December 1, 2003 News

Universal Health Care







Universal Health Care

The Wall Street Journal had an article on the Canadian health care.  It extolled the virtues of the costs and benefits but did emphasize the waiting times and lack of modern technology.  Since the government purchases all equipment, it does so as the money is available.  With less equipment the waits for the tests that we get in the United States in days take weeks to months to obtain in Canada.  This also translates into elective surgical cases where the  wait may be up to two years. If one is referred to a specialist, the wait time may also be months. There is also no give in the system.  When the SARS hit Toronto last year the entire provincial system was overwhelmed which helped spread the infection.   

In an article on Yahoo, another universal health care plan is begging for equipment.  England has six PET scanners in the country.  Germany has 80 and the US has perhaps a thousand. Can you imagine if you had a lung cancer and had to wait to get a PET scan to see if it was operable or not?  It might be well to notice here that neither Canada nor England have the same type tort system as we have in the United States.   

Canada has told the United States to mind its own business.  The Canadian government has denied that any of their medications that the Americans are buying are harming anyone and it is not against the Canadian law to export the medicines.  The only thing the Canadians are worried about is that too much medication will be shipped south and the may be shortages in Canada.  To date, that has not happened.        Top


The Washington Post states that nursing is suffering because of the television program ER. A group of nurses in Baltimore is engaging in a letter writing campaign to stop showing the "misrepresentations" of the nursing profession.  They don't like that physicians are doing the nursing jobs such as talking to families and wielding the defib shock paddles.  Where are these nurses hiding?  In a busy ER, all do all jobs, no matter the title.  The group especially didn't like one nurse deserting and going to medical school, at least it wasn't law school.  It seems that the nurses who complain the loudest are those who do little if any true nursing but have become paid advocates.  I wish the nurses would get off these type matters and go on to the lack of both hospital and university training programs and the immediate need which may overshadow the four year undergraduate program requirements.

In a fascinating story the has released information regarding a convicted rapist who escaped from prison 20 years ago.  He was found posing as a nurse after stealing an identify.  He had been hired by a temp agency.  He is in jail without bond.        Top


The idiots at Oxford Health Plan saw their own stupidity and dropped the unreasonable demands for the return of money from psychiatrists whose notes were not acceptable to Oxford.  There are no standards for psychiatric notes.  In return for the dropping of the money demands the NY Psychiatric Society have agreed to work with Oxford for standardization of the notes.  Oxford audited the physicians and said the notes weren't long enough to cover an hour's session or left out medication.  The amount put down in the records depend on the psychiatrist paranoia for privacy.  They also audited a fraction of the records and stated that this applied to all the records.  

The physicians in the Fort Worth, Texas area may get fifty cents on the dollar owed after the largest IPA went belly-up.  It turned out that the money manager of Medical Select was stealing and was sentenced to eight years in jail along with return of the money and an additional major fine as well.  It would be doubtful if someone had much money left after paying the attorneys.  The doctors are receiving the money because of the D&O insurance that paid. 

The AMANews has an article regarding the theft of practice money by employees.  It is usually in a small office and the same person has been there for years.  The person is usually one who handles both the billing and receipts and the real telltale sign is that the employee rarely takes a vacation.   Doctors usually don't prosecute the defrauders and may or may not work out a deal to have a repayment plan.  The doctor also believes the CPA will catch any fraud.  Wrong! It is a rare accountant who checks the receipts that closely. One needs to ask the CPA to periodically specifically look for fraud.  Also if one uses an office credit card the bill should be sent to the physician's home and not the office.  

After the wonderful series of articles in the Pittsburgh Gazette regarding the railroading of physicians who are attempting to better care but are making waves, the Philadelphia Inquirer has an article about the "secrecy" of the peer review process.  It focuses on one physician at Hahnemann Hospital who had been under supervision and made an error on a patient.  The gist is that if the patient had known about the supervision, she wouldn't have consented to the procedure.  She sued the hospital and its chief of surgery.  The records on discovery were all public records regarding malpractice judgments and the records that the affected physician had released in his suit against the hospital.  This physician had his GI surgical and later his vascular privileges removed by the hospital.  He put a dialysis catheter in the patient's carotid artery instead of the jugular vein causing a stroke.  

