See Recent Legislation for information on the nation's worst hospital, Drew/King.
The California Nurses Union and Northern California Kaiser have reached an agreement. The nurses will receive a 25% increase in pay over five years. They also have agreed that even if the NLRB agrees that nurses can not be employees if they are supervisors, they still will be considered employees with Kaiser. The Sacramento and Fresno nurses would get raises to put them on par with the San Francisco nurses. The agreement will not be valid in the Kaiser Southern California area. The nurse's union hopes to make this the prototype for all future negotiations. This will mean long strikes at most California hospitals.
In Medford, Oregon, the one cardiology group has worked at both hospitals in town. One of the hospitals has grown its cardiology program and hired one new cardiologist. That physician has been not given privileges at the second hospital. It was done by a moratorium on new cardiologists by the second hospital. This is true economic credentialing and should be fought by the remaining physicians. However, as I stated in my article Water Carriers and Sheep the physicians will not fight for their rights as it might hurt them in the pocketbook immediately, a very short sighted view. Baa.
Eliot Spitzer is running for governor of New York in the Democratic primary. He states that if elected governor he will lower spending. He will do this by closing hospitals. It is hard to believe that the citizens of New York would vote for someone who would close their hospitals, but look at the carpetbagger they elected to the Senate.
Beth Israel Deaconess has decided its better to join than to fight. They have joined with Harvard physicians to form an outpatient surgical center and other joint ventures.
The hospitals of Philadelphia have found money. After only five years of waiting they have been paid $60 million from a defunct health plan. It has taken the state the five years to audit the billings at a cost of $4 million. The money is half of whatr is owed but the hospitals will not see the rest and they are happy as clams. This gives some idea of the real profit in hospitals. Top
The Florida medical Board is under fire for taking too long to investigate cases against physician and giving too much due process to physicians over patient harm. The Board is 15 members with 12 physicians. The time to investigate mistakes is down to 18 months from 24. The state has a clear and convincing standard instead of a preponderance of the evidence standard for cases against physician licenses. In a standard year 2/3 of the cases are dismissed within 10 days since the complaint is not punishable. Top
Disruptive, Mentally Ill or Both. The New York Medical Society has printed a biased and terrible anti-physician article in their newsletter about how their Committee for Physician Help is empowered to rehabilitate physicians. The article is interesting since it starts out equating disruption with mental illness. There may or may not be a connection. They also believe that physicians that use non formulary meds but refuses to serve on the pharmacy committee is disruptive. The authors contend that physicians who make rounds at odd hours are disruptive. They also contend that if you change jobs alot you also will be considered disruptive. The pediatrician who doesn't do the required paperwork but blames mistakes on the hospital is also considered disruptive. To me, these are not disruptive people but do represent system breakdowns. I do agree that if necessary the "disruptive physician" should be referred to a confidential in house physician assessment program. Most of these evaluations will show no drug problem or mental instability and if done correctly will show hospital system breakdowns. The real problem is the inability of the hospital to see or be able to correct the systemic problems. The article does state that all accused of being disruptive should be given due process. Again the question is in the definition of due process. What is the definition? To me it is the actual or potential for patient harm. It is not the potential for driving nurses out of the hospital unless it can be shown that this is the actual case. One of the physicians I was involved with lost his privileges due to this allegation. In reality, one nurse did quit but it was to go to another state with her husband. The hospital used this to drum the physician out. The real reason for the hospital wanting to be rid of the physician was economic. To you physicians out there, be careful. Some hospitals are not your friend.
Three medical schools, Jefferson, UCSF and Michigan, looked at their graduates who were disciplined by the state medical boards and then went back to their medical school records. They found that those disciplined by the medical boards had a notation in their medical school records far greater times than those that were not disciplined regarding irresponsibility such as not attending clinics and resistance to self improve such as being argumentative or not accepting constructive criticism. Less strong correlations were with low MCAT or low grades in the first two years. Being male was no longer seen as a factor.
Urologists are always smarter than other physicians. We in Contra Costa County, California, were a bunch of solo independents competing with each other. In 1995 we all came together under the same corporation and gave up our old offices to practice together. All the competing urologists were invited to join and all but two did. Our clout with the hospitals and the managed care organizations improved with increased compensation per unit. Now the urologists of Maryland have found the promised land. Three local groups in Baltimore have banded together. The group consolidated offices from 25 to the current 18. Those in the group with business acumen can do that without those who do not want to be part of the daily operation. The Baltimore area has prior large groups such as the cardiology group with 65 physicians and surgeons.
A report in JAMA from the Mayo Clinic shows that residents who have made a clinical error become depressed and are at greater risk for further errors. The researchers recommend that schools develop support networks for residents who are coping with distress.
A recent study in JAMA stated that physicians are not good at assessing their own competence. They recommend outside people be employed to judge physician performance and any appropriate CME classes necessary. The worst were those physicians who were the most confident and those who were the least skilled. An editorial said the study was a cause for awareness.
