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A study by the University of Chicago on testing errors in the physician office showed over 1000 errors in 590 reported patients. The physician made an error in 13 % by ordering the wrong test or not ordering a test. Not a bad figure for primary care physicians pushed to see more patients. In 18% the right test was ordered but the lab goofed. In 25% there were problems with getting the results and this was made worse my the lack of follow-up by the physician's office. The errors led to patient harm either via delay or by spending more money in 75% of the cases.
Ten physician groups got $16.7 million for doing the right thing in the treatment of chronic disease in a CMS demonstration project. Not bad for practicing medicine correctly.
In Great Britain, a study has shown that same day appointments caused a decrease in patient satisfaction. The reason was that the patient could not see their own physician. Top
California has investigated and cited the celebrity psychiatric hospital Pasadena's Aurora Las Encinas for several deaths in April of this year of apparent drug overdoses. The hospital also had a rape of a young girl patient by a young male patient. This is an expensive hospital with costs up to $850 per night for regular rooms and private rooms at $1,400 per night. One of the physicians on the staff at the hospital is Dr. Drew Pinsky who co-hosts the radio show "Loveline" and anchors the TV show "Celebrity Rehab with Dr. Drew". Dr. Drew is also the co-medical director of the hospital and has issued a statement that he had no direct role in any of the patient's care. Several of the relatives are suing the hospital.
Kaiser Hospital in San Francisco had a nurse on the night shift in the postpartum unit with active TB. This has led to the notification of 1000 people to be screened for potential contamination. The nurse began having a cough when she was hired. She had a normal chest x-ray within the past year. The nurse was Asian and foreign born in a country where TB is endemic. The babies exposed are receiving skin tests and some are started on antibiotics.
In the bastion of medical care Boston, Beth Israel Deaconess had a wrong sided surgery. The analysis revealed that there was no time out, the marks on the incision site washed off so there was no mark at the time of incision. The hospital has new rules that the blades will not be put into the scalpels until the time out is complete and they are now using FDA compliant markers along with writing the left or right and not using abbreviations.
The University of Maryland is in crisis. Ten of the 22 directors have resigned as has the CEO. This is due to meddling by the Governor who wants to put his cronies in although they have not been recommended by the Board. The remaining Board members immediately elected new leadership. The physicians have pushed the CEO to resign and the Board then rescinded the offer made two weeks ago to a person from a competing organization. The chancellor stated that he knew of no allegations of bad capitol allocation. He either is lying or so out of the loop that he is ineffectual.
Los Angeles Century City Hospital is out of money and is shutting down. This is the tenth ED to shut in Los Angeles County in the past five years.
Miami's Mt. Sinai Medical Center has a major problem. The doctors and administration are at major odds. This has caused a major defection of the top medical talent from the hospital, the only one left in Miami Beach. The Board president is backing the administration which only adds to the strife. The administration has been accused of replacing the department heads of this teaching hospital with physicians who will do his bidding. The older physicians would still have privileges but not the prestige so they are leaving and will take the patients with them. This hospital will not survive over the next few years.
Under most circumstances when a person comes to the hospital for an elective procedure, the procedure is performed and then the patient is billed for the amount the insurance does not pay. A new trend, especially in South Florida, is to have the hospital get the money up front or not perform the service. Locally, we had a hospital that required $95,000 upfront for radiation therapy needed to stop bleeding from an erosive cancer on the face. The patient was told to go to the ED and was admitted as an emergency so the radiation could be done under EMTALA for stabilization. Sometimes you have to work the system to get what is needed and what is right.
North Oakland Medical Center in Pontiac, Michigan, has filed for bankruptcy. It is out of money. The Center has nine facilities and 366 beds. It is scheduled to be sold to a group of physicians in October but needs to stay open until then. The Center is attempting to borrow money and needs to pay a required bond payment.
