The Feds raided a medical marijuana farm in Santa Cruz, California and confiscated about 170 plants. These were owned by the patients as a cooperative and no one was ever charged. This is typical as the feds know that no jury would convict. The city of Santa Cruz decided to hold their own pot party and the supervisors smoked marijuana in public on one day to flaunt the federal law. No arrests were made. California allows medical use of marijuana but the feds do not. The US Supreme Court stated their could be no medical necessity defense for the use of marijuana but the California courts do not agree.
To add insult to injury the people arrested have now filed a motion against the Feds to get back their confiscated plants. The rationale was the raid was illegal under State law and the plants were seized illegally. This lawsuit cites US Supreme Court cases allowing State's Rights and is being led by a University professor. All newspaper op-ed pieces have been anti Feds, including one by the Mayor of Santa Cruz in the NY Times. The hearing on this motion will be November 4. Top
Alabama now only has one Level one trauma center at the state run University of Alabama at Birmingham. The other major trauma center closed on May 1, 2002 and is not planning to reopen in the near future. The closure was secondary to finances. This means the UAB hospital will lose over $100 million in uncompensated care expenses this year. They may also lose physicians as trauma surgeons and orthopedics.
Back to West Virginia where the once Level 1 Charleston trauma Center is continuing to attempt to get 24/7 orthopedic coverage. The medical center is now offering $2000 per day for call. There are other major problems at the center with anesthesiology, surgeons and invasive radiology call schedules. Top
In California, the San Jose/Good Samaritan Medical Group is about ready to fold. This San Jose Group has 100,000 patients. They are attempting to stem the tide but if they cannot then the private physicians and local ERs will bear the brunt. One of their clinic offices recently received an eviction notices due to unpaid rent. The most likely option is a Chapter 11 bankruptcy and reorganization. It's problems are both reduced payments and the opting of patients away from HMOs as well as the loss of jobs in Silicon Valley. The Clinics HMO population went from 90,000 to 60,000 in the past year.
Still in San Jose, Lifeguard HMO has been taken over by the state due to poor finances. The new conservator has decided to close down the HMO at year end. There is enough money to allow providers to be paid until that time. Most of the HMO patients are in the Silicon Valley region which has been hard hit by lay offs. This was a quality organization with high rankings on all scorecards, who turned down an offer from Blue Shield to join them. They are also the only HMO in the state to pay claims in the fee for service mode. After they fold there will only be Blue Shield and Kaiser as non profit HMOs in the state.
As the people leave the unaffordable Silicon Valley the Good Sam Hospital has reported a dramatic decrease in births. Good Sam has a second major problem, their OBs have dropped all managed care contracts. In their neonatal unit there has been a change from 80% admission from their own patients to 80% admission from patients outside of Good Sam. The OB group does not even contract with the employees of Good Sam insurer. These employees must go to other hospitals. Since the demise of Lifeguard HMO there will be less patients for the OBs and this will dictate to go after other contracts or give up OB.
In Pennsylvania, the Magellan health Services that oversee mental health care for Highmark is denying authorizations. The Allegheny County Medical Bulletin states that this is true for the high cost procedures of hospitalization. The editor also believes Highmark is not doing their homework and are only looking to the figures given to it by Magellan.
In Illinois, an large medical group went belly-up. The Meyer Medical Physicians Group went the Chapter 11 bankruptcy in May, 2002 and then closed its clinics abandoning their 100,000 patients. The worst part is the patients can not get their medical records and the state can not go after them since they are under Federal bankruptcy protection. The state can punish private physicians who abandon patients like this but can not punish individual physicians when a clinic goes under. Alexian Brothers Medical Center which owned the buildings of one of the closed clinics has begun to transfer the records at a cost of about $250,000.
In Ohio, the Department of Insurance will hopefully start the crackdown on the insurers who are not obeying the prompt payment law. Of course, the Department has had over a year to fix its web pages to reflect the new law and the new form physicians are to use, but have not. This may tell the physicians how much help they will get from their government. The new law give a 30 day window for the insurer to pay or pay 18% interest. The insurers can also be fined in the hundreds of thousands of dollars.
In Colorado, the Medical Association may bring legal action against HMOs for illegally denying claims. The HMOs that will be sued are Aetna, Cigna, Blue Cross/Shield and United. These have already been sued in Tennessee, Connecticut and New York. The State Medical Society Board does not recommend suing since the legislature passed two bills. The first prohibits the insurers from retroactively adjusting a claim based on eligibility if that eligibility had been check before the service. The other requires insurers to notify providers within 30 days if their claim needs more information. The insurers have 90 days to settle the claim.
After I wrote the above the Medical Association showed their true color, yellow. They instead will "monitor" compliance with state law and report at some future unnamed date to the county medical societies. One county medical society may break with the state society and join the Connecticut Medical Society law suit.
PacifiCare Medicare HMO has left the Houston, Texas area leaving those foolish physicians who only dealt with the HMO scrambling. This is what happens when one only has one major source of revenue.
In Louisiana, Amcare Health Plan HMO is broke and the state is taking over. This means the coverage ends September 30 or later if a judge gives time to try to sell the defunct HMO. It covers 28,000 people, mostly state and federal workers. Several months ago the Texas arm of the company was taken over by that state. United has agreed to take on the 9600 commercial patients.
Highmark Medicare HMO in Pennsylvania is going to triple the cost to be in the HMO. This means people will pay $36 per month for their insurance, up from $12. Aetna has already stated it will pull out of the west Pennsylvania area.
JAMA has reported that the low scoring HMOs are not continuing to report their scores to NCQA. This means the mean score for the HMOs across the board goes up, but not legitimately. About 15% of the plans are not telling their scores.
