April 1, 2008 Recent News






Wenatchee Valley Medical Center in Washington is an unique institution.  It is a full service hospital owned entirely by physicians.  This hospital is in danger due to the AHA's position on physician owned hospitals and the money they are spending to bribe (lobby) legislators to do away with them. This particular hospital serves as a community hospital and the physicians are not willing to sell.  They will either change the structure to a non profit or merge with another hospital but keep control. 

Below there is an article about concierge physician practices.  This is the first time I have heard of extra fees by hospitals to patients who see physicians in office buildings that the hospitals own.  This is true in Milwaukee at the Meriter Health Services.  For a consultation the extra fee for the hospital was $157 plus $266 for the physician fee.  Another goniff is Froedtert & Community Health and Children's Hospital. Some of the hospitals only charge facility fees at some but not all offices in the building.  Others charge in some buildings they own but not others.  Patients, or in this case consumers, should think long and hard before making any appointment with any physician who works in a building that charges these fees.  

A week ago a study came out stating that routine testing of patients for MRSA was useless.  Now a new study by Evanston Hospital of the Northwestern University states that it is helpful in reducing MRSA hospital infections.  The difference is that Evanston tested all patients not just those that went to the ICU or surgery.  They found an incidence of 8.5% in the population.  

The hospital is truly the physician's friend.  When six physicians at the University of Pittsburgh Medical Center gave notice of their leaving for a better position they were locked out of their offices and the patients not told where to find them.  These were OBs some with high risk patients.  The University just plain lied to the patients and treated them like dirt. 

California's nurse staff ratio law has not given the protection to the patients that was predicted.  The number of falls and bed sores are the same as prior to the law.  The radical CNA states that the study performers, the Association of California Nurse Leaders and the American Nurses Association have close ties with hospitals so their report should be viewed with suspicion.  The CNA has done no studies.      Top


Some physicians when they read this will already be out of compliance with new Federal laws.  Starting today, April 1, physicians are required to to begin writing Medicaid prescriptions on tamper proof pads.  Physicians have until October 1, 2008 to get completely tamper proof pads.  The way to get around the dumb law is to fax, phone or electronically submit prescriptions to pharmacies.  The rule does not apply to these methods of delivery.  Physicians who still take Medicaid patients should contact their state Medicaid office to find where they can get the special pads.  

More physicians are asking patients to sign arbitration agreements prior to offering any services.  Occasional states have addressed this.  Utah states that the agreements are legal but that services can not be conditioned on an signed arbitration agreement.  California requires certain prominent placement of the agreement and the agreement is binding on newborns if the pregnant mother signed the agreement.  The trial attorneys don't like them so they must be good.    

In Texas there is a feud between some insurers, United and Cigna,  and those physicians that practice concierge medicine.  The insurers state that it is against their contract and are dropping some physicians.  Other insurers in the state have no problems as long as the patient knows the company will not reimburse any of the upfront fee.  

The year's resident match is now history.  There was some minimal increase in those that chose primary care since more primary care slots opened up.  The percentage was 7.6%, a minimal increase, in family medicine but this was overshadowed by a drop in of about 1% in internal medicine.  

In Florida, a radiology group is having a contract dispute with Florida Hospital.  They will not be rehired after their contract expires in several months.  The radiology group has sent a letter to about 2000 physicians in the area warning them that their radiographs could be "interpreted by unknown entities with unknown credentials in unknown locations."   The hospital states it will contract with a US based board certified Florida licensed group.  This could be interesting if the group or part of them went into competition for the outpatient business. 

In a relatively new trend about 20% of physicians are now working part time to balance work and family.  Of course the more physicians that go part time the more need there are for physicians.

The Californian physicians are doing what is expected, dropping Medicaid patients.  When the idiots at the Democratic controlled state legislature and the Governor passed a 10% decrease in the payments to physicians they knew this would result.  The state has even stopped assessing if they have enough physicians for their program.  They just don't care.  They are willing to pay the higher fee for emergency room visits for those patients willing to sit for hours to be seen.  Those in primary care who do see Medicaid patients have no one to refer them to.  They are sent to the ED.        Top 


The continuing saga of lost or stolen patient identities continues.  Advanced Medical Partners, a New Hampshire hospital, had 10 computers stolen from one of its vendors in Texas.  Only about six patient's information were involved.  That is six too many. 