Akron General Hospital in Ohio, does not like the even playing field. A group of physicians from a rival organization is planning a physician owned 100 bed hospital near the Akron facility. The hospital is afraid the well to do will go to the new hospital instead of one that is old and needs alot of work. The new hospital will be part of Summa Medical Health, a cross town rival. The new hospital will be full service including an emergency room. The closest hospital to the new hospital is running a 16% census. Should it be in business? The local communities want the new hospital and are willing to give $5 million toward the project. The new hospital will employ 600 people in the area and generate revenue of $150 million. The hospital would be for profit so the community would also benefit from taxation.
The community non profit hospitals were raked over the coals by a front page article in the Wall Street Journal. It showed how when two hospitals in Roanoke, Virginia, merged into Carilion that fees sky rocketed since there was no competition. The hospital charges $4700 for a colonoscopy, an outrageous sum. Carilion justified its huge charges by stating they need the money to pay for the ED. The hospital is trying to save money by hiring physicians so they can control what they order for the good of the patient and who to which specialists should be referred patients. When an outside group of physicians started an ad campaign against Carilion, the local newspaper started a series on the dispute. The hospital pulled its advertising and the reporter was transferred from healthcare to transportation. There are also perceived if not actual conflicts of interest between some of the Board and building projects of the hospital. The hospital is not going broke. They made a net profit of $107 million last year and paid their CEO a salary of $2.07 million plus a pension contribution of $7.4 million. Carilion claims $42 million in charitable tax exemptions. It does not state if this counts the differences between what is billed and what is paid. If so, that is not a charity but a contractual matter. Carilion takes one morning a week in court to sue people that have not paid their hospital bills. They put liens on approximately 4000 homes per year. The Roanoke area now has the highest costs in the state from the lowest prior to the merger.
The price of healthcare in the Roanoke area will even become higher. Carilion has purchased the only two independent institutions left. The ambulatory care center and the radiology practice both owned by the same person were sold to Carilion. The rationale for the sale was the Carilion was purchasing the medical practices of the local physicians so the two independent institutions would be getting less business. I am truly surprised that the state does not come down on Carilion hard for monopoly. Carilion states that there will be another hospital built in the area soon but this has not been confirmed. Top
The Toledo, Ohio, Blade newspaper had a series of articles about the interference by insurance companies with physician-patient decisions. It gave a litany of problems caused by the named insurance companies. It also did a survey of Ohio and nation wide physicians. The results were startling. Ninety nine percent of the 920 physicians stated that insurance companies interfered with their treatment recommendations. Prescription interference was in 95%. Testing interference was 74%. Hospitalization decisions were interfered with in 69%. Patient care was compromised in 86% with 76% adversely affecting the patients. The physicians were not able to dispute the decisions in 65%. The worse one was 14% believed an insurance decision interference led directly or contributed to the death or serious injury to a patient. Both Senators Obama and McCain were aghast at the figures.
The Daily Mail of Britain had an article of the NIH canceling 100,000 operations in a year. That's the way to keep costs down.
Whilest still on the other side of the pond, Robert Mackie, a Scot and a hemophiliac, received tainted blood and became HIV positive in 1984. He was not told of his diagnosis for three years until his case had been published in Lancet. Without his consent or knowledge Mackie was enrolled in an AIDS study. His physician lied about the patient's knowledge and consent when he enrolled the patient in the study. Several of Mackie's relatives died from AIDS due to Factor 8 treatment for hemophilia. Mackie developed symptoms of AIDS in 1997 and started on the new retrovirals. He also found out in 2000 that he has Hepatitis C. There is currently an investigation of the illegal things that were done in the early 1980s.
Still over there, an increase in deaths from C. Difficile in England and Wales has occurred. At the same time the number of deaths related to MRSA has fallen for the first time.
HHS has investigated CMS audits and found many errors. Medicare did not follow its own policies to check physician orders against DME purchases. HHS found not only fraudulent claims but claims without sufficient documentation. CMS has stated it has made appropriate changes to require more documentation. 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.