November 15, 2004 News

Kaiser, The Future?





Kaiser, The Future?

The New York Times asks the above question in two articles.  In the two articles, the evenly balanced pieces describes the positives of the use of technology, the alignments of incentives with its less money spending per patient and the emphasis on preventive medicine.  It also states the negatives of the attempt to fit one size fits all, the lack of the ability to see outside physicians, the impersonal and non-caring of its pay no matter what physicians and administrators.  The articles also state the large amount of physicians that want to work for the HMO.  The secret is to find physicians that will buy in to the Kaiser culture.  Kaiser has attempted and failed in their using outside physicians for their patients.  They don't follow the Kaiser rules and think independently, a no no at the HMO. The articles also describe the fee for service world but of course that does not exist anymore.  It also denigrates the fee for service world as one that doesn't practice preventative medicine.  That is not true.  A good physician is a good physician no matter in which system he/she practices. There is no doubt that Kaiser is a good model and they do great work with IT, but they still have the problem of the physicians who get paid on salary and many of which are only interested in their paycheck and year end bonus.  The articles do not mention the Kaiser cross-over of the physicians needing to pay the insurance arm when the insurance arm loses money and the Permanente physician arm makes money and vice versa.          Top


The Pacific Business Journal has an article on the beginning of the significant loss of primary care physicians as more Hawaii graduates go into specialization.  The specialist make more and work less.  They have more predictable hours with less paperwork than their primary counterparts.  One of the major reasons beside the obvious want of a family life is the large loans that are present when they start practice.  The average loan for a medical student when they finish is over $100,000. 

The IT field is coming into the ICU.  A new device called eICU is on the march.  It allows sophisticated monitoring systems at the bedside to transmit information to a central monitor manned by an intensivist and a nurse.  The interesting thing is that these people don't need to be at the same hospitals as the patient.  They can monitor multiple sites from one central location.  This may be helpful with the still sparse intensivist population.  The statistics to date seem to pint to a shorter ICU stay and better outcomes when the device is in place.   

The largest physician group in Oregon has decided to help keep physicians in the state.  The Oregon Medical Society House of Delegates decided to help more Oregonians get a medical degree.  They have asked the University to take more in-state students and provide more scholarships. 

The ABMS has decided on a new specialty recredentialing process.  The new process will be more continuous than the current every 6-10 year reexamination.   

In Wyoming, the turnover of physicians is very high.  This year 51 physicians have left and there are currently 115 vacancies.  One county only has one general surgeon.  The state will continue to have difficulty recruiting since their malpractice proposition was turned down by the electorate this year. 

The American Assn. of Family Practice House of Delegates has voted to ask for money when writing prescriptions due to formulary changes or filling out insurance forms. They also feel they should be compensated for their coordination of care with other physicians.  The physician is one of the last that do not get compensated for their time, energy, and liability risk.

The Philadelphia Business Journal has an article on the growth of concierge practices in the area.  They state that about 1000 people have signed up for the programs.  

In the Buffalo, New York area three cardiac surgeons who did not agree with Kaleida Health's plan to consolidate services have left to join  rival Erie County Medical Center. The three had been stripped of their privileges under the economic credentialing of Kaleida.  There is currently a suit between the physician and Kaleida.  The surgeons state the hospital system refused to allow them to operate on sick patients in order to boost the hospital statistics.  The three were allowed on appeal to keep their thoracic and pacemaker privileges.  They had done about 1/3 of the cardiac surgery at the institution. over 1000 per year.    Top


In a prelude to lawsuits, Putnam General Hospital in Hurricane, West Virginia, has sent a notification to about 1400 patients that it messed up its sterilization of endoscopes.  This seems to be a more common occurrence with endoscopes and neurosurgical instruments.  The patients have been offered free counseling and blood tests.  

San Jose Hospital in California, has decided to stop taking straight Medicaid patients unless they are emergencies or via some third party intermediaries.  

In Massachusetts, the hospitals are having difficulty finding all positions.  This includes some physicians, nurses and technicians.  The problems are the lack of nursing instructors, the malpractice climate and the high cost of living.  Some of the problems could be curtailed by not demanding nurses teach nurses, and med mal reform.  Neither of which will happen in the near term in the state.  

One of the first specialty heart hospitals in the country is no more.  The MedCath facility in Glendale Wisconsin has been sold to a local hospital.  The specialty hospital did not get the business to sustain operations. There are already a large amount of cardiac beds in the Milwaukee area.

As one specialty hospital is sold, another opens.  In Southlake, Texas, a specialty hospital with six bed, four suites and diagnostic equipment is opening.  The hospital will be an orthopedic, pain management, GYN  surgery ENT, and plastics hospital.  It is a joint venture between 40 physicians and Harris Methodist hospital.

Tenet has sold a Los Angeles hospital to a group of fertility treatment physicians.  The hospital is the 434 bed Hollywood Presbyterian Medical Center.  The hospital will be kept full service and with an ED. 

If one looks in this edition, one would find the name King/Drew appears in several places.  This poorly run county facility in LA wants to close its trauma service.  The County Board screwed up.  They had a meeting that did not conform to the open hearing law of the state.  They then voted in open forum on the closure.  They got their collective hands slapped but the vote still holds. 

California Hospital in downtown LA is opening up a trauma unit.  This is a prerequisite for King Drew to be shut down.  This requires the county board's approval.  Top


In a recent article, the Associated Press wrote an article regarding the better results in med mal situations if the physician takes the time to sit down and explain adverse situations to the patient r the family.  There are less suits filed and less money recovered.   

In Missouri, the amount of suits has dropped significantly in 2003.  Payouts went up 14% from 2000 to 2003 but premiums went up 121%.  This came from the Department of Insurance.  One of the problems with the report is that it does not include any self insured institutions like two of the largest in the state, Tenet and BJC.  

In Florida, a recent poll of rural physicians showed that 53% had cut back on offered services over the past year due to the med mal climate.      Top


Cigna is back to its old tricks.  Cigna has long been known for its miserly ways and settled with physicians for a significant amount of money due to this.  They also are in deep financial problems with the loss of many subscribers to their remaining healthcare unit.  Now they are involved with shady operations using durable medical equipment.  They negotiated a contract with a company Gentiva to keep their DME costs down.  Gentiva recommended a company called Dana for diabetic insulin pumps.  When patients or physicians requested Medtronic or other pumps rather than the Dana pump, they had to fax their request or talk to fictitious people at Dana.  These people, under orders from Dana, lied to the patients and physicians stating they were benefit people, not Dana employees. Dana has since been removed from Cigna DME suppliers but Gentiva remains.  As long as Cigna attempts to chop expenses at the expense of their customers, they will continue to lose market share and their recent 90% cut in their dividend will be just the beginning. Hopefully, they will go the way of Enron and just wave bye-bye.       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.