August 1, 2005 News





The use of electronic records is not being done in most of the medical offices in the country.  The problems are the expense, not offset by the decreasing payment, and the hassle factor.  The government will take away at least some of the pain by supplying for free software to computerize their offices.  The government will begin next month providing Vista, the program that has been used for years at the VA systems, although with some problems.  Medicare will also give al list of companies that are trained to install and maintain the system.  It will cost about $10,000 for the installation of the system.  Vista has a reputation of being a difficult installation.  The physicians also believe, and rightly so, that the extra time needed to use computers will cost them many thousands of dollars a year in lost revenue.  As another potential drawback is possibly coming under the auspices of HIPAA, when now you're not in a small office.  

A new study has shown that physicians, especially those in EDs, do different treatment decisions due to malpractice concerns.  They order more tests and they admit people that should not be admitted just to CYA.  

A new study in Pennsylvania has confirmed what what already known, that young physicians were choosing to not stay in their state due the malpractice clime.  Following their residencies, the Pennsylvania grads are leaving.  There is currently a glut of specialists in the urban areas but as they retire the problem will become noticeable.  A survey of residency directors of the state programs received no positive vibes for staying in the state following the residency programs.  The residents are now becoming more aware of the implications of being sued on their premiums, time, emotional well being and future with data bank reporting.  

A study of the Sacramento, California area shows the demise of the solo OB practice.  The individual physicians are now forming groups as are those in almost all specialties.  They have found some economies of scale and the help that each needs for interaction and be secure in being able to take the necessary time off. 

It appears that the rural hospital in Nashville, Illinois has picked a fight with the wrong physician.  Dr. Coy has been a surgeon in the hospital for over 30 years and is now slowing down.  Normally this is no problem but the slowdown happens to coincide with some problems between the hospital and the physician.  Dr. Coy also controls about 40% of the town's patients and is sending alot of them out of town.  The hospital is now in financial turmoil and my need a white knight to save it with giving up its autonomy.    Top


As is my routine, I usually start with a story about the worst hospital in the country, Drew/King in LA, California.  Navigant Consulting, the firm that was hired to attempt to turn around the cesspool at he hospital has reported that its efforts are hindered by the media and the Board of Supes that control the hospital.  The hospital continues to lose more nurses than it can recruit.  It has a major healthcare problem with over 1700 x-rays not read. Navigant states some of the fault rests with the Supes for not funding the refurbishing of the facility or to create an authority to run the county's  hospitals.  The consulting company also stated they are required to spend too much time answering media and the Boards questions which takes away from their ability to focus to the actual work.  

On the positive side the hospital has opened a clinic for women.  However, as is their bent, they made it difficult to find.

An outside consultant has stated that it could take up to a year to get a feasibility study to determine the turning of the hospital over to an outside agency and who that would be.  The Board does not believe it has that much time as Medicare funding may be stripped.  The supervisor in whose district the hospital is continues to put her head in the sand in the hope that she can continue to be reelected.  She wants the hospital to remain like it is, under her thumb and completely intolerable.

In Yakima, Washington, the CEO of Yakima Regional Medical Center has received a vote of no confidence by 150 of the 260 physicians of the staff. The other staff for whatever reason did not vote. This is the same hospital that ignored complaints by its physicians and then replaced the complaining ED physicians with an out of state group.  The hospital was not listening to the physicians and the doctors have become more frustrated.  The no confidence vote also questioned the veracity of the CEO. It will be difficult for this CEO to continue to govern with this type of resolution.  It would be better for all concerned, especially the hospital, if the CEO left. 

California's Napa Valley State Hospital has been cited by the DOJ for its poor care and the obstructionistic attitude of the California Department of Mental Health.  At Napa there have been ODs on amphetamines and three patients obtained and used heroin.  One patient had to wait two YEARS to have a psychiatric evaluation.  The Department of Mental Health has also been accused of attempting to keep any investigators out of two other state mental institutions until 2006.

Specialty hospitals continue to be debated.  No one agues that they are more efficient and cheaper than community hospitals but they do argue the reason.  Is it that the specialty hospitals are skimming the more healthy patients with fewer co-morbidities?  If so, than the data is skewed.  If not, then the specialty hospitals should be allowed to flourish.  The spurious argument of taking money away for the other services the community hospital maintains is just that.  If the community hospital was forced to become efficient, they could and save the reason for the specialty hospital.  The community hospitals are also partnering with physicians to keep part of the pie. This is a recognition of their own inabilities to become efficient.  

An article that shows the poor thinking of some hospitals, build it and they shall come, was in the Columbus, Ohio, Business First paper. Ohio State University is putting up a $150 million biomedical research tower.  They were hoping for at least $24 million and have gotten zilch. They now have to change their fundraising strategy. The University thought it was behind it's competitor universities in this research.  They needed to move quickly in the publish or perish world.  They bypassed the use of state construction funding for that of private money, research grant money, which was not earmarked for research, and university backed bonds.

Three Democratic House members have asked CMS to look at the discharges from specialty hospitals in non-Medicare patients for racial bias. It is amazing how far some will go to stifle competition.  However, since one of the people asking about this is Pete Stark, eh.       Top  


The Governor of the People's Republic of Massachusetts hd proposed a plan that the state's uninsured purchase health insurance, in some cases with help form the state.  Now the state's socialists are testifying that this does not address the rising health care costs and does not provide insurance for all.  They want the usual one payor system that does not work in England nor Canada and takes away choice.  It also drives physicians away from the places that have this form of payment.  The socialists want Lexus treatment for all at Kia prices.  It ain't goin to happen.         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.