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In the Stanford U.C breakup Stanford has incurred massive debts. The adult hospital is facing a $40 million dollar shortfall for this fiscal year and $70 million in the next fiscal year. They state the cause is the low reimbursement relative to the care given. However, they are not willing to discontinue the money losing contracts that got them into the problem. They are also not willing to look at how expensive it is to continue to provide care at the institution. They are now looking to not fill vacancies and to possibly selling off one of their hospitals, as if a buyer could easily be found. Top
San Mateo General has a $12 million budget overrun, personnel problems, non-collection of money owed and a poor computer system. They are looking to partner with Stanford (see above story) or UCSF. The county manager has pushed the Health Service Director aside and has taken over. He has hired a consultant for the structure and another one for collections. The latter collection agency takes $0.16 of each dollar collected. They hope to have shaved $17 million off the amount owed by May. The receivables are now down to $29 million but only $1 million is accounted for. The mystery is what happened to the other $10 million. The recently (3 year old) installed computer system will not get files for the ED physician, bills wrong codes and does not send bills out in a timely manner. Does this surprise anybody who has worked with governmental institutions? Top
The LA Times reports that rural hospitals are fiscally not doing well. The story focuses on Lone Pine and Southern Inyo Hospital. The 37 bed district hospital is in bankruptcy and the people believe it is still needed. It is the only hospital in a 60 mile radius and sees a lot of auto accidents as well as medical emergencies in the ED. The question is how to salvage this and other similarly situated hospitals. The only answer from the monetary standpoint is for the district to get more money from the state. One way to do this is from the cigarette tax and settlement money. The county politicians think there may be a better use for the money. Top
A New York Times article discussed wrong side surgery.
The interesting thing was they got it right. It is not a physician error
when this happens but a systems error. The x-ray may be put up wrong or the
orderly brings the wrong patient to the OR without checking that the bands match
the name on the schedule for that
room. There was a recent case in California where a physician took off
the wrong testicle for cancer and then took off the correct one. He lost a
bit of money on that case.
The Florida Board of Medicine is proposing a fine of $10,000 and telling their
peers if they do wrong side surgery. This is a stick approach and does not
take into account the systems errors that may play a significant part.
Top
In a follow-up to the prior story on Northside Hospital's exclusive contract with insurers to do OB, the state legislature session finished without any resolution. It was hoped by the hospitals left out that a bill to prevent exclusive contracts with insurers by any hospital that is the sole provider of OB services within a one mile radius. This would open the door for other hospitals in the geographical area to get contracts. The bill never came to a vote. Top
The Tri-City Medical Center in southern California received a 78 in their recent JCAHO survey. They are now trying to do the improvements suggested by the JCAHO. This score is in the bottom 1% of all hospitals that are being rated. The "conditional accreditation" was for crowded ED, lack of infection control officer, inadequate recording of medication dispensing and other administrative problems. The Board chair proposed canceling the $43,460 bonus paid to the CEO in December. The motion died for a lack of a second. I think the Board should re-think their lack of a second. Any hospital with that low a score should not give an approval to the CEO. I might add that a San Francisco Hospital in it's last regular JCAHO inspection received a 72. They fixed their problems and are now are fully accredited. Top
The black residents of Americus Ga. are boycotting Sumter Regional Hospital due to the summary suspension of one of four black physicians on the medical staff. Dr. Marshall was summarily suspended for "willful disregard of hospital policies and because (his) conduct requires that immediate action be taken to reduce the substantial likelihood of immediate injury or damage to the health or safety of any patient, employee or other person present in the hospital." Dr. Marshall states patient care had no part in his suspension. He states it was triggered by his complaints to hospital officials about "unfair hiring practices" and racial discrimination. Dr. Marshall is the president of the local NAACP. If one reads the quoted section it states "and" which does not state anything about patient care. This sounds like the immoral and possibly illegal use of summary suspension to get rid of a "disruptive physician." It also sounds like the disruption is an embarrassment to the hospital and the allegations may be true. Top
Lasik Vision, a discount eye surgical chain owned by Icon Laser Eye Centers in Canada, has closed its operations. The close-up of the operations has some potential medical-legal ramifications. The first is what happens to those people that have pre-paid and not received their surgery. The centers did both eyes for $1000 and the money was paid in full prior to the first exam. There are about 2000 such patients nationwide. The second is what responsibility does the chain and especially the physicians working for the chain have to the patients already operated upon for follow-up and treatment of any complications. Top
Prudential Health Care, a Florida HMO with 100,000 members, has cancelled its contract with Florida Hospitals, a six hospital chain. Approximately 4000 HMO members will need to find new physicians or change their insurance since their physicians are only on the staff of Florida Hospital. There are two other hospital chains in the area that still have Prudential contracts. Top
UCSF has released a study stating physicians are not leaving California for greener pastures. The opposite is true. the number of physicians per 100,00 population has risen from 177 to 190 in the past six years. The CMA does not agree with the study since much of its data is 2-3 years old. Top
Fresno PacifiCare commercial members have been switched from St. Agnes Hospital and Matrix physicians to Community Medical Hospital and Sante Medical Group. The 61,000 people were given one week to change physicians and the new list given was the usual erroneous one. PacifiCare used a 1999 list. The 8000 Secure Horizons seniors also must find new physicians. The Health Advisory Program "worries" that the seniors will go back to traditional Medicare. That statement tells how unbiased the program is.
