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The USA Today has two articles on physician entrepreneurship. The first is the trend of physicians starting their own specialty hospitals due to the inability of non-specialty hospitals to be responsive to the needs of their physician constituents. Of course a side benefit of this is the hope that the physician will also make money from their ownership interest to overcome the deficits paid by insurers. The hospitals accuse the physicians of "cherry-picking" and causing the regular hospitals to lose their viability. What they don't say is what they have done or not done in the past or will not do in the future to continue physician's loyalty.
In the second article, there is a scare piece about Congress closing the loophole that allows physicians to own surgical centers and hospitals. The CEO of a small northern California hospital where physicians are rebelling against the status quo states that he is afraid that if physicians see red in their bottom line, they will do more and possibly unnecessary surgery. This is a statement by a scared administrator.
In this issue under Legislation Massachusetts has approved the concept of concierge practices. However, the Internal Medicine and Family Practitioner Medical Societies are against it since it forms a two tiered system and will reduce the patient's ability to find a physician. These are two stupid statements due to the fact that there probably will be only several hundred of the over 600,000 physicians doing this type of practice. In case the people who make the statements haven't looked recently, there is already a tiered system in the country. There is also the right of the individual physician to accept in his/her practice only those patients they wish to see and the right of the patient to do what they wish with their income. Top
Parkview Hospital has gotten back, at least temporarily, it's Medicare and Medicaid deemed status. However, when it temporarily lost its status, private insurers dropped the hospital as a provider. Now, the hospital will not take the insurers back unless there are new negotiations regarding payments. The hospital also has not yet opened it's emergency room.
The hospital's non-opening of their emergency room is creating a hardship in central Riverside County for patients. The County is now considering leasing the physical space and equipment of the ED. This has never been done in California. There are about 14,000 Medicaid patients living in the hospital's area who were left behind by the county when they moved their hospital to a new location. These patients make up the bulk of Parkview's patients. Is it any wonder they are having financial difficulties?
As a matter of fact the difficulties are so bad that they just declare Chapter 11 bankruptcy and then borrowed $7 million to pay payroll and other short term expenses. Top
The legislation to break the stranglehold of Northside on the Atlanta community has failed. Northside had exclusive contracts with insurers that are detrimental to the surrounding hospitals and the patient community.
In nearby Russell County the only hospital is closing. The county wants the hospital to maintain an emergency department and morgue while closing the rest of the hospital. I hope the patients don't get confused about where they are going. Top
St. Vincent's Medical Center in Jacksonville, Florida, has seen the light and is letting my people go. They have learned that physicians make terrible employees and are money losers. They have also learned that hospitals are not capable of running physician practices. This exodus will happen over 4-6 months. It's a shame it could not happen in time for Passover. Top
A study has shown that consumers who have filed disputes for external review win almost half of the time. The lowest state was Arizona and Minnesota where the managed care organization was overturned only 21% of the time. The most was Connecticut with a 72% overturn rate. The study also found that only a small number of health plan denials are actually challenged. I wonder how many denied patients either don't know about the review process or just are passive.
In Texas, Humana is trying a new insurance gambit. They are offering the employers a full range of services from indemnity to HMO. The employee picks the policy that they believe is right for them, depending on their circumstances. The idea is to teach consumers to be better purchasers of health care and to lower cost by spreading the risk across all the employer offered plans and not each plan individually. It sounds interesting. Humana does this for their own employees and they state it reduces costs. To me it also increases choice which is good.
The Colorado Kaiser HMO has dropped Medicaid due to the low payment by the payor. There are other Medicaid HMOs in Denver and Boulder. The HMO had lost about $2 million each year for the past two years and about $4 million in 2001.
Massachusetts employers are getting the message. They can save on premiums by just paying the physicians and not the overhead of the middleman, the HMO. This direct contracting is already in Oregon, Minnesota and Colorado. A company is to set the process up in Massachusetts. This direct contracting will mean small organizations will need to be formed around hospitals and physicians. The employers will then pay the cost of the cheapest group and the employee will pay the difference if they choose a more expensive group. The groups will also be ranked to the nebulous term , quality. This is usually a synonym for cost. The Massachusetts hospitals are not going to give more discounting since they are already at the breaking point. There will still need to be a company to adjudicate the claims as well. Time will tell whether or not this will work. I believe it will work only if the providers get more money and less hassles by the removal of the HMOs.
There have been several sensational stories in the press recently about how race influences care. In a recent article by Reuters physicians state the thing that influences care the most is not race but whether or not the patient has insurance.
