals because that's where the money is. The reporter didn't buy the "large eastern firm's" answer. The reporter went on to state in the next paragraph that doctors who question quality standards or practices can pay a steep personal and professional price. The physicians quoted by the reporter told of the hospital strong arm tactics and the loss of their practices and money when they have done nothing wrong. One of the physicians stated that the hospital believes it's better to cover up a problem so the public is kept in the dark. This is done by making sure the physician is discredited. The article goes on to state that the affected are not only physicians but also other health care workers. The first article then goes on to discuss the Federal law Health Care Quality Improvement Act (HCQIA) which allows hospitals to get away with the lying about physicians without worrying about any legal retaliation. This law was written in part by the "large Eastern law Firm".
In a second article on the first day of the series Mr. Twedt, the reporter who broke the story, talks about the problems between Dr. Thomas Kirby and University Hospitals in Cleveland, Ohio. He had started and ran the lung transplant program at the hospital which is associated with Case Western Reserve. During his stay at the hospital he found that the mortality for the cardiac surgery was double or triple the national average. On his investigation he found multiple deaths caused by shoddy medical care. All of a sudden he was disruptive and was demoted. He got caught between some of his less qualified colleagues and the administration who wanted more money for the hospital. The final straw was when he testified for a patient suing the hospital for its poor care. When he finally got a chance to get a "fair hearing", it was disbanded because Dr. Kirby's attorney found that two of the three people on the panel were on the panel that ordered his suspension. This is a "fair hearing"? He, like others in this series, were all exonerated by various state or national agencies who agreed with the original allegations. The physicians all are in ruins.
In the second article on October 27, the reporter goes into detail on the hospital lies and how they control the process and the legal process after their internal processes have humbled the "disruptive physician". The bottom line is not to fight for patient rights unless you are willing to lose your practice and reputation. (Please see my prior white paper on the Disruptive Physician on the main page of the web site.) One of the ways the playing field can and should be evened is to take the peer review process out of the hospital and into the hands of a neutral third party.
In another article on the second day of the series the case of a physician at Roper Hospital in Charleston, South Carolina, was aired. It showed how the hospital gave a physician a summary suspension for disruptive conduct after it knew he was only stepping to the plate for his patients against a poorly run hospital. Summary suspension should never be used in this context. It is only for quality concerns that might immediately negatively not positively impact patient care. The medical staff overturned the suspension but the physician was removed anyway and reported to the National Practitioner Data Bank (NPDB).
In the third day of the series, the Gazette talks about Centre County Hospital at State College, Penn. It discusses the anesthesiology department at the hospital and how the hospitals got rid of it critics, who they labeled as disruptive. The State agencies however agreed with the physicians. The doctors all sued the hospital and each won settlements. The hospital has now put in its bylaws verbiage to make it harder to complain about the lack of quality without getting thrown off the staff. This, of course, is exactly they wrong course to take.
In another day three story about the case of an alleged multiple murder by a nurse at the Columbia, Missouri, VA Hospital it has been revealed that the hospital was warned about the nurse but failed to investigate but did retaliate against the physicians who reported their suspicions. The nurse was too be tried but the evidence was faulty due to lab error.
In day four of the expose, the paper talks about one o the fired Centre Hospital physicians who became president of the Pennsylvania Medical Society and began the push for an independent state commission with subpoena powers to oversee the peer review process. It is being opposed by the hospital association who want each hospital to keep control and get rid of those who call for better patient care.
In another day four article the paper takes on the HCQIA and its unfairness to the physicians. It talks about two attorneys who believe the fight needs to go to Congress to overturn the law. The article talks about a nephrologist in Maryland's Harford Hospital who lost her position after complaining about the care at her hospital. The letter telling her of her non-rehiring stated the cause was not the clinical care but her uncooperative attitude. The state cleared her, but the hospital sent a report to the National Practitioner Data Bank. The lower and 4th Circuit both agreed with the decision since the medical community is best equipped to conduct the balancing of medical resource allocations including whether or not to re-hire a whistleblower.
