December 1, 2007 Recent News

Peer Review


It's been a while but computer theft is back.  Three computers with patient identification were stolen from the VA hospital in Indianapolis.  The information was password protected but the patients are being offered one year credit monitoring.

The Wall Street Journal Online did a poll and found that in 2100 respondents 68% felt that EHR was good and would prevent errors.  51% felt privacy would be impacted.  One has to look at the respondents.  They were on the on line edition of the paper.  

UnitedHealth posted the SSNs of the Columbia University faculty physicians on line.  The list was accessible to people for the Columbia employees for enrollment purposes.  United has given a one year Equifax protection and sent a representative to answer the physician's questions.      Top


Sometimes physicians and hospitals can work together, when the hospital is in financial straits.  In Munster, Indiana, the physician owned hospital was in financial straits and a not for profit hospital system purchased the hospital as a joint venture.  

In Northern California, as elsewhere in the country, physicians are becoming more of a scarce commodity.  Most of the physicians coming to Northern California are being taken by the two large entities, Kaiser and Sutter Palo Alto Medical Foundation.  Kaiser Permanente is a for profit physician organization owned by physicians who are under contract to care for Kaiser HMO patients.  Sutter is a 501 (c) (3) organization which can employ physicians in this corporate practice of medicine state.  Kaiser has hired about 1000 physicians in the past three years including some small existing primary care groups.  Sutter has hired about 300 physicians in the same time period.  The usual starting annual salary for primary care physicians in the two organizations are about $140,000 plus perks.  In small groups the annual starting salary is many thousands lower.  

In two articles on physician shortages, different reasons are given in different areas.  In the San Joaquin area of California there is a shortage of physicians due to the area, lower reimbursement due to the rural nature, lack of academic resources and a desire to get higher reimbursement.  This is an area of Medicaid an non insured.  In the California Statute Correctional System they are paying good money but the clientele and working conditions may not make it a safe environment.  

Not only are there shortages but only 31% of primary care physicians are US medical school graduates.  The US physicians are becoming specialists.  The foreign physicians are recruited for being high in standing in their countries and most are from poor countries that can not afford to lose their physicians.   

In Wayne County, Michigan, the physicians are getting a 13% decrease in their med mal premiums.  They are seeing the fruits of the change in the med mal laws from14 years ago. OBs in Michigan will pay about $120,000 per year compared to about $150,000 in Ohio and over $300,000 in Illinois where there is no tort reform.    

The AMA House of Delegates adopted principles to ease physician hospital relationships.  One of the main issues is economic credentialing.  The AMA is calling upon the Joint Commission to protect confidential physician financial information.   

Dr. Howard Lang, an advocate for physician autonomy, has written an article for Southern California Physician.  In the article he discusses his view of how physicians can regain the leadership roles they had in the past.  The underpinning is to see your fellow physician as a peer and not as a competitor.  If that can be done he recommends that physicians from various local hospitals band together into a true professional corporation to provide services to the local hospitals.  The hospitals would need to contract directly with the corporation to get the services of the physicians.  This would include payments for being on committees and being on call.  It is an interesting concept and one that should be discussed.    

Medical Economics has a report in the November 16 edition that stated that a third of primary care physicians put in 60 hour weeks in order to keep up with lowered reimbursements.  About 1/3 of pediatricians worked fewer than 30 hours a week.  This compared to 15 % of FPs and 14% of internists.  They felt that many pediatricians are female and are doing more life work balance. The GPs were working less since they were older and phasing out of practice.  Internists work longer but see less people since they have sicker patients and can charge higher prices.  Group size is also important.  Soloists tend to either work the least or the most amount of hours.  Those in small groups are forced to push hard since the overhead is high and they are usually on the eat what you kill compensation package.  Large groups can have a good year and an individual physician can skid some.

An article in HealthLeader Media tells that the older physicians look down on the younger ones as slackers.  They have inferior training, poor work ethic and are disloyal.

The two largest ambulatory surgical groups have joined together.  The Tennessee AAASC will join with the Alexandria, Virginia, FASA.  The new group will have over 3200 members and will be called the Ambulatory Surgical Center Association.  It will be housed in the current FASA headquarters.            Top


Bayonet Point , Florida, Regional Medical Center has a problem.  The medical staff have total distrust in the CEO, Steve Rector.  The medical staff is now on record as a vote of no confidence in the CEO due to his continued seen problems with the suspension of nine cardiologists at the hospital. The cardiologists have sued the hospital but will probably lose since the peer review process is not finished, therefore the administrative appeals have not been completed.   

An Article in Modern Physician talks about the ED staffing problems.  It states that more hospitals are solving their problem by paying physicians to take call.  This is specially true for the scarce physician specialists such as neurosurgeons or dermatologists.  

