HMO

The San Jose Mercury News stated the California physicians are fleeing the HMO business.  The article state that only 58% of the state's physicians are taking new HMO patients.  Over 1/3 of the specialists and 23% of primary physicians in the state have no HMO patients.  This makes it difficult for patients who opt for this insurance to find qualified physicians in their locale.  About 1/2 of all the insured in California have HMO insurance.  Some physicians have dropped all insurance and have gone to a totally cash practice.  The only one that is coming out in the plus column is Kaiser with their captive Permanente Medical Group. 

The MGMA states that those physicians working in groups who do not have capitated contracts make more than their counterparts that do take capitation.  The percentage difference was a startling 32%.  There was a large difference in staff salaries also with capitated groups spending almost double than those without cap.  The increase was not as large for each specialty but there was a significant increase for each specialty that refused cap payments.  

The country's second larges insurer, CalPERS had only agreed to use Blue Shield an Kaiser for their HMOs.  This meant 170,000 families changed plans.  The bottom line is that 90% of those switched to Blue Shield in order to continue with their physician. 

Now to the greatest fiasco in the country, TennCare.  The state Medicaid program pays virtually nothing for the care received, they make the attempt to collect money from the system a series of hoops and they wonder why physicians don't rush to join.  The specialists are staying away in droves.  Those non-contracted specialists are getting paid more to see patients and means long waits for the patients to see the remaining specialists.  After following this fiasco for many years, it is easy to understand why a person from Tennessee should not be President.           Top

Hospitals

Tenet has decided to mend fences with health plans and the Feds.  The new way is for outliers to be paid a fixed fee as opposed to a percentage of retail prices.  The new contract was between Tenet and Health Net.  It covers 27 California hospitals.   

The Chicago Tribune reported that in Illinois a new boutique hospital has been approved.  On the north side of Chicago a new 85 bed orthopedic and neurological hospital will open next year.  It is a for profit run by a group of neurosurgeons and a financial backer. Northwestern, a nearby competitor doesn't like the idea since "it cuts into our already tight profit margin."  The hospital plans on having a full medical staff and an open ED.  

As a follow-up to the above story, what have you done for me lately?  In Waco, Texas the Hillcrest Baptist Medical Center is recruiting specialists by giving income guarantees and forgiveness of debt.  There is a major market now for physicians who want to move, especially to rural areas.  The salary offers are also up in hospital and group recruitment.  These can be up almost 15% from last year.

In the three years since the Institute of Medicine released it's criticized report on medical errors, not much has been done by the nation's hospitals to correct their faults.  There has been no legislation although their has been bills introduced in Congress.  The JCAHO is only now starting to require hospitals to do something to show they are attempting to reduce errors.  Only 3% more of hospitals have gone to electronic medical records and there has been an increase in wrong site surgery.  In hospital acquired infection the idea of Semmelweiss is finally getting through.  Wash your hands. In Allegany Pennsylvania the hospital had a death from Pseudomonas after bronchoscopy.  They did a great job of tracking down problems related to resterilization and then shared that information with other hospitals.  The other causes such as tired residents and lack of nurses are attempting to be addressed.  The hospitals fight the limitation on resident hours because they would have to hire more and pay more money.  The nursing shortage is well known.    

For those of you who are following the Indiana and Ohio specialty hospital debacle where the only hospitals in the areas are threatening to dismiss practitioners who own part of specialty hospitals, the December 2002 issue of Modern Physician has a wonderful item by Dr. Alan Pierrot.  The article shows the fallacy and biases of the community hospital position.  

King-Drew Medical Center in Los Angeles has lost its accreditation for radiology raining.  This will impact the center's ability to provide healthcare to the population.  This takes effect June 2004 and will probably be rescinded before that. 

The hospitals of the People's Republic of Massachusetts are attempting to get a law through the legislature to open up the blood banking business.  Currently, in typical Massachusetts manner, there is no competition to the Red Cross.  The Red Cross continues to raise the price of the blood and blood products without fear on competition.  Of course much to the raise was due to federal unfunded mandates.  The blood banks were mandated to use leukoreduction.       Top

Nurses

The Massachusetts Nurses Assn. has started its push for legislative relief by using ratios.  This idiotic suggestion is a follow of California's ratio law which is not yet in effect.  As all know there is a nursing shortage due to the aging nursing population, lack of educators, poor pay and very had work.  Ratios will cure none of the above.  If there are not enough nurses, hospitals will need to close beds to stay within the law.  This will impact the general population and especially the lack of beds for EMTALA cases.  There will be an increase in ED closures and ambulance diversions.  It would be more prudent to hold off until the California experiment has several years under it's belt.        Top

Malpractice

See Nevada story under Legislation.

