The seven hospital Alegent Health System of Omaha, Nebraska, has done a major overhaul of its system and hospitals. The reason is physician discontent. The physicians had complained to the state and federal officials of the exclusion of the medical staff from decisions affecting patients. One of remaining nine positions of the original 23 is the office of chief medical officer. That job will no longer be to sell the programs of the system to the physicians but now to represent the physicians. Each of the hospitals will also now have medical officers. all of the officers are expected to provide unfiltered comments to the hospital folk.
In California, the Downey Regional Medical Center has been added to the growing list of hospitals that have refused to contract with Medicaid. This means that they will no longer do elective cases on Medicaid members but will see them as emergencies as required under EMTALA. The reason is simple, money. The money paid is not enough for the care. The hospital had 18% Medicaid and losing money on them. They are also considering quitting the 911 system to decrease the uncompensated care given in the ED.
An edition of this newsletter would not be complete without news from the Los Angeles County Hospitals. The JCAHO has pulled a surprise inspection on all four county hospitals. these are the USC Center, UCLA Center at Harbor and at Olive View and Rancho Los Amigos Rehab. This came days after the Joint's CEO sent a scathing letter to the County Board blaming them for the problems at the dreaded Drew/King Center. The raid is to assess the quality of care at the remaining County hospitals. There is a rumor that the embattled Health Service Director invited the inspection. O Leary also agreed that the trauma center should be closed. The Supervisor in whose district the King/Drew Hospital lies is continuing to blame others for her mistakes.
Yet another hospital, the tenth in California and the 9th in LA is closing its ER. Suburban Medical Center is changing its ER to an urgent care facility.
Several years ago the powers in the People's Republic of Massachusetts allowed community hospitals to start to perform open heart surgery. The first several years have shown no difference between the community hospitals and the ivory towers in mortality rates. The community hospitals are still only doing the simple procedures and will slowly get into the more complicated ones. There is no data on any other parameters than mortality.
In Lourdes Medical Center of Burlington County, New Jersey, the union nurses are still on strike after six months. No talks are scheduled. The hospital has replaced the strikers with temp nurses at a higher rate. The nurses are fortunate that there is a shortage as most have found other part time or full tie jobs. The union doesn't care as long as they get their dues.
In Florida, Sarasota Memorial Hospital had an unannounced survey and flunked. The hospital has been the target of sloppy medical procedures in the past and again now. This time they even had nurses giving shots drawn up by other nurses. This visit generated a 54 page report. They have hired a Director of Patient Safety, retrain its nurses and make a myriad of other changes.
MedPAC, studying the specialty hospital situation under the Medicare Modernization Act, has stated that specialty hospitals, like all hospitals attempt to get the favorable selection of patients. The main report will be issued in March, 2005, just before the moratorium should expire in June, 2005. Top
The New York Times has run an article about the problems of physicians treating pain patients. It tells of the problems with Dr. Frank Fisher of Shasta County, California, who lost his medical license, house, practice and five months of his life in jail for the incompetent work of the authorities. He was accused of killing five patients by giving them too much pain medicine. It was later determined that the five died of other causes. He now has all his life back. This shows what can happen to physicians who prescribe pain meds to patients. It also shows the zeal of the prosecutors and the misinformation they have and give to juries. The DEA had on its website a well done article on pain and narcotics and when the narcs should go after physicians. It was later abruptly pulled stating it had misstatements. In reality the document could have been used against the feds in trials against physicians. If a physician does specialize in pain relief they are targeted by both patients and the regulators. AAPS has advised its members not to do pain control lest the physician become harassed and broke. (See Legislation)
In a typical use of a cleaver instead of a scalpel, the USA Today has a story on one medical student who killed his wife and himself. He had lied on his admission form stating he had no felonies or misdemeanors when he had a conviction of a plea down to a Class A misdemeanor. The story states that maybe all schools should do background criminal checks on all students they are planning to accept. A background check by the paper did not turn up any problems with the student but when they checked on line they found the old criminal files. Does that mean that anyone with a criminal event can not be a good physician? Does one event impugn the integrity of a person their whole life? There is no doubt that some get through the process and become good productive members of the community as a physician.
Concierge Medicine is now slowly spreading to the specialties. Some pediatricians and cardiologists are now utilizing the methodology. The pediatricians ill charge extra for the parents having the luxury of a call back within fifteen minutes, longer appointments and same day appointments. Cardiologists also end up with many long term patients and become their de facto primary care physician. They charge for allowing the patient the same services as the pediatricians.
Patients are also being asked to help pay malpractice payments. One doctor in Connecticut charged each patient $3. This is now become a voluntary surcharge since physicians are not allowed to bill Medicare patients more than the allowed. If the patients don't pay the physician must make the decision to continue to see HMO and Medicare patients or not.
Some groups are also billing for paper work. This includes calling in refills, filling out medical forms and other things they do that are not covered. Some of the annual charges are up to $40 for an individual, $50 for couples and $60 for families. This is what happens when free enterprise goes away. The power of supply and demand no long is operational in the industry and some physicians need to do this to keep open. Some of the fees are voluntary and if they don't pay the annual fees they get charged an amount for each individual service.
Appalachia is short of physicians. One is being forced to leave due to a non-compete clause that states he can not practice with fifty miles of any Appalachian Regional Hospital. The system has multiple hospitals throughout Appalachia so away he goes. The physician, an OB/GYN, left one of the hospitals because of the hospital reneging on their contract to provide an ultrasound machine and competent anesthesia. The clause is being challenged in court.
California physicians are the recipients via the health insurers and the IPAs $50 million in pay for performance bonuses. The six insurers have also paid about an additional $50 million for pay for performance but tied to the group payout.
The AAPS and the Pennsylvania Medical Society have decided individually to investigated the hospital's use of the disruptive label on physicians who work for better patient care. California and Oregon are also looking into the problem.
The San Francisco Business times has an article on Kaiser's recruiting of physicians. They are going gangbusters. About 14,000 physicians have applied for a position in the past five years. This is in a state where most coming in to practice cannot afford to buy a home. In the past three years over 2300 full and part time physicians have been hired in northern California. Forty percent of the new hires are from existing practices and the rest are the newbies. The small practices and groups can not compete but the large groups can compete very well. Even with the new physicians Kaiser is still stuck with its worst enemy, Kaiser.
In a recent study it was found that those physicians who are allowed to get enough rest make fewer mistakes. This shows that working resident physicians long hours is going against patient safety. Top
In interesting study by UCSF has shown that over 80% of those in EDs have insurance and a physician. There were on difference between those with insurance and those without in having emergencies. What the study did not state is the disparity in the population of the EDs depending on where they are located. This is what is forcing the hospital EDs to close. Top
In Maryland, the Governor and legislative leaders are attempting to decide whether to call a special session of the legislature. In the meantime six legislators including two top Democrats are backing the medical society reform package. The package is basically the same as the one that went down last year in the Democratic controlled Senate. It calls for limits on non-economic damages and on attorney fees.
The Baltimore Business Journal has reported the difficulty Maryland has in recruiting new physicians. this is directly due to the malpractice climate in the state.
The Coalition of Affordable Healthcare in Wyoming just released a report that capping of non-economic damages at $250,000 led to a 15% decrease in malpractice payouts.
In a national survey of physicians about 86% agreed that there should be national malpractice policy via federal law. Top
In the November 2 election three states will vote on medical marijuana. Alaska, Montana and Oregon will all vote on the issue. Alaska will decide whether or not to decriminalize marijuana for al adults not just medically needy ones. Oregon will vote on expanding their existing medical marijuana laws. Montana will vote on starting a medical marijuana law.
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.