Another article in HealthLeaders emphasizes the same on call problem but states the reasons are less physicians needing hospitals, payments for emergency care and liability concerns.  Hospitals are using multiple means to have physicians take the call including forcing them which leads to more defections, paying the physicians a per diem or for those patients who do not pay their physician bills as well as doing things to improve the physician work environment.  This may include providing practice management services, life insurance or paying med mal premiums.  As long as there are safeguards to show that the physician is not obligated to send patients to the hospital it would not run afoul of the anti-kickback rules.

California Pacific Medical Center was prominently featured in the November 29, 2007 Wall Street Journal article on padding medical bills.

In the same paper on the OPED page there was a commentary regarding the American Hospital Assn. recommending against routine culturing of surfaces for MRSA.  They don't think it is necessary.  They may change their minds now that Medicare and other insurers are quitting paying for hospital acquired infections like MRSA. 

Again in the same issue, but buried in the paper was an article on the scare paper in the New England Journal regarding CT scans.   

The poor hospitals of Pennsylvania are having financial difficulty all due to the proliferation of outpatient surgical centers that they do not control.  They didn't have the foresight to put them in and allow the physicians to give input so they are now only making money instead of more money. The last operating margin reported by the Pennsylvania hospitals was 4.2% as opposed to New Jersey 0.6%.  The hospitals are paying for their past mistakes and are crying wolf using the old bromide that the best patients are being siphoned off.  A report showing apples and oranges states that only 2.5% of outpatient surgical center income came from Medicaid as opposed to both outpatient and inpatient hospital Medicaid of 11%.  Another hospital scare tactic that shows their backward thinking.  

Don't feel too sorry for the hospitals now, wait until Congress gets through with them.  Newsweek has an article regarding the hospitals selling their uncollectable debts to various credit card companies who charge very high interest rates.  That wouldn't be bad except that the hospital sometimes forgets to tell the patient that what they are signing is a credit card debt.  They have the patient sign the small print form when they are distraught.  Congress is now looking at the community benefit aspect of this behavior.  This may be another nail in the ability of non profit hospitals to retain their non profit status.       Top


In Minnesota, the physicians have turned the table on the insurers and have ranked them.  They have ranked the insurers "pay for performance" programs.  Medicare came out on top and Bridges to Excellence came on the bottom.  The physicians are concerned that P4P is one that will coerce physician behavior and will force future physicians to follow guidelines whether they fit the patient or not.  They will do the Willie Sutton Law, "Follow the money."    

UnitedHealth and other insurers have signed on to the New York rule for ranking physicians.  

The AMANews has an article about the problems with VA access to care.  The well written article describes the massive increase in people attempting to access care, the lack of physicians and locations for that care and the cost along with the problems of how it is funded.  I again reiterate that the VA system is one that should be abandoned and replaced by allowing all vets with disability to access outside care via Medicare. 

The chief of medicine at the People's Republic of Massachusetts Cambridge Health Alliance has been after his physicians to order less CT scans for patients due to cost.  That has not worked so now he is using the discussion of too much radiation.  The problem is there has been no studies done showing that the average CT scan increases the chance of cancer in the future.  The data is all from the atomic bomb explosion in Japan in 1945.  The average person gets 2-5 millisieverts of radiation per year from normal sources.  The Japanese who were the farthest from the blast got up to 20 millisieverts of radiation with a small increase in cancers.  A normal chest x-ray is under one millisieverts.  A chest CT scan is 8 millisieverts.  The chief now wants his medicine physicians to give an informed consent discussion to all patients who may need a CT scan and to use MRI or hopefully ultrasound, a study that is user dependent, to do the work.  

Minnesota HealthPartners and Blues have put restrictions on ordering scans.  There were no medical benefits of note to cutting of the scans, it was strictly money.

While Congress fiddles, Medicare burns.  Congress still has not taken up the overturning of the 10% payment reduction to physicians scheduled to take place starting next month.  In the meantime there are 1.3 million more people on the Medicare managed care plans, especially the PPO plans,  between 2006 and 2007.  HMO plans have seen a significant continuation of the drop in enrollees.  They lost about 9% of their enrollees in the past year.  These people will find it increasing difficult to get appointments with a decreasing population of primary physicians taking Medicare patients.        Top

Peer Review

Cr. Larry Huntoon, of the American Association of Physicians and Surgeons has just written an editorial in the Journal of American Physicians and Surgeons about the foibles of sham peer review and how the hospital attorneys and the courts have made a mockery of justice.  The article is in Volume 12 Number 4 Winter 2007.          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.