I have written frequently about the duplication of care at VA facilities with the waste of money. I have often stated that in my opinion as a veteran that those that served the country would be better off in the private sector under Medicare and with full pharmaceutical and rehabilitation benefits. Recently the VA again appealed to Congress for more money for their screw-ups in the computers that they purchased. There was an independent committee set up to make recommendations regarding the computers. The VA does not want to abide by the number one recommendation of the committee but wants to do another lower recommendation. The Congress is not happy with the VA since they have already spent over $2 Billion on failed computer projects. The committee also found that the VA accounting was in shambles. Anybody who has worked at the VA can attest to that fact. There is no central IT office but multiple regional offices.
On top of the above is the government attempts to give Vista Office Electronic Health Record software to the nation's physicians. This has been delayed several times due to SNAFUs. If one doesn't know what those letters stand for they should ask their colleagues who have been in the service. Vista is the VA computer system (see above story). The physicians will be given the system but must pay a nominal $2700 for site licenses for the data base. Top
The proposed takeover of PacifiCare by United has run into a snag. The California Treasurer has asked the Governor and the state's pension funds to oppose the deal. The reason, the massive amount of money the executives of PacifiCare are going to receive if this goes through. If the executives don't change their stance they may foul the whole deal. All they have to do is delay their stock options and decrease some of the money to more reasonable levels. The executives state and rightly so that their payments are on par with other industries. The problem is healthcare is not viewed as the other industries, even though it is the same.
The Missouri HMOs are following the same trend as the rest of the country, losing business. All the state's HMOs dropped over 10% in population with stagnant revenue. United lost 45% of its patients and its state revenue went down 36%. The HMO concept is dead as patients finally figured out they wanted choice and that HMOs are not saving money.
Kaiser Health Plan has done it again. Another HIPAA breach. This time in Colorado where they inadvertently sent the Kaiser numbers on their quarterly newsletter mailings. This should cost them the maximum of $25,000.
Kaiser also has a new program to teach their physicians how to cram more appointments into the overcrowded schedules. It involves teaching the physicians not to chit chat but to get to the crux of the problem quickly. It is called the four habits and has been around for over 15 years. These are quickly developing a close rapport with the patient, drawing out and prioritizing complaints, exploring the problems from the patient's perspective and expressing empathy to engage patients in joint decision making about treatment. There should be eight questions asked. These are what patients call their ailments, when and why they believe the ailments started, what challenges or hardships the ailment presents to them, what they fear most about the ailment. The program is to teach the physicians how to make the most out of less patient encounter time. For those who compete with Kaiser this program should be a boon.
In an interesting story regarding the new TennCare, the physician taking care of a patient who passed away filled out the death certificate with a contributing cause of death of lack of needed medications. The other side is that he was in the hospitals an received all requested medicines and died several days after discharge. The patient was extremely ill and would have died soon even if he took all his meds. Both sides of the political fight that took place over the past six months blame each other.
TennCare has also hired and not utilized 120 attorneys for the expected appeals that never materialized. This is utterly stupid. They can hire as needed as there are more attorneys than jobs.
In central California the Medicaid patients with fee for service can not find any specialists to take care of them. All know about the problem but the state will not pay anymore money so patients are being sent over a hundred miles away for care. The state is hopefully solving the problem by shunting all Medicaid patients to HMOs where they must be provided with specialist care. Of course, the very few specialists that join the HMO are those not busy in private practice and are looking for any income.
Some Palm Beach pediatricians are limiting the flu and other immunizations they give their patients due to poor reimbursement. The immunizations to the Blue Cross HMO patients will not be given. The flu shots cost the office $18-$20 per dose and the HMO is not reimbursing that much. The pediatricians can not legally get any difference from the patients so they are not willing to lose money for the insurer. This throws the burden of school required immunizations to the health department.
In the first type of Medicaid reform, the liberal Vermont has begun to cap federal funding over the next five years. This gives more flexibility to the state. Top
The countries physicians are not rushing to purchase electronic medical records. According to MGMA only 12% of the practices with 5 or less physicians have EMR. With 6-10 physicians the rate rises to 15%. Even the large groups of over 20 physicians have only a 20% EMR rate. Most have no immediate plans for purchasing the EMR either. Why? The costs and the lack of trust in the government or the insurers to increase payments to cover the costs. This is the only major industry that does not run on supply and demand.
In Baltimore two groups of Obstetricians left their hospitals due to cheaper malpractice rates at their new hospitals who also own their own med mal companies. The switch saved each group six figures.
Tennessee may be finally getting the message. The physicians are getting a head start on working the legislators prior to the start of the session. As of now many OBs are not delivering babies and the state is losing their medical school graduates.
With payment capped and expenses rising, physicians are starting to look at other avenues of income. This is especially true in the franchise business for skin care and related businesses.
Washington, DC is in trouble. Almost 20% of the physicians are quitting the city due to the high rate of med mal insurance. As the city counsel opposes caps on non economic damages they will continue to lose their physicians until it is too late to have any return.