In a recent story in the Jacksonville Times Union the issue of going bare, which is allowed in Florida, is discussed.  It is the only way many of the physicians can keep their doors open.  The Florida governor has stated that this is a top priority for his administration but the committee to recommend changes will not report until after the first of the year.  By that time the physicians will either have made the decision to go bare or pay the sky high premiums.  If they go bare it will take a toll on their office being able to take HMO patients.  Some may find their income increases because of the non-HMO patients and less money our of pocket for premiums.  This isn't only the physicians.  Hospitals are also feeling the pinch with six closing their OB services.  

Abington Memorial in Pennsylvania has notified the state that they plan on shutting their trauma service due to the  malpractice premiums of their physicians.  They will keep the center open past the December 20 deadline if the problem can be resolved.  Abington is the only trauma center in the county. 

About 60% of the Pennsylvania physician malpractice policies are to expire at the end of the year.  In Scranton, there is a fourteen person practice of seven surgeons and seven urologists that is planning to close.  This would leave Scranton Hospital with no urology and the nearest one about an hour away.  A long time if you have urinary retention and no one can insert a catheter.           Top  

Universal Health Care
Commentary

Recently, the CEO of a major California health plan came out in favor of universal health care.  A recent op-piece in the San Francisco Chronicle also recommends universal health care.  The writer believes health care is a right and not a privilege.  I believe all agree with that statement, but is it a right for all to receive the same healthcare?  Should some receive better health care than others depending on their ability to pay?  Should all get the same car or be able to get the one they can afford? Twenty years ago all received health care but some either by choice or lack of insurance went to county hospitals.  These hospitals are usually the best in the area for trauma and social services.  They have medical students and residents.  They have attending physicians who are usually affiliated with medical schools.  Now the county system is dead or dying except in areas where the States either create road blocks or do not provide adequate funding for Medicaid patients to see private physicians.  In these areas the county system continues to thrive.  I did my training at Cook County Hospital. My wife had explicit instructions that if I was ever in an accident or had something serious I was to be taken to Cook.  Yes, I had insurance and Cook County was farther from my apartment in Chicago but they had the only trauma center in the country and always had residents available in all specialties with immediate consultative abilities with attendings.  The closer and nicer private hospitals had no in-house physicians except for the emergency room and many lived up to a hour away. This is not true where I currently live.  There is a trauma center and hospital three minutes from my house.  Another major hospital is 10 minutes away.  The local county hospital, where I worked and taught, has been relegated to a jail ward and those patients who opt for the very inexpensive HMO that only allows care at that hospital and via their resident physicians.  Although it is the newest hospital in the area, it is no longer a place that offers first class care. There institution is geared to family practice training only.  If it affiliated closely with a medical school in all fields and allowed those residents and medical students to rotate through with medical school attendings, it could become an excellent hospital. Do we need universal health care?  I believe the answer is no.  I believe we need a good second tier of medicine that may even give better care in some areas of medicine than the top tier. 

While I'm on my soap box, we also do not need the VA system.  This expensive drain on medical resources should be closed and all those with true service connected disabilities should be given free Medicare and free prescription coverage with the ability to go to any provider.  The remainder of the veteran population, including me, should not be given free or even the current low cost care.         Top 

Physicians

The San Diego Union Tribune states that about 1/3 of the San Diego county physicians plan to leave practice in the next 3-5 years.  The biggest reason is early retirement due to decreased reimbursement.  Currently in is a month wait for urology, OB/GYN, neurology and dermatology.  Only 70% of the county physicians now accept Medicare and that will decline as the reimbursement is lowered an additional 4.4% next year.  Only half of the physicians accept Medicaid and that too will decrease.

California Pacific in San Francisco is planning to put a foundation in place to manage about 40 specialists who top the residency and teaching programs of the Sutter hospital.  This would help get money to these hospital based physicians.         Top

Medical Errors

There has been no significant reduction in medical errors since the disputed IOM report several years ago.  In a recent New England Journal report about 35% of the physicians polled and 42% of the public polled had experienced a medical mistake themselves.  The study stated that the best way to reduce mistakes were using systemic methods and not focusing on individuals.  However, only 23% of physicians felt that computer hospital ordering systems were very effective in reducing errors.  

The JCAHO inspected Palm Beach Gardens Medical Center in Florida after their rash of infection problems.  The Joint found no infection control problems were now occurring.  This Tenet hospital and multiple others have received or will receive targeted inspections.        Top