A follow-up a judge has stopped the transfer of 2500 of the enrollees (county employees) from the switch since they need a 30 day notice.
PacifiCare has reported that the first quarter and year will be on the high side. "We are continuing to advance prices and cut benefits in all markets" stated the CEO. This includes a slowing of its move to a shared risk product. They are also doing tighter drug management and placing nurses into hospital to "guide patients so they receive the most appropriate care." Translation: cheapest care.
In western New York the area's three largest HMO's have come together to publish asthma guidelines. This is only one of many coordinations of HMOs that have published combined guidelines. In the near future Minnesota will establish guidelines to 50 common conditions, including asthma, hypertension, diabetes and breast cancer.
Wisconsin HMOs are raising prices by 15% to 25% in order to widen profit margins.
Kaiser Colorado is lifting the freeze on enrollment. They stopped Medicare enrollment January 1 when PacifiCare dropped their Medicare HMO. Since that time Kaiser has hired new primary and specialty physicians to take care of the expected increase in population. Top
The Washington physicians are shunning Medicaid patients due to low reimbursement. In the Puget Sound area there are only three of 25 individual physicians and three of seven groups taking Medicaid. I'm surprised there are that many. The State says we have anecdotal information but no data. They do know that more people are calling to try and find a physician to take them as patients, but they have no data. The State has increased payments a whooping 2.1% for the next fiscal year. The State also has a MCO but believe that less insurers will contract with it, but they have no data. A recent survey show physician payments are 26% below private insurers and 14% below Medicare, but they have no data. Top
An Stanford Hospital employee was arrested for extortion when she attempted to blackmail a physician with whom she was having an affair. The physician called the police and a trap was set. This story has two interesting twists. The first is the physician admitted to the affair but was not named in the story. The second is a HIPAA concern. The woman made an error. She sent an extortion note to the wrong computer printer, a potential HIPAA violation. Top
The Wall Street Journal reported on clinics operated by bilingual physicians in Puerto Vallarta, Cancun and Cabo San Lucas. The clinics use American CPT codes and are paid by American insurance companies except for Medicare. The doctors do well by Mexican standards making $40,000 per year. The clinics are open 24/7/365. Top
In Charlotte five OB/GYN practices with 27 physicians have merged and are going it without a management company or hospital backing. The Board consists of one doctor from each of the five merged practices and they are hiring out any management duties they can not perform. They look at this as the next step in the transition of healthcare management. Currently they are all keeping their own offices, etc. As one who has gone through this myself and for others, I know that eventually they will end up with only 1-2 offices in order to get rid of duplication. Top
Two physician practice groups have been purchased by a third practice group, HealthCare Partners. The two groups bring 55,000 lives and 363 physicians to the table. These two groups were owned by Cedar-Sinai Medical Center. I bet they're happy! Top
In Denver, as in the rest of the country where managed care is strong, many primary care physicians are finding it more cost effective to stay in their offices and allow hospitalists to care for their hospitalized patients. This allows them to be more productive and also allow presumably better, if less personalized, care for their hospitalized patients. The statistics show that hospitalists can reduce LOS and cost by almost 20%. Top
Morning After Pill Over the Counter
California has joined Washington to allow the "morning after" pill to be sold over the counter. A pilot program in San Francisco, Marin, Los Angeles, San Diego, Santa Cruz, San Joaquin and San Luis Obispo counties will start soon. The CMA is in favor of the program but in a turf battle believes this will lead to pharmacists being able to prescribe other medications. This program is under the emergency contraception exception of the FDA and bankrolled by the David & Lucille Packard Foundation. Top
The FAA has ordered all US airlines to carry portable defibrillators and train their attendants in the usage as well as the medical kits containing IVs, oral antihistamines, and an Ambu bag. The airlines have three years to comply. The regional airlines need to have the equipment in 2/3 of its planes. 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.