Dr. Terry Bennett, the physician who called a fat woman fat is now the recipient of a defense fund for his fight against the ridiculous Medical Board. He plans on taking the Board to Court to make sure he has all the protections of other people except physicians. Top
In a political fight for his position the mayor of New Orleans has started to allow some people to return. The US Coast Guard and the JCAHO are attempting to tell the mayor not to allow the populace back in. There are no hospitals, no drinking water and the muck is disease laden. So far, this has made no dent in the mayor's plans. That is until Rita showed up. This gave the mayor the chance to reverse his mouth.
The Democratic coalition of labor and patient advocacy groups has asked the Democratic California Attorney General to investigate Sutter Health. Sutter will not allow the coalition to organize in their facilities has been accused of making excessive profits, aggressive debt collection and not providing enough charitable care. These are all bogus claims. A non profit can make as much as it can as Kaiser has shown. The hospitals are entitled to use all legal methods to collect debts owed. Every time a no pay comes to the ED the hospital provide charitable care. Top
As usual, I will start with Drew/King. This time it has to do with the alleged double billing by Navigant, the firm hired to get the bad hospital turned around. The auditors have found the double billing in plane fares and other billable items. The County is to reject $300,000 of Negligent's submitted expenses of $1.3 million.
Now Negligent Consulting is being accused of not completing the work it was supposed to do. It has refused to turn over the results of a practice inspection. The other screw ups are not completing nurse evaluations, not having the hospital ready for accreditation in any area and only doing less than half of the recommended urgent changes in its bailiwick.
The hospital is your friend! In Chalmette, Louisiana, the nurses and staff of Chalmette Medical Center stayed at their peril during Katrina. They felt they had an obligation to their patients and the hospital had ordered them to stay. Now the owner of the hospital, Pennsylvania based Universal Health Services has given their employees at the hospital a two week notice. The miserly hospital management system also gave pink slips to a total of 1900 other employees at two other hospitals. They are also canceling their health insurance after one month. It is doubtful if the hospitals reopen that they will find first class staff due to their callousness.
On the flip side of the coin, San Francisco's CPMC has a strike by the union and has hired Katrina evacuees to fill in for the strikers. The fill-ins have been told that after the strike they will be encouraged to stay and apply for a job.
Speaking of closures, it is truly a sad day when two of the best teaching hospitals in the country are considering closing forever or at least for many years. Charity and University Hospitals in New Orleans have been so devastated by the floods that it appears that they will not reopen.
Stuart Hospital in Palm Beach should be commended. They did an inspection of their surgical room vents and found condensation. They prophylacticly shut down two ORs until they had done the proper tests and found the ORs safe.
For those of you who have not read anything by Joe Flower, the futurist, he is always thought provoking. In his latest short article in Hospitals and Health Networks he writes about the power of the consumer. He discusses consumer directed health plans and how they empower the consumer who is paying the premium. He believes that these will continue increase exponentially over the next five years. He also warns community hospitals to stop their whining and look how to position themselves for the change in consumerism. He believes that specialty hospitals are here to stay and that all services that can be profitably broken out of the hospital will be.
UMass Medical Center in the People's Republic of Massachusetts has stopped doing heart surgery. The reason is their higher than expected mortality rate. They have known about the problem for two years which included high infection rates. The death rate is about double the other hospitals in the state. The state is forming a committee of other heart surgeons to determine the cause of the high mortality. To their shame the hospital knew about the mortality problem and did nothing until now.
In California Downey Regional Medical had stated it was closing its emergency room due to money losing treatments of Medicaid patients. That caught the state's attention and they have raised the payment rates to keep the ED open.
The idiocy of the Hospital Association in trying to protect their turf has reached a new high in Tennessee. The Association is suing to attempt to block any surgery that requires general surgery from being done in the physician's office. The state is allowing it to occur with oversight. The offices need to have certain equipment and procedures as well as be certified by a national organization. This is another of the turf battles that the hospitals are fighting and losing instead to attempting to cooperate. See Joe Flowers article several stories above.
The CMS had a open forum telephone conference that allowed those in favor of and those against specialty hospitals to call in and give their ideas and suggestions to the feds. The community hospitals merely aped their AHA and the specialty hospitals aped their lobby words, so nothing was accomplished. The talk was to discuss EMTALA and the specialty hospitals and the definition of a hospital under section 1861(e)(1).
St. Vincent's Hospital in Los Angeles for some unexplained reason ( read significant money) skipped its own transplant patients to do a liver transplant on a Saudi who was number 52 on the list. The hospital has stated it was the physicians who breached hospital rules to do the transplant and the hospital has severed relations with the transplant surgeons and stopped the liver transplant program. St. Vincent got a 30% bonus to do the transplant. They received $339,000. This does not include the physician fees. The two physicians are now under investigation by the MBC.
In a sad piece of news, New Orleans Charity Hospital is too far gone and needs to be replaced. This is the end of the old great charity hospitals of Cook County, Bellevue and LA County. Top
In the wake of Katrina, it should be noted that over 34,000 medical personnel volunteered for work in the gulf states. The government sent its public health corps and about 150 of the volunteers to the fray. Now the government wants to improve medical disaster response by having a network of trained volunteers. They want less red tape to stand in the way of registering to volunteer and get the liability protection of the federal government. The Democrats want an expansion of the full time corps of medical first responders. This costs money and will hopefully not be needed for many years. It appears the administration's plan for lessening the burdens and having a database is more reasonable. 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.