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The Colorado HMO enrollment and the profits have dropped in the past year. The insurers lost about 100,000 consumers in the past year and had a 27% decline in profits. This shows the trend in the state and the nation away from the rationing of the HMOs to the more consumer friendly modes of insurance. It is interesting to note that about half of the total HMO profit in Colorado came from one HMO, Kaiser. Kaiser's profit had decrease in the past year by about $12 million but their enrollment was up 1.9%.
Blue Cross in Alabama has stopped paying for gastric bypass surgery for morbid obesity. The insurer has taken comments on it's proposed decision and then will come to its final decision. They will probably require strict attempt at dieting first and allow the surgery only after all else has failed and are then sued by the patients. It is a risky surgery with about a 1-2% mortality rate but the diseases it treats have a 100% mortality rate.
The Midwest division of Anthem will soon require again the dreaded pre approval process for outpatient, MRI, CT or Cardiac nuclear study. The rationing come as the HMOs are having a reduction of membership but a rise in profits. Top
If it's a new edition it Drew/King. This time it's good news. The Board of Supes in LA have finally voted to close the trauma unit and have put in a proviso that if possible after all problems have been corrected they will revisit the issue. The Board also took the first major step in putting an across the board raise of 9% for all nurses working for the county plus a special bonus of 10% providing they have clear records with no complaints or bad evaluations. This is an attempt to decrease the numbers of travelers at the hospital.
Several weeks after the Board of Supes did their thing, JCAHO did theirs. They have withdrawn the hospital's appeal of their denial of accreditation. When the loss of accreditation becomes final, they will no longer be eligible for federal funding and may also lose their ability to get private insurance as well. The hospital will apply for re-accreditation in February. The main Supe showing her ignorance stated she hoped the Joint would delay the denial for a year to allow the hospital to right itself. The Joint stated they don't go on promises. This would be especially true coming from this person.
The LA Times has a series on the foul-ups at Drew/King. In one a pathologist had made multiple mistakes. These were caught by the other hospital pathologists and reported to the proper authorities including the noble councilwomen from the district. Nobody did anything and the pathologist continued to practice until he resigned. He is currently a pathologist in San Antonio Baptist Hospital. The LA hospital never did a through background check when he was hired.
The following article blasted the ineptitude in the Orthopedic, pharmacy and nursing areas. It named names and specific terrible incidents which were covered up by the administrators and ultimately by the LA County Board of Supervisors.
CMS has certified a new specialty hospital may proceed since it was underway prior to the moratorium was in place. The proposed hospital is unidentified. There are still about 37 other requests under review.
MedPAC, the reviewer for specialty hospitals, will recommend the end to the "whole hospital" exception which will eliminate all the non-grandfathered specialty hospitals. The recommendation will be voted on later in January and then go to Congress. Other notable draft recommendations released today include a proposal that Congress establish pay-for-performance incentives for hospitals, physicians and home health agencies.
MedPAC continued with a recommendation that Medicare reduce physician physician payments by 0.8% under projected inflation in 2006. The reason is the lack of physicians were leaving Medicare or there was an access problem. Fortunately Congress does not have to and many times does not accept their recommendations.
The AMA in it's winter meeting has voted to go on record as against the specialty hospital moratorium. This puts them at odds with the AHA and sets up a major lobbying brawl between the two.
The sixth Virginia hospital, this one in Emporia, has decided to shutter its OB service. They have only one OB to care for the patients and the hospital delivers about 200 babies a year. There was a second OB but that one left due to the small number of deliveries and the rising malpractice premiums. The last OB is working to get hospital privileges in North Carolina.
Maryland hospital laboratories are back in the news. Remember Maryland Hospital had the problem with dry labbing. Now Good Samaritan and Union Memorial of Baltimore are both on the chopping block. Good Samaritan has been accused of failing to follow up on their mislabeling of blood bank blood. Union Memorial didn't timely review transfusion reactions and didn't have any process to evaluate and remedy lab complaints. This, as with the Maryland Hospital problems, followed an accreditation visit by the College of American Pathologists. It sounds like they are taking a page out of the JCAHO book with sloppy work.