In a short and meaningless follow-up article the Inquirer told about the Data Bank and how all reports to them and to the Medical Board are secret to protect those physicians who have done nothing wrong.  The article doesn't state that all hospitals must contact the Data Bank on appointment of a new physician and every two years thereafter and if something is found investigates the allegations.  

In a dumb move the chief of staff of Christ Hospital in New Jersey lent his name to an organization that opposes the tort reform sponsored by the doctors.  The medical staff was so incensed at this that they voted him out of office.  The head of the consumer's organization (read trial lawyers) blasted the medical staff action and stated he will ask the state to investigate the legal action of the medical staff. The chief of staff does have a first amendment right to speak his mind but also has an obligation to take the consequences for his views.   

Governor Schwarzenegger has proposed a huge cut in spending for California.  This includes an additional 10% cut in MediCal payments to physicians over and above the current planned 5% cut this year and the additional 5% cut next year.  This should take all physicians out of the program except those working for county hospitals.        

However, the newly passed Medicare Reform Act will give physicians instead of a 4.5% decrease in compensation a 1.5% increase. Not much, but better than a kick in the rear. 

The Modern Healthcare has a special report on peer review in community hospitals where the big producer physicians need peer review but it's not happening due to the economic pressure.  It article stresses that good CEOs will go along with needed peer review on these physicians.  The problem is that many physicians live off the scraps of the big money makers and they will look for ways to let him/her off.  The article doesn't mention the flip side.  There are hospitals that have "special relationships" with certain physicians or groups and will go after their competitors if asked to by the groups. I have been involved with some of these cases where a good physician has been targeted for being an economic competitor of the favorite group.        Top


Santa Paula Hospital has had its last hope for help declined. Ventura's Community Hospital has declined to aid Santa Paula due to its own problems with money.  Community has had its money problems since its ill fated attempt at the coup over the medical staff.  The surgeons took cases to other hospitals.  Santa Paula is now back to working with the city administration or closing. The city council has agreed to pay the grand total of $15,000 toward a  mediator in the impasse.  

At the infamous Community Hospital in Ventura, California, the hospital's medical director has gone the way of the CEO; out the door.  The Medical Director resigned to help quell the war at the hospital.  He will stay on for a short time as as director of the clinics and then return to private practice.  The new medical director is a 73 year old former chief of the medical staff.  The next to go is the hospital attorney, who has been left out of all negotiations to return the money stolen by the hospital and reverse the code of conduct.  The leader of the hospital opposition was awarded the physician of the year honor by the medical staff.  The Eastern law firm has been quiet.  Have they been fired?

Winona Memorial Hospital in Indiana had a inspection by the state health department and JCAHO.  The inspection followed the resignations of the medical staff executive committee for concerns about patient safety.  The physicians have complained about patient care issues to the organizations.  The CEO stated that following the inspection he was told by the JCAHO that there no significant patient care safety concerns. The Department of Health was still inspecting.  Also the hospital lost its director of nursing and its infection control nurse over patient concerns.  The hospital has significant financial problems running a census of about 25 percent. The hospital has been accused by the physicians of running out of supplies due to unpaid bills.  The hospital is a for profit owned by Leland Medical Centers in Texas.  This sounds like a death spiral for the institution.  

Yale-New Haven Hospital was sued and had terrible publicity regarding its policy of placing liens on home of patients who do not pay their bills.  The hospital is response to all the negative publicity has announced that it has withdrawn most of the liens and hired a new collection agency.  

Brigham is attempting to hire a surgeon to head its heart program but they have a hard time paying the surgeons what they are already making.  The difference may be up to $450,000.  Harvard, the school who runs Brigham, also has an unrealistic salary cap of 4% per year on physician salaries.   

Another person has died while undergoing stomach stapling.  The patient was a nursing assistant and died a half hour into the laproscopic surgery.  The hospital, Roger Williams Medical Center in Rhode Island, states that this is the third death among 340 gastric stapling surgeries done at the hospital over the past three years.  The hospital has suspended all gastric stapling procedures at the hospital. The cause of the death is pending the autopsy results.  A month ago Boston's Brigham Hospital stopped the laproscopic procedure after a death there secondary to a faulty stapler. 

