April 1, 2005 News




Medical Board



Two Duke professors of Law and sociology have studied Florida's malpractice arena and have concluded that there is no crisis.  These professors state that the amount of suits have not gone up more than the population increases would say they should. The studies used data from public records at the Department of Health.  The Duke study showed the average award has almost doubled from 1990 to 2003 using the same 2003 dollars. Also the amount of money paid per claim since 1990 has gone up 500%. They also found there has been no increase in filing of suits.  When I look at these numbers I see a significant problem.  They don't.  I wonder what they would say about their own institutions increase in premiums since they are self insured.  

In Pennsylvania, where the above "professors" did not study, the insurers reported steep increases in payouts.  In 2004 they paid out $448 million or an increase of 13.6% over the year prior.  The reporting federal agency said there has been a steady increase but this jump was believed to be from non reporting the year prior.  Some payouts the last month of a year are reported the following year.  The Pennsylvania legislature has a new bill to help the physicians but the Democrats control and so it will not pass.

In 2003 three states- Ohio, Texas and West Virginia passed med mal reform.  Now they are seeing their physician premiums stabilize and even become lower. 

The Florida legislature is now taking up a trial lawyers bill to forbid physicians from going bare.  Currently there are about 3000 physicians in that category.  If the bill passes there will be a mass exodus of these physicians from the state.  Since many of these represent the high risk specialties, vast shortages will evolve.  Personally, I believe all physicians should be made to have med mal insurance if they practice in a hospital.  If this is not the case, their co physicians will be left holding the bag.  However, since this state has allowed the posting of a bond for these many years, to stop it now would be disastrous.  The other problem with the bill is that it would require double the amount of insurance that is currently required in most hospitals.  This would raise premiums through the sky.  The bill is sponsored by two chiropractors who pay about $5000 a year on med mal insurance.   Top   


The TennCare fiasco continues.  The judge has stuck his nose into the problem and made suggestions regarding changes to the program.  He suggested nine changes, none of which are in his job description.  The suggestions are to use medical schools to care for the patients, competitive bidding for drugs and providers, cooperative dug purchasing arrangements.  The court of appeal has already decided to give a quick hearing to the ruling by the federal judge.   The judge says he will look at all aspects of the cuts in TennCare.

CMS has agreed with the plan of TennCare cutting back its program to basic Medicaid.

There is a debate in Louisiana between the governor and the private hospitals.  The Governor wants to tax the hospitals to give more money to the state but not give any of it back to the hospitals for caring for uninsured patients.  In other states the money is being matched by fed funds and then more money is paid to provider of services for Medicaid patients.  These providers want some of the money to also pay for some of the uninsured expenses.  (See Recent Legislation)

The Associated Press had an article about the long waits for everything in Canadian medicine.  There was a three month wait at one hospital in New Brunswick for an EKG.  The problem is one pays for the health care but its not available when needed.  Presently each Canadian spends almost 50% of its income  each year in taxes, most of which is healthcare.  Some provinces spend about 40% of its taxes on healthcare.  This is predicted to rise to 85% by 2035. There is good and bad news in the lack of funding for the heath care of its citizens.  There will be massive layoffs of nurses who can all come to California to alleviate the ratio problem of the state. Now the average wait for a surgeon is 18 weeks and to see an orthopedic surgeon it is over nine months.  The Canadian physicians also are leaving the country for the US in order to escape the huge taxes and better working conditions.  

In North Carolina, the HMOs continue to lose business and increase their profits.  It would be nice to see what the profits would be if the HMO population dropped to zero.  The reason for the increase in profits is the large increase in premiums and since there are less insureds, the spending is less.

Two hospital execs from the Peoples Republic of Massachusetts have spoken out in favor of physicians getting behind universal health care.  Their ulterior motive is shore up their hospital. 

In an interesting story the AP wrote that patients with employer sponsored health insurance are will to get rid of their physicians for lower premiums.  They are willing to go to a panel of physicians rather than free choice if it would cut back on their premiums.  The reason for this is the shift to the employee more of the payment for services.  Most of the respondents who answered for the more restrictive policy were in the lower income brackets.  I believe that if the employers look at HSAs or their ilk, it would be a win win for all.   

Medicare Part B premiums are increasing for 2006.  The premium will be up 12% for all patients who elect to take the insurance. 

The UnitedHealth plan to allow employers a discount if their employees utilize the 25% of UnitedHealth's physicians who have "high quality and low cost."   The physicians and  MGMA have both criticized the plan as on evidence based and really only caring about cost and not quality.  It really speaks to how poor an organization UnitedHealth truly is when only 25% of the physicians in their organization are capable of being members in their own plan. The remaining 75% should be dropped or should drop out of the organization. It sounds like the old Groucho Marx saying "I would never want to be a member of an organization that would have me as a member." 

Everyone believes that computers in the office will be good for patient care creating less potential for error.  The problem has been the cost.  With the small payments the physicians are now receiving and the increases in expenses, it was not reasonable to purchase the systems.  Now one company, CareFirst Blue Cross will pay physicians to install electronic patient records.  The total amount of patients that are expected to be covered by the computers are 2 million in ten states.  The payment will be about $50 per CareFirst patient that is tracked on the computer database.  