In 2001 health care spending went up about 10%. This is the largest increase in a decade. The majority is due to increase use of the hospital which wasn't supposed to happen under the HMO system. The economists forgot that hospital outpatient utilization is growing and is becoming more technical and expensive especially with the increasing use of outpatient surgery. It is interesting that the outpatient care accounted for 51% of the overall spending increase while pharmacy accounted for 21% and physician visits 28%. Interestingly, in the first six months this year the increase in healthcare premiums was only 8.8%. This is due to the greater amount being paid by the employee which causes a decrease in the demand for services. If it's free people want it but if they pay they think twice.
Even the no for profit plan Kaiser needs to make a living. It has dropped the Oregon Medicaid plan. Kaiser is the third one to leave in three years. Kaiser expects a $18 million loss this year on the plan. There is still one plan in the state but it dropped its enrollment to 7400, only 1/4 of what it was. Top
West Virginia rural hospitals have gotten together to form a cooperative for malpractice insurance. They did a study and found they were being charged in the past 10 years between $800,000 to $1 million. Their outlay was only $400,000 in the same period. the new company will pay up to $250,000 per claim but can purchase more if they want.
In Florida the OBs are paying the largest premiums in the country, especially in South Florida. This is causing many OBs to give up the baby delivering business and stick to gynecology. The Orlando Sentinel had a commentary that mused that Florida may not be worth it for physicians in view of the high rates.
In Broward County Florida about 500 physicians rallied for lower premiums and tort reform. This will be fought out in the legislature next year as well as in Congress where the House has already passed a bill regarding tort reform but the Democratic trial lawyers paid Senate will not take up the bill.
In Ohio, where all of 50 doctors rallied for tort reform, there will be no tort reform. Even if there is a bill passed the Supreme Court will overturn it. The Ohio physicians are not concerned enough to come to a rally and the legislators see that apathy.
In Seattle, more physicians are giving up the high risk procedures such as OB due to malpractice premiums. The HHS states in a new report "Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs by Fixing our Medical Liability System" that 72% of the health care liability premium is spent on transaction costs such as legal, administration and related expenses. The Washington State Medical Assn. has passed a resolution to go to the legislature for tort reform. To date, 20% of OBs have stopped delivering babies. In the state the amount of claims have not risen dramatically but the per claim amount has wit a 43% increase. In 1989 the state Supreme Court declared unconstitutional a cap on non-economic damages. They have also declared unconstitutional a 8 year statute of limitations, although this may have been too long and not too short.
Mississippi has a physician owned insurance company, Mutual Assurance Co. This company is raising rates to its 2200 physicians by 45%. The raise was partly due to the trial lawyer's domination in the state. It is interesting that the legislature is meeting to help resolve the tort problem but will adjourn without a resolution prior to October1. They will then come back in special session to continue the debate but at a cost of $1500 per day for convening out of session. I'm sure that's only a coincidence. Top
Massachusetts continues to extend deadlines as the pharmacies continue to ignore them. The legislators originally thought a federal study showed that they were paying the pharmacies too much. A new study by the Feds showed the opposite. Stick foot in mouth. The state legislators are not bright. They continue to want proprietary information with no regard to the secrecy of it. If they got their feet out of their mouth and made more room in their skulls for brains, they may get the information.
In Minnesota, Blue Cross wants to cut pharmacy payments and the pharmacies are balking. About 1000 pharmacies have been told they will get reduced fees as of October 1. Many stores will cut their contact with the insurer. In about 120 communities there is only one pharmacy which means there will be no where for the patients to go. Blue Cross doesn't care. They expect enough to cave in so most members will get their drugs. Top
The Chicago Tribune reported on the Catholic hospitals that merge with secular hospitals. In one California hospital the still is a statute of Jesus, there is still a Mass every morning and the hospital can do no abortions or tubal ligations. In these hospitals there can be no talk of condoms for prevention of AIDS, no in-vitro fertilization nor emergency contraception in the case of rape. The latter has been overruled in California where the state has mandated, even in Catholic hospitals, the offering of emergency contraception in cases of rape. Last year the California attorney general would not allow the merger of a Catholic hospital with a for profit one until all restrictions had been removed. It was a first but probably not the last in the country. He also is going to sue Tenet Healthcare for agreeing to follow the old Catholic tenets at Freeman Hospital. Top
The Hunter Group, a noted turnaround group in Florida, has sold for big bucks ($25.4 million) to Navigant, a computer data management company. Hunter was noted for its coming in to an organization and kicking out the old CEO and putting in its own people at first temporarily but ending up to be a permanent position. Top
The pharmacy wars in the People's Republic of Massachusetts continue. This time it is a battle victory for the Republic. CVS and Brooks two of the three largest state pharmacies sent to the state their information but via a law firm to keep the information confidential. It will be interesting if the Republic will continue with their war on drug reimbursement with the information at hand and with the threat of the pharmacies dropping Medicaid over their head.
In a second article reviling the proposed cut a spokesman for the LTC pharmacies states they will lose significant amounts of money and will have to cut back on such things as delivery to the LTC units. The exemption for LTC pharmacies has already been vetoed by Gov. Not Too Swift. Top
Cleveland's University Hospitals had their 35 year old thoracic surgery program taken away as of 1/1/03. The accreditation withdrawal had to do with resident education. The hospitals are going to appeal. Earlier this year the hospital suspended its heart transplant program due to poor results. They also lost their lung transplant service when they fired the director after he went to the press regarding the poor quality of care at the hospital. There are law suits by the physicians fired going through the courts.
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.