The Medicare HMOs are starting to fight back. They contend that they provide better coordinated care that is more cost efficient and therefore they should get the additional 14%. They analyzed government data for California and Nevada and found fewer hospital days and fewer readmissions than non-HMO patients. The problem is that the two states picked had a long history with HMOs prior to the advent of Medicare Advantage. The government agency commented that they found the same thing when they analyzed the data. However, the new data still being analyzed did not find the same favorable results.
California is putting on-line the controlled meds used by patients. This is to stop physician shopping by drug abusing patients and to cut down on insurance costs.
The Harvard Medical School has come out with a study that 45,000 deaths a year are directly related to having no insurance. I wonder how that fits in with the IOM's 96,000 deaths per year due to errors. The reporters of the study are ardent single payor advocates.
A new study has shown the way to drop healthcare costs dramatically. The American Journal of Health Promotion has an article stating that we could get rid of $50 Billion annually in healthcare costs by getting rid of NaCl (Salt). Over the decade of planning by the legislators that could save half the cost of the healthcare program but I have not seen this as a strategy by out nation's leaders to reduce the cost of the reform package.
Several other ideas to decrease costs without making more problems for physicians and patients have recently come to the surface. The first is to have everyone using the same EMR, VistA. This is already in many hospitals and states as well as the VA. It is free which may be a major problem for vendors but no one else. The other suggestion is from the Imaging e-ordering Coalition. They have come up with data that can score the symptoms of a patient while the patient is still in the examining room and decide what is the best diagnostic imaging study for that patient. The beauty of this is that it takes away all those wasteful and frustrating calls to radiology managers who at first deny everything and if the physician is persistent will approve all. The insurers will pay for the test recommended and may review it retrospectively but still it is done promptly and paid for. Top
Obama has signaled he wants to try some kind of reform for the tort system and has started the process with giving $25 million for states to test various ideas for med mal reform. This small amount will give no meaningful information and will go along with Senator Reid telling Baucus to take med mal out of his bill. Reid denies that the $1 million Reid got this year from the trial attorneys had anything to do with his order. Let the facts speak. The president is also an attorney and favors the current tort process. He has thrown the small bone to keep the physicians from walking out on the process. He at least is somewhat more forthcoming by stating upfront that he is against caps on non economic damages. The trial lawyers state that only 1% of the costs of healthcare are due to med mal payments. I believe them. The problem is not the payments but what happens to a physician when and if he is sued. The psychological trauma is tremendous. The physician is afraid of his name being on the front page of the paper and being chastised by the hospital and the report for even a settlement to the National Practitioner Data Bank, a death knell. Until all the above are changed physicians will continue to raise the cost of medicine by ordering tests that may not be needed but are wanted by the patients or are of only equivocal value. This behavior is the true cost increaser of medical care and is difficult to measure. Top
The AMNews has an article on the NPDB telling the problems with some of the reporting requirements and the inability to get erroneous reports changed. The article cites a Nevada physician who was wronged by the hospital misreporting him to the bank. The courts have ruled in his favor but he still can not get the bank to change or get rid of the erroneous report. The article also cites the ridiculous Public Citizen people who only care about raw numbers reported and not about thought. One of the real problems is the lack of guidance as to when an investigation of a physician officially begins. If the physician resigns and does not know there is an investigation he/she is automatically reported to the bank. Since there is no specified time therefore all physicians must go through judicial review and possibly sue at a great cost of money and psychological problems. The article also states correctly that the first thing a physician who does not agree with the report must do is to ask the reporting entity to change their report. This is basically a futile exercise. After that then one puts a dispute report as an addendum to the original report. This automatically is forwarded to all institutions querying the bank. The practitioner can also ask the bank to omit the report but they really won't do that if the reporting agency will not change their report. The last item for the practitioner is an appeal to the Secretary of HHS who will only look at the process and not the facts and will almost never overturn anything. The entire process is truly stacked heavily against the physician and any semblance of fair play. Top
Northwestern is at it again. After they were rebuffed by the feds for buying Highland Park hospital but were allowed to keep the hospital, they are now purchasing another northern Chicago suburb hospital Lake Forest. This will make Northwestern the dominant player in the area. This will also have to go before the feds and state for antitrust potential.
The unions are criticizing Beth Israel in Boston for putting on a surcharge on patients seen after 10 pm. The hospital and four others in the People's Republic charge $30 extra to be seen between the hours of 10 pm and 8 am. It should be noted that the union that is complaining also is trying to get into Bet Israel hospital. Could this be a PR stunt? No, the unions would never do that.
The day following the story the surcharge was dropped. I guess in a Democratic state the unions do have significant power.
California has fined 11 hospitals for various errors. The biggest fine allowed is $25,000 and they all received it. The hospitals were Alta Bates Summit for leaving a foreign object in a patient; Coast Plaza for the same thing; Kindred Hospital for failing to monitor a patient; Loma Linda for a retained foreign body; LA County/USC for a retained foreign body; Mendocino Coast for inappropriately trained nurses; Redwood Memorial for a retained foreign body; Saint John's Santa Monica for not following their own surgical procedures; Sharp Chula Vista for a retained foreign body; Tri City Hospital for not following its fall prevention procedures; Tenet Hospital now USC University Hospital for communication problems of lab tests. The above were all for 2008. The law is now $50,000 penalties. 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