The next article describes the National Practitioner Data Bank ( NPDB) and the problems physicians face in getting erroneous reports erased. The case in this article in about a physician in San Francisco who was reported to the NPDB after he was notified of an investigation against him. It happened to come one week after he raised concerns about the care in the hospital. The case is still in the courts.
The Nassau County Health Agency fired 35 physicians due to cost cutting of about $6 million. These were mostly pediatricians in the community health centers. The new acting medical director stated the physicians were terminated with no warning due to either not seeing enough patients or disloyalty for sending some patients to hospitals other than the county medical center. Who says economic credentialing doesn't exist?
After the firing of the physicians, two of the other chiefs resigned in protest and the chief of the agency that did the firing is now in the process of being ousted. The State Ethics Commission has also charged that the agency including the chief have accepted gifts from companies who wanted no-bid contracts. If he leaves the agency chief may get $700,000 in severance pay. He has a future ahead of him in hospital management. Top
UCSF sends its medical transcription overseas. It got a rude awakening when a Pakistani clerical worker threatened to post medical records on the web unless she received more money. UCSF actually outsourced its work to a nearby company who continued the outsourcing until it landed in Pakistan. Neither the university nor the primary contractee knew the information was actually going overseas. It is estimated that about 10% of all transcription work is done overseas. When contacted about the threat the transcriptionist, who is a physician, replied she would never carry out the threat but was only trying to get her pay from the Texas person who sub-contracted the work to her. Top
The use of emergency rooms are not the entire province of the uninsured. A new report states that the insured are using them in increasing numbers. Between 1997 and 2000 there was a total jump in ED visits of 16% with a rise in the use by privately insured patients of 24%. This included a rise of 10% in Medicare patients. The potential reason is the inability of physician offices to see patients after working hours, closing their practices to new patients and long waits for appointments. It appears that patients will pay more deductible for the ED visit since they can see a physician, get lab tests and the reports of same in one visit instead of three separate visits. They miss less of work time.
The University of Colorado emergency rooms have been accused of turning away Medicaid patients or they have been made to wait long times for appointments to the clinics. Each separate clinic is allowed to determine how many Medicare or Medicaid patients they will see and put them on the waiting lists which may be up to eight months. This is due to the fact that the clinic must pay their own expenses including physician salaries. Medicare and Medicaid do not pay enough to pay the expenses. The hospital is a Hill-Burton hospital and potentially may be fined for differential treatment by insurance. The hospital states it is not a Hill-Burton facility. Top
In a recent BBC News there is an article the Health Secretary responding to criticism by the Royal College of Radiologists stating they are understaffed and are in need of new equipment stated that death rates are falling about 10%. The Secretary wants to know why the women are treated differently in different parts of the country. The Secretary is also asking why women in one part of the country have access to Herceptin but this is not true in another. This is what the people who favor single payor system wants here in the Colonies. Top
The American Medical Student Association has pushed through a proposal to make the matching process more open starting in 2005. This will allow better comparisons of salaries, working conditions and benefits. This will not affect the ongoing suit against MATCH.
Martin Luther King Hospital in Los Angeles will have a two year reprieve to get its problems fixed or lose all its residency programs. They still lose their surgery and radiology programs next year. Top
California's lame duck Governor Davis has appointed all the judges he could before leaving office and is now appointing his political friends to high paying low-work jobs. He is appointing his chief of staff and his appointments secretary to a state medical board that reviews Medicaid contracts that meets twice monthly. The pay is $99,000 a year part time. The two appointees have no knowledge of any medical issues. If the state voters want to know why the state Medicaid program is failing, maybe they should start to look here. The Governor also appointed others to the Regional Water Quality Boards at $114,000 per year. I guess it's OK to appoint them since they do drink water. 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.