April 15, 2006 News

Insurance

Hospitals

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Physicians

Insurance

The people who want you to "thrive" in their advertising are taking some of that back.  Kaiser Senior Advantage be raising all their members rates for prescriptions.  They are using the new Medicare Part D for their members when that is not necessary.  They are doing it to make more money.  When the member reaches the "donut hole" the member must pay like all others if he/she is enrolled privately.  If the member is enrolled via a company then they will not have to pay the money during the time in the "hole".  This will cost Kaiser members as not only do they now have to pay for the meds but they also have to put up with the Kaiser system, a double whammy.  Some members wrongly blame Medicare when it is Kaiser that is doing the charging.  If they take the time to compare drug costs on line they will find Kaiser as one of the most expensive.        Top

Hospitals

In the last edition I wrote about the dumping of homeless hospital patients in skid row by the Los Angeles Hospitals, namely Kaiser.  The LA Board of Stupes who have messed up so badly in the Drew/King debacle may have finally done something that makes some sense.  The County is flush with money due to high real estate prices. They also want to do something to revitalize the downtown.  They have decided on a four to one vote to have regional homeless shelters.  There will be one in each district.  The homeless released from the hospitals will now be sent to these shelters and not dumped on skid row.  The shelters would also have social services for the homeless. 

As all know the University of California, Irvine has been plagued by healthcare scandal due to their transplant program.  They have now decided the correct control measure is to hire outside consultants and hire new people.  The outside consultants are the same ones that have been chastised by the LA Board for their work at Drew/King. 

After they had an editorial blasting the community hospitals in their fight with specialty hospitals, Modern Healthcare is now receiving letters to the editors.  In the April 3 edition, a CEO from Florida had a rant without anything concrete.  A FP from South Dakota spoke more eloquently regarding the potential for conflict of interest.  A Urologist in South Dakota spoke about the community hospital lack of referrals to those physicians who have an interest in a competing hospital and their hypocrisy of with owning medical clinics and steering patients to those entities.    

While on the topic of specialty hospitals, Benefis has filed a motion to not allow Essentia Health, a not for profit health system from purchasing the Great Falls Clinic in Montana.  They claim the new entity will be a specialty hospital but they are licensed by Montana as a full service hospital.  They will provide surgery, physical therapy, pediatrics and other services but no ED.  This is not required of full service hospitals i the state.  This is purely another turf battle regarding NIMBY.  

Allegany Hospital in Pennsylvania was discussed in the last update.  Pennsylvania has continued to stonewall against the illegal acts of the hospital of having a non physician in charge of the psychiatric program.  This may have to do with money and grants to the Center for Traumatic Stress in Children and the payment of less money to a psychologist than an MD.  It should get interesting when the JCAHO does it's inspection and dings the hospital big time for their stubbornness.  Of course,  JCAHO has now relaxed their standards to allow more hospitals to pass and continue to pay their dues.  

Sutter Hospitals in California have another good year.  They have reported a net income of $442 million in 2005.  This is a 5% operating margin, a good figure.  They also announced that providing care to uninsured patients cost them $59 million.

Alameda Hospital in California is planning to cut people due to poor planning last year.  They did not plan for the nursing ratios that went into effect in January.  This means getting rid of the union staff by either laying them off, attrition or early retirement.  The union just got a 4% raise.      Top 

Associations

In an interesting table in Modern Healthcare, the organization with the most revenue is Blue Cross and Shield.  Their revenue is $270 million with a net income of $11 million.  The second highest is the AMA with $250 million and a net income of $42 million, the highest by far of all on the top 25 list.          Top

Physicians

See story under Legislation re reduction in Medicare pay.

Pennsylvania has finally noted that they have fewer physicians.  As part of the same report it was noted that there are fewer of the citizens that are covered by private insurance.  The state has had a 10% decline in physicians from 1999 to 2005.  No surprise to those who followed their med mal problems.  The physicians of the state pay the most for med mal premiums of any in the country.         Top 

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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.