September 1, 2005 News






Drew/King again leads off.  This time the community is as dumb as the Board of Supes.  One hundred of them held a rally to protest the closure of the unused portions of the hospital.  Since the bad publicity, many of the community have been going elsewhere for their OB and other care. The Department of Health wants to close the pediatric, obstetric an neonatology sections.  This would free up nurses and money.  One of the speakers at the rally was a pregnant woman who stated that if she went into labor she would have to drive further to deliver her child.  In fact, this woman did not say she has received no prenatal care at the hospital and was planning to deliver her child at another hospital.  The hospital district's supervisor also continues her obstructionist tactics to further her own potential re-election instead of attempting to lead the community.

The Board began the process of closing the units at their usual meeting.  The vote was 3-2 with the Supervisor from the district in the minority.  The people at the meeting attempted without success to make this a race issue.  The speakers stated they felt betrayed but they don't understand the issues of a hospital that is killing their community.

Drew/King has a new chief executive.  Ms. Epps, the prior director of systems operations at Baptist Health System in Birmingham will start October 17.  Her pay is $225,000 per year.

The LA Times writes that Drew University is fulfilling its goal and that their graduates are practicing in underserved areas.  The ratio was three times more than those that graduate from UCLA.  This is not surprising since Drew has a majority of minority students and they serve a minority population while in training.  The same was true in the 1970s when I trained at Cook County Hospital and many of our graduates went on to practice general practice in rural or underserved areas.

The LA Board of Stupes have ordered the Department of Health to tighten their oversight over the time cards for the physicians.  The Auditors trailed physicians and found three had time cards showing them working when they weren't at the hospital.  One was taking his car for repair, one was at the gym and one was at home.  

Internal investigators of the health care system are finishing up their report on Hawaii's Kona Community Hospital.  The medical staff had complained of fraud and mismanagement.  The CEO and COO have both been placed on leave.

Banner and CHW are two systems that both see potential the same.  They are building new hospitals close to each other in one area of Arizona and are now going to do it again in another.    

A report by the Center for Studying Health System Change shows a more difficult time for the hospitals in Orange County, California, due to the nurse ratio law.  The study shows the highest cost in the nation for nurses and the diversion from EDs and closing of service lines due to the ratios.   

Speaking of the nurse ratio law in California, Sutter Hospitals has just finished negotiations with the California Nurses Union for three of their hospitals.  In one of the hospitals, Alta Bates in Beserkley, the deal was for the hospital to become over time an all RN hospital.  This along with the raises will cost Sutter a pretty penny.  Alta Bates was in trouble with the JCAHO but as all figured they are now off the bad person list.

In Loma Linda, California a 28 bed specialty heart and surgical specialty hospital is being planned. The community hospitals are all atwitter about having competition.  The hospitals of the area have gotten together to leaflet the community and have a protest at the council where the hospital is to be discussed.  The specialty hospital has used the community hospital figures showing a soaring growth in the area which will strain the community hospitals ability to provide care.  The hospital is planning to provide care to Medicare and Medicaid patients.  At the Council meeting there are five council people and three have recused themselves.  The three drew straws and the one that will vote to break a tie if necessary just happens to teach at the University, one of the staunchest opponents to the new hospital.  After listening to seven hours of testimony the panel delayed the vote.  Law suit coming.   

In a story that takes the facts of a report by the Center for Studying Health System Change and twists them for their own use, the AHA states that physician owned facilities are creating cost and access problems.  The actual report states that the competition between hospitals as well as the physician competition of working in their office and not needing the hospital are creating the problem.  The Study also found that hospitals competing against each other in building extensions in the more affluent suburbs are soon to affect costs and access. The report also states that hospitals are paying physicians for being on call and are brokering deals with physicians to retain a portion of the pie.  The AHA seems to have overlooked that portion of the study.

As most know Duke and Durham Hospitals have been in a pickle and sued for washing instruments in hydraulic fluid by mistake.  The judge in the case has allowed punitive damages.  Since no one knows the long term effect that the oil may have, Duke has decided to hire an outside organization to be named to provide long term monitoring of these patients.  

Ottumwa  Hospital in Iowa was scheduled for the Medicare axe.  They screwed up big time with their psychiatry program and EMTALA.  Two days prior to the axe falling they were granted a stay of execution.  The only two psychiatrists quit and the hospital will probably close their unit.  

In a recent posting on line Intermountain Health Care has shown why they are considered one of the most physician unfriendly institutions in the country.  Their definition of summary suspension which is to used only for "imminent danger" to patients is actually used for "those whose conduct materially disrupts the operations of the Hospital or any department or unit thereof."  In other words if the hospital doesn't like criticism, even if legally called for, they may suspend the physician.  What a travesty!  They truly deserve the criticisms of the states and the physicians that they have had.     Top   


German physicians are protesting the increase of their workweek to 40 hours and a decrease in the payment for holidays.  About 3000 physicians descended upon Berlin in the protest.  I doubt they would get much sympathy from the American physicians.