Last year CalPERS, one of the nations largest insurers decided that some hospitals were too expensive.  They dropped the hospitals.  The hospitals asked the state to investigate.  CalPERS stated that by dropping the hospitals they would save $34 million.  The problem is that the state believes CalPERS did not have a credible basis, in other words lied, about whether the projected savings would be true.  The analysts hired by the insurance company could not verify any of the projections made since they had no prices.  

In Pennsylvania, the HMOs have improved their patient satisfaction.  They did this by becoming less of an HMO and more of an PPO.  They allowed specialists to treat patients and did not ration care.  They still do ration some care by delaying access for treatment.  Since in the HMO arena a primary care physician must approve the referral, it seems there are no restrictions and therefore it is unreasonable to continue the practice.    Top


The nation's vascular surgeons continue to strive for their own medical board and continue to be beaten down by the American Board of Surgery.  The Boards are created by the American Board of Medical Specialties and the AMA.  The vascular surgeons may go outside the current structure to get their own board. 

The Cardiovascular Consultants of Kansas City have agreed to stay in the Blues for a short period of time after the Blues began to pay them alot more money.  The remainder of the issues of pay for performance will be decided later and the patients have already been warned that if the issues are not settled by August, the group will again withdraw from the network at the end of the year.  This group does the heart transplants that are crucial to the insurers. 

In a study of why statistics are what you want them to be, the US Bureau of Labor Statistics Consumer Price Index has stated that physician's prices charged to consumers rose 0.7% in February.  The charges could have risen 100% but it's what is paid not what is charged that is important.

In Oregon, more physicians are turning to concierge practices.  The hassle of medicine along with the low reimbursement is becoming more threatening to the insured practice of medicine.  

In Miami the primary care physicians must see patients every 9-10 minutes to break even.  For those that want to spend more quality time with their patients the choices are limited.  One is leaving private practice thereby putting more pressure on those who remain.  It is understandable when most office fees have risen 4% per year over the last three years and the cost of doing business has risen 7% annually over the same time period.  Those primary care physician that have attempted to sell their practices have for the most part just closed the office.  It is truly sad.      Top 

Medical Board

The California Medical Board will increase the oversight of foreign physicians practicing in the state.  The foreign medical physicians are able to practice under the auspices of an accredited medical school.  They must also be board certified or eligible in their specialty.  It seems the Board has been lax in their oversight of the requirements for these physicians to remain.  There is no enforcement mechanism for failure to follow the B&P Code 2113 regs.        Top


It always makes me feel good to know I can lead off this section with a story on the Drew/King Hospital.  As I am sure you know Navigant is now in charge of running the day to day operations of the hospital under a contract.  However, Navigant now wants more money.  They were originally given a $13.4 million dollar paycheck.  Now this organization wants $3.4 million more for more managers.  This is something they should have planned for in their original bid and contract.  They should not be allowed the extra money for their own shortsightedness.  Navigant wants $36,000 per month per nurse manager.  They also want $52,000 per month per physician to mentor other physicians.  These are ridiculous, especially from one that was hired because they submitted the lowest bid in order to get the job. Navigant has also recommended that both the hospital and medical school be put under the same united management.

Ah! They are not done.  The County is fining the medical school $20,000 for not complying with contractual requirements.  The school is not timely turning over the information required.

The physicians at Cedar Sinai in Los Angeles continue to use paper and pen for their hospital charts.  This is three years after the hospital pulled its $34 million electronic medical record entry system due to a physician rebellion.  The non physicians continue to push for the computerized system but have learned to integrate it slowly and with alot of input from all the staff, not just a select few.  Today, only 6% of America's hospitals have computerized records.  The Cedars hospital has computers but they are to impart information to physicians such as lab tests, not to have physicians enter information. The problem with the old system was the time involved.  Things that took several minutes morphed to 45 minutes. The machines put up alerts on routine orders that the machine did not understand. After three months the machines went bye bye until technology improves and there are more young physicians that are more computer savvy.

Marin County, California, has a hospital that has been mired in controversy for years.  The local people on the Board are divided about continuing the Sutter Health contract. There have been suits and counter suits.  The problem now is whether or not Sutter should be granted a long term lease of the facility since since they have been operating the hospital there have been accreditation problems. If the hospital cuts the tie with Sutter, Sutter may enlarge a hospital they already own in the county to make real competition for Marin General.  Marin general would then need to find another management company for the hospital.  

The Wisconsin Governor is against a moratorium on hospital construction or a certificate of need program.  He believes that the state should not stifle competition. 

Two hospitals in the LA area have been warned by the JCAHO that they may lose their accreditation if they don't correct some problems.  The two are City of Angels and Kindred in La Mirada.  City of Angels got the warning for their poor performance in the lab area.  At Kindred both the pathology and lab failed miserably.  

Approximately 85% of California's hospitals are out of compliance with the ill thought out nursing patient staffing laws.  There are longer waits for beds in the med surg areas meaning longer waits in the ED for patients.  There are some intermediate hospital bed closures as well.  The problem is the lack of nurses, even with using staffing services and locums.  

It's over.  The 82 year old woman at Kaiser Hospital San Rafael, California has been ordered out and to a nursing home.  she has been there for over a year and run up a bill of over $1.3 million.  Of course, she is penniless.  She can not walk or move out of the bed except with help.  Kaiser finally got a judge to appoint a conservator for her and then they found a nursing home willing to take her.  She wanted a nursing home in Marin County but that was not to be.     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.