H&HN had an article on the troubled OR and how to correct it. It is interesting that this should appear since the specialty hospital moratorium is now over and one of the main drivers for physicians breaking away from the community hospital is the poor OR performance in the community hospital. The article stated that those who have the largest stake in the OR should determine how it is run. Many hospital ORs are run by a nurse manager and maybe a medical director for the hospital who can not devote enough time to solve problems. The needed aspect is cooperation, which is rare. Some hospitals have fixed problems by naming an anesthesiologist as the OR medical director. This person is more full time on premise and more aware of problems and potential solutions.
Many physicians in training are violating the 80 hour per week cap for working putting their patients in jeopardy. The physicians are supposed to work only 30 hours in a row without a break. In Europe there is a maximum of 13 hours a shift and 56 hours per week. In a recent JAMA article, it was noted that about 80% worked over the limits and if broken down monthly the percentage was 62%.
CMS is starting a new pilot project to pay the hospitals the same amount of money but have the hospitals engage the physicians in quality of care improvement. It is hoped that this will lead to shorter stays with more money for the hospital. The hospital will be expected to share the saved money with the physicians. The money will be based on an entire episode of care in the hospital and beyond in follow-up and long term outcomes. An example is less infections and fewer readmissions. There will bee no more than 72 participants in this study and the medical groups and the hospitals must be aligned.
Aetna is starting a pay for performance program in Washington DC but there might be fewer takers than they thought. The program requires electronic medical systems which cost too much and can not be paid for by the amount paid by Aetna. CareFirst last year started a pay for performance and the participating physician got about $16,000 per physician. An electronic medical system costs about $60,000 to $100,000 not counting the monthly fees and upkeep. This makes the break even point too far in the future and is economically definitely not worth it. Top
The recent edition of The Health Lawyer, a publication of the Health Law section of the ABA, has an article by two attorneys that by their description are hospital friendly. The article stated that as long as entities report accurately what happened to the National Physician Data Bank they are immune from suit. The underlying action does not need to be truthful nor accurate. I am sure that the article was written prior to the August Nebraska District Court case of Costa v Leavitt. That case showed that the hospital reported for the physician being under investigation for issues of competence and professional conduct. In fact the physician had withdrawn his application for reappointment after a quality meeting reviewed three of his cases. Later the MEC refused the physician's privileges even though he had withdrawn his application. The hospital reported the physician to the Bank and the Secretary affirmed. The Court overruled the Secretary and stated there was no investigation since the QA meeting did not qualify as an investigation and the MEC did not state anything about competency or professional conduct. This shows how well the Secretary reviews the issues and how the deck is stacked against the physician. Top
Oxford and its parent company UnitedHealth, probably the two worst insurance companies in the country for hospitals and physicians, are now being investigated in New York. Apparently, they have screwed a HMO patient by not paying for the entire hospital bill because her physician was out of network. They defended their actions by the contract which had on three separate pages a line or two that if someone could connect the dots would constitute the agreement. This is deception of the first order. The company needs to be fined mucho dinero for its deception and made to change its contract so that someone could actually read all the sentences together. They should also refund the money to the patient who complained to the Department of Health and pay the money due to the hospital.
The sneaks at UnitedHealth are also attempting to sucker the physicians in California to join their organization with money that is a significant amount below that of PacifiCare, who they took over. They also have illegal California terms in their contracts and will not remove them. I hope that very few if any physicians will join, but they will. Baa to the sheep!
The US Senate is investigating hospitals for lying about their charitable non-profit purposes. The Washington Post story tells about hospitals having programs to help out those who can not afford the care but somehow forgetting to tell the patients about their programs. The also frequently charge the uninsured much higher prices than those paid by those with coverage. The Senate hearings will focus on the lack of standards for community and charity care and how the hospitals report. It has been found that the for profit give as much charity care as the non profits and maybe the non profits should pay the same taxes as the for profits. Some hospitals have already lost their ability to not pay state property taxes.
Kaiser is adding several coverage options to their original HMO plan. They have added a high deductible plan, a high deductible plan with a HSA, and a small business plan that allows members access to real physicians. They expect most people to stay with their mainstay HMO plan. Their PPO plan has been around for some years but now is being offered to small business.
Blue Cross of California has been fined $200,000 by the Department of Managed Health Care for illegally canceling individual policies. They cancelled the policies prior to examining the medical histories or by stating wrongly that the patient willfully misrepresented the health history. The company was the one that lied, not the patients. There is an ongoing investigation of Blue Shield and Kaiser for the same lies. Blue Cross has decided to change some of its policies regarding canceling policies and creating a committee with at least one physician to review cancellations. This still is not legal since once they issue a policy, by law, they cannot rescind unless fraud by the consumer. They will also hire an ombudsman to better communicate with its members. Can you imagine an ombudsman hired by the organization. Kaiser does the same thing with most discussion against the consumer.
There are about 7 million people of Medicare age that do not have Medicare but a lower cost program. This private insurance is being paid about 11% extra to provide the coverage. This is a fee for service program. The main providers are Humana, United Health and WellPoint. The plan does co-pays for doctor visits instead of the 20%. The patient pays an addition amount per month over the normal Part B premium. The patient may also sign up for a combination plan with Part D. Top
One of the stolen VA computers has been recovered. This one had about 16,000 names and was taken from Unisys. There is no word if any data had been compromised.
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.