Speaking of American physicians, last issue I stated that the physicians of Washington were bluffing when they stated that if Medicare decreased their payments they would stop seeing Medicare patients.  I may have been wrong in my assessment.  I received an email from one of my readers in Oregon who stated that they have already started to cut back the percentage of Medicare in the practices.  Now an article in California reiterates the same thing.  The article states the physicians would cut back their Medicare patient load and some would drop out of Medicare completely.  

Aetna has released the rates they pay physicians in the greater Cincinnati area in about 600 procedures.  They are doing this to better help consumers who purchase the HSA coverage to know who is charging what for an office visit or an EKG.  What this doesn't state is how much one would be charged for a full diagnosis and treatment since one physician may see the patient more often or order more tests than another.  It can also be used to attempt to leverage lower prices from physicians so they can look better on the web.  This could also backfire on Aetna as the lower paid physicians will want more money or drop out of the network leaving only the high pay ones. 

In a potential major problem for the Wichita Surgical Specialists, three cardiac surgeons left the group.  They then sued the group regarding the non-compete clause and won in the lower courts. The decision was overturned by the Kansas Supreme Court.  One of the three cardiac surgeons went to a nearby town that used to send its heart surgery to Wichita and now set up its own program.  The group potentially can lose 150 of the 350 heart surgeries it did the year prior.  This is a true lose situation for the group and a win for the surgeon.  Be careful what you wish for, it may come true.

To make matters worse for all cardiac surgeons, the cardiologists are keeping most of the patients off the operating room table.  The new stents have dramatically reduced the need for surgery.  This has made the cardiac surgeons dispensable with less taking the training programs.  For those already in practice, we are seeing more economic credentialing and more removals from the medical staffs of the less politically powerful surgeons.  To make matters worse some cardiologists are doing aggressive stenting in areas of three vessel blockage or diabetics that seem to do better with surgery than stenting.  Also, coming on the market are aortic and mitral valve devices that are placed non-surgically.  

In medical school, the students are complaining they are not being trained for the real world.  They say there is no training in bioterrorism and disaster preparedness.  There is little in the way of medical ethics and health disparities.  This may be a way for the schools to improve their graduates.  

In a bizarre story, an obese woman was offended when her physician told her she was obese and that she needed to join a group to get rid of the fat that will kill her.  She was so offended that she reported the physician to the New Hampshire Board. The Board subcommittee recommended a letter of concern to the Board as punishment for the physician's true advice.  That was rejected and the Board proposed a course and have the physician acknowledge that he erred.  He did not err and would not agree to the eccentric Board suggestion.

Blue Cross of South Carolina has agreed to pay for some of its network physicians PDAs, and printers when they write three months worth of 200 or more on line prescriptions.  This only applies to the first 300 physicians who qualify.  The rest of the physicians do not have to do it.       Top


In an interesting turn of events, the major malpractice carrier in Maryland has reported no increase in premiums for the coming year.  The company's payouts had dropped during the prior year by almost $15 million.  The legislature had made some minor modifications to the tort system and formed a payment system to help physicians pay for their premiums.  There does not seem to be a true answer to the drop nor if the stability will continue.  The trial lawyers are using the stability to state there was no med mal crisis and it was all made up.  The lawyers continue to be disbelieved. 

In West Virginia, the medical schools could save about $10 million per year on med mal premiums under an agreement with the State.  The state would institute a $250,000 individual medical deductible.  The school would obviously pay that amount if the physician was found guilty.  

The new law in Illinois limiting damages in med mal cases has just been signed by the Governor despite his opposition to caps.  Before the ink is dry the trail lawyers are looking for a case to challenge the law in court.  They are attempting to get the case to the state supreme court that is  Democratic controlled by a 4-3 vote. 

Missouri is inundated with malpractice suits in the past week.  Why, one may ask?  The new malpractice law goes into effect today.  This will hinder the vultures from filing suits in counties where juries give out big verdicts and will restrict awards.  Attorneys always do nothing today they can put off until tomorrow.  Also if they didn't file by the deadline they would be on the hook for legal malpractice. 

The HMOs are back at the same tactics that made them so hated in the 1990s.  They have found they are spending too much on radiology studies so are now beginning to return to the preauthorization routine.  This means waits for patients with potential harm and clerks turning down physician requests for needed studies. Aetna made the absurd comment that they are using the pre-certification since they found there was not an increase in surgery after the tests were done. It may mean that after the tests were done surgery was no longer the correct option and surgery was no longer necessary.  This is another broad attack where a scalpel should work.   

Tufts HMO in the People's Republic of Massachusetts has decided to follow and expand on the return to managing or mangling care.  The physicians now not only must get permission to do certain tests but also hysterectomies and back surgery. They are also going back to the outdated methodology of having their own nurses at the hospitals do utilization review.  The physicians are beginning a push back and are telling their patients they will need to switch insurance due to the hassles of Tufts HMO.     Top


According to HIMSS there is a significant lack of compliance with the "new" HIPAA security rules.  The reasons were the lack of anticipated legal consequences for non compliance.  There have also been virtually no legal consequences for non compliance of the privacy rules either.  This may account for the 18% of providers and 6% of of payors who remain non compliant over two years past the deadline.    About 1/4 of the payors are not in compliance with the security rules.  Less than 1/2 of the providers are in compliance.  There have been a large amount of security breaches in most organizations.         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.