The lack of privacy with electronic devices continues.  A laptop computer from the NIH which was not encrypted was stolen.  It had everything on it a good person would want for massive identity fraud.  The NIH waited a month before notifying the people.  There was no mention of paying for credit watch. 

UCLA's neuropsychiatric hospital has banned all cell phones and laptop computers.  They are afraid of pictures being taken of the patients. 

CareFirst BlueCross dental HMO in the Baltimore area put the information of about 75,000 members on line and then didn't tell them for three weeks.  Sounds like an HMO.  State law requires that credit bureaus allow security freezes on their credit. 

CVS has been fined and agreed to settle with Texas for $315,000 for the illegal dumping of patient records in a garbage dumpster.       Top


An interesting article put out by Health Affairs state that physicians refer their privately insured patients to ASCs but their Medicaid patients to hospital outpatient departments. The article has many faults.  Although it covers over 1 million patients, it only covers two cities in Pennsylvania.  The authors who do not disclose any potential conflicts narrowed their parameters due to the expense of doing more areas in the state.  The study showed that most of the non insured went to ASCs and that this was probably due to cosmetic surgery not covered by insurance.  This means that the ASC was significantly cheaper for the patient than the hospital.  The study also looked at only the top 50% of the admitters to each type facility.  These physicians did send almost all of their insured patients to the ASC but split the Medicaid patients almost evenly between the hospital and the ASC. There is no interviews with any physician as to why this occurred.  The study was on patients from 2003.  Again, an interesting but incomplete and old study.   

The insurers are at it again.  They are requiring more pre certification for CT and other advanced procedures.  The fear the patients may be getting too much radiation.  Yeah, right!  If there is too much hassle, and there usually is, getting a thallium heart scan the patient will get a cardiac cath which does not require pre authorization.  Are some of the scans un needed and used just for financial gain of the physician.  I am sorry to say yes.  However, it is a very small percentage of physicians who do this.  Next is expensive meds and procedures.  We will soon be back at the time of the original HMOs who gave insurance a black eye and are hell bent to do it again.  

The administration has issued another report on Social Security and on Medicare.  It states that Medicare will be bankrupted by 2019 and Social Security by 2041.  The Democrats are talking about "reform" whatever that means and ignoring the financial problem.  McCain has stated that costs must be gotten under control.  The problem is that Medicare is not a worry to some since it can tap general funds. 

The physicians of the public hospitals in the Dominican Republic have again gone on strike.  They continue to want better pay up to a whole $1750 a month and improved conditions at public hospitals.  The Health Minister has stated that the strikes are illegal and he will meet with the physicians only if they suspend their strike of 10 days which they will not do.  There is a better way.  The physicians can do what we did as residents at a county hospital with a county board that wouldn't listen to us.  We staged a heal in.  We admitted everybody and discharged no one.  This meant there were no beds available and patients had to go to private hospitals who wanted no part of them.  The private hospitals put pressure on the county board and the impasse was over in a week.      

A father has found the way to put pressure on an insurer.  In Grand Rapids, Michigan,  a father of a recently disabled daughter was going to be removed from a rehab hospital to the home setting before she was ready.  The patient's physicians agreed she should stay in the rehab hospital.  The father and several hundred family and friends began an email blitz of the insurer Blue Cross and the media with multiple emails that made the boxes stop working.  The insurer then apologized for the miscommunication and authorized the additional two weeks of needed care. Maybe more people should do this.  

I think things may be changing slowly.  Group Health in Washington has changed its policy on transplants and stopped using a loophole to not pay for needed care.  The insurer also wants to work to change the state law to remove the loophole that insurers now use to deny care.  

A New York Times article details the dissatisfaction of patients with their hospitals.  In a national patient survey, the main complaints were of the hospital professionals, arrogant physicians and crabby nurses along with the lack of respect shown the patient.  I wonder, since the study article didn't say, how many of the hospitals where there were problems in communications had EMRs where the staff were too busy with the computers to care for the patients.           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.