There is a war for emergency angioplasty in Connecticut. The state has a policy currently that only 7 of the 31 acute care hospitals in the state can do emergency angioplasties.  The doctors in some hospitals follow their patients after doing caths and do the angioplasties at the approved hospitals.  The money for the approved hospitals is huge, with the government paying an average of $12,000 per procedure to the hospital.  The state Health Care Access Chair abruptly resigned and the Governor wants someone in the position who will be more lenient to granting the hospitals permission to do angioplasties.  Now the patient gets diagnosed at a local hospital and is then transferred to an approved hospital for an angioplasty.  Since the state is so small most hospitals with privileges are within one hour of referring hospitals.  However, this does not take into account the length of time necessary to get the patient ready for the transfer nor the time at the receiving hospital to get the patient ready for the angioplasty. This should be an interesting political battle to watch as to if any other hospitals get the privilege and what system they belong to.  

Blue Cross has decided not to pull the contract from Doctors Medical Center in Modesto, California.  It originally decided to pull its entire contract due to the assertion that the hospital, owned by Tenet, was performing unnecessary heart procedures.  The hospital has agreed to tighten it's internal oversight of the cardiac program, which led to the agreement with Blue Cross. 

In Milwaukee, Wisconsin, the MedCath Heart Hospital has been up and running for one month.  Most of the patients of the MedCath Hospital are Medicare since it is JCAHO accredited. The usual insurers have not given it a contract either due to the high rates or pressure by the full service hospitals.  Humana will not give it a contract but will give another specialty heart hospital owned by a hospital a contract.  This may be illegal tying under the Federal Antitrust laws.    

In the new Medicare reform Bill, there is a 18 month moratorium in any new physician owned but not hospital owned specialty hospitals.  The moratorium began on any hospital that had not begun by the start of the legislation.  This is a major victory for the AHA, but the war is not yet won.  

Greater Southwest Community Hospital in Washington, DC, will be auctioned off to satisfy debtors in bankruptcy.  Part of the auction will be to have the insiders who "borrowed" money return the money.  The borrowers did not want that to happen. This may be the only way to salvage this turkey of a hospital to live another day.  It has had its ability to be a hospital removed by the Department of Health and at one time had its accreditation removed. 

An article in Modern Healthcare describes the new practice in some hospital emergency rooms of after a medical screening exam and showing the patient has no true emergency, the emergency room asks for money from the uninsured prior to treatment. They also have the patient talk to financial counselors prior to leaving. In some hospitals this is the only way they can stay open and provide the necessary services.  Minor medical care is not considered a necessary service.  As the word gets out about these hospitals, the minor ailments are not coming and there is more time for those who truly need the care.           Top 


The Institute of Medicine has never been known to be practical.  They continue.  The Institute recommends all doctors, hospitals and pharmacies use electronic medical records. The information would be placed on a secure server (if there is such a thing) and the information be disbursed when necessary for patient care.  They also recommend the government set the standards but not tell all medical providers what to buy.  This is a noble suggestion but will never happen.  With reimbursements down and Medicare cutting an additional 4.5% next year and expenses, especially malpractice insurance premiums, up there is no money available for the recommendation.  If the IOM wishes to fund the costs for EMR then it is wonderful.  If not, then have the intellectual honesty to state that this is a pipe dream.        Top


The usual suspects, physicians and attorneys, are at it again in Ohio.  The physicians are continually being hit with larger malpractice payments.  The two sides held a debate in Cleveland attended by about 700 people. The physicians call the meeting and their agenda is to put malpractice into the hands of a special court and a recognition of the fact that malpractice is more s systems error than an individual physician error.  The attorneys blamed the insurance industry and their faulty investment strategy of the past several years.  

Pennsylvania, who enacted the sham malpractice reform earlier this year, is now showing their true nature.  They are getting billed not only for next years premiums but also for this years Mcare premiums. The repeal of the premium was promised last year by the Democratic Governor.  He lied.      Top


California Blue Cross has offered a new product that to date is looking for buyers.  They are offering a 15% discount to large employers who sign up for the plan.  The problems is the plan only uses physicians that are "cost efficient" ( read as cheap or rationing of care). This is about half of the usual number of physicians.  They have not gotten the idea that cheap does not equate into quality and that people want choice, not restriction.  The benefits will be about the same as the normal HMO plan, not much.  Two of the three largest IPAs in the Bay Area are not cheap enough.          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.