About 100 physicians in Sonoma County, California are dropping contracts with Blue Cross. The Blue Cross contracts are some of the lowest paying in the area. Blue Cross states they are not concerned since there are other physicians who will accept their rates and the patients can be switched to these doctors. It makes no difference to Blue Cross about the disruption of care. Top
Nevada leads the list in this issue. St. Paul Insurance Company has discontinued all it's malpractice contracts throughout the country, as is their right. The problem in Nevada is that there is a new state run malpractice company coming on line April 15th. Some physicians are losing their St. Paul on April 1. This poses a two week hiatus in which a physician such as an OB will be bare. Unless the legislature makes a prohibition against claims against physicians or starts the program two weeks early these physicians will have to not practice during this time span. This will cause significant problems especially in OB, where there is a bond usually built between the woman and her physician. If physicians can not practice during that period then neither can their nurse practitioners, office assistants or midwives. They will also be laid off during this period.
In Las Vegas the only trauma center was to lose two of their surgeons forcing a part time closure of the center. That was averted when one of the two became a part-time government employee and had his malpractice insurance paid by the state. His maximum liability is also reduced to $50,000. There is a group of five surgeons who also practice trauma who have threatened to quit unless the state looks at more long term solutions to the malpractice crisis such as tort reform. The surgeons don't believe the part-time government employee is safe enough for them to put their houses and families at risk. They will meet as a group in June and decide whether or not to stay in practice. The trauma center is attempting to recruit trauma surgeons from other states but of course is having no success due the Nevada malpractice climate.
Las Vegas also has a medical school that may not be able to function after July 1 die to the malpractice problem. The school pays the malpractice premium for its faculty and residents and can not afford the high premiums. Without these physicians the school will close. The state may have to kick in more money to the school to pay the rates.
Mississippi physicians are also making plans to move to states with more palatable malpractice reforms. A group in Natchez is planning to move to Louisiana and the medical society who's numbers are always suspect state that 10% of the physicians will either quit or move by year's end.
New York physicians, already one of the highest paying groups in the country, are looking at another 10-40% increase in their malpractice premiums. In one group of six physicians, two had quit OB due to the malpractice premiums. Insurers in New York as in other states are pulling out of the malpractice business.
As I reported last time, the physicians of Rio Grande Valley in Texas are planning a one day walk-out on April 8. All offices will be closed but the hospital emergency rooms will be open. The physicians have been asked to also pony up between $500 and $1000 for marketing costs.
West Virginia is back in the news. They have just passed their watered down version of malpractice changes. Now Medical Assurance, the second largest insurer in the state has asked for a 23% rate increase. They want it to go into effect on July 1. This and the third largest companies are also considering leaving the state. This should increase the exodus from the state in a quick march action.
Broward County Florida is going to lose six OBs at Memorial Healthcare due to the hospital's insistence of having malpractice insurance. Memorial is the only hospital in the county that requires malpractice insurance. Memorial doesn't care since there are about 40 other OBs on staff with insurance. Many of these physicians are employees of companies that pay their malpractice premiums. Memorial currently delivers about one third of the babies in the county. Top
Since 1996, when Congress opened the VA to all veterans, not just those with service connected disabilities, the hospitals and clinics have been bursting. In Haley VA, Florida, the VA had a 20% increase in patients over the past year. Is this because of the free care as opposed to HMOs, and other insurers with their co-payments and decreasing pharmaceutical benefits? In Florida there was an increase of 80% increase in patient load. I continue to wonder why the system even exists. The budget is now more than $20 billion with 163 hospitals, 175 nursing homes and over 800 clinics. The budget is always short and need constant increases. Why can the government not put these patients in Medicare and pay for all insurance and deductible expenses. It would cost significantly less and be more convenient for the veterans as they could go to any physician and hospital. Top
The city of Boston is short of money so they have brought back a 1917 ordinance that has not been enforced for twenty years. The city is charging physicians and later other health care providers $100 to register their state license with the city. There are about 700 physicians in Boston and therefore about $700,000 will be added to the coffers. The city will provide no extra services not already provided by the People's Republic for the money. Top
A HIV positive nurse at the South Texas Regional Medical Center in Jourdanton has admitted taking drugs from the hospital dispensary. She also may have used the same syringe and need she just finished using to inject herself with the narcotic to refill the bottles with saline. The nurse states that this did not occur but it puts all patients that received narcotics from these vials at minimal danger for HIV. 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.