In Florida St. Mary's of Palm Beach has been warned for the second time to clean up it's act or be removed from Medicare. The feds accuse the hospital of patient safety violations stemming from a patient suicide. The hospital created a corrective action plan and was revisited to determine the validity of the plan. Earlier in the year the hospital was under scrutiny for failure to provide neurological care to ED patients. Top
The Georgia legislature is afraid of national malpractice reform so they are being lobbied by "consumer groups" to have any physician with three judgments have their license revoked, require public reporting of all malpractice incidents even before the case went to trial, have victims of malpractice and their attorneys go to any hearing on the physician's license to give a victim impact statement. The "consumer groups" have not yet gotten any legislators to carry their "bill".
A father of a bad baby plus the trial attorneys have collected 200,000 signatures for an initiative. The initiative would revoke the license of any physician who has three malpractice judgments against him in 10 years for preventable medical injuries and bad secret settlements.
In Maryland, the Governor has rejected all proposed options for reducing the 33% increase in malpractice payments that the physicians now need to pay. The Governor wants a broader solution. However, there does not seem to be any way there will be a special session of the legislature called by the President of the House and Senate, both Democrats and lawyers. Top
In Pennsylvania, a large amount of independent OB practices have joined together into a fully integrated group. They hope to be able with this group obtain cheaper insurance and attract new physicians into the area. There was a unification of 14 practices consisting of over 40 OBs. They have integrated their billing and hope to be able to be offer research to the large amount of women in their practices.
An article in the Sacramento Business Journal has nailed a current problem, peer review. They state that peer review can and is used for economic reason as well as the correct reasons of taking care of patient care. There is a current lawsuit before the California Court of Appeals by a physician against Kaiser for wrongful peer review has opened the process to public scrutiny. The suit states that the local chief of staff, who initiates the peer review also picks the panel that will review the physician. In Kaiser the physicians are also the shareholder ad have exclusive contracts to only work for the Permanente Medical Group. The process is now being used for a sword to get rid of troublesome physicians and those who have economic interests adverse to the hospital. The current case is one of accused harassment followed in two days by denial of privileges by the same physician who was complained of in the harassment. The physician was then accused of eight problem cases. She wanted a neutral review of the cases and offered to pay for them. She was denied this and refused to go through peer review without the neutral case review. Kaiser lost the first round as the trial judge stated that the physician was denied any viable administrative remedy on a timely basis. The judge also stated that a hearing officer who works for Kaiser may have a financial motive to support the employer's position. All are now waiting the Appeals Court decision.
In Washington, D.C., a group of physicians are taking on the local Blues for their shoddy practices. The insurer admitted to problems and the Insurance Commissioner has stated that if the insurer hasn't fixed the problems by spring, he will make them do it. The problems are paying electronic claims slowly and denials for timely filing despite proof the physicians did file timely.
There has been a recent report showing the major differences between large medical groups (over 50 physicians) and small groups or individual practices in the IT arena. The problem is money, where the small groups have none to spend for the computer equipment. The national coordinator for health information technology at HHS realizes that most of the care in the country is by small groups or individual practices and these are the ones that need to be supported.
Clark County Nevada has approved a bonus plan for physicians based on the number of patients an hour they see in the county urgent care clinics. The county has deleted longevity pay and cost of living increases to have the money for the productivity pay. The physicians must see a minimum of 2.8 patients per hour and 2.5 patients per hour for primary care physicians. The primary care physicians who see three an hour over a three month period will get $250 and those who see four or more will receive a $5000 bonus.
Regional Medical Center in the St. Petersburg, Florida, area has been busy. They have suspended the cardiac cath privileges of nine physicians on their staff. The were obviously done for quality of care considerations. The hospital states it is "to enforce established guidelines for medical documentation, to improve device selection and utilization, to implement the latest pharmacotherapy guideline, and to develop and implement clinical protocols for certain procedures." The hospital had outside experts review the work done at the hospital prior to the action. There remains 16 invasive cardiologists on staff. I think their peer review committees will be busy for many years to come.
The physicians are squabbling over the crumbs. A report at the recent Radiological Society of North America blasted the specialists, especially the Cardiologists, for their self referring of imaging studies. The report said the self referring in the offices are a major driver of the rapidly increasing utilization and costs of diagnostic imaging in the healthcare system. The report also went after the CT and MRI studies done in the orthopedic offices. The radiologists don't like losing their bailiwick. The American College of Cardiology responded by pointing out it is the loss of their market share the is bumming out the radiologists with the loss of money. The American College of Radiology is now proposing a rule for the doing and interpreting these lucrative studies. The rule will be slanted towards their pocketbook.
The AMA reports that the state medical boards are increasingly checking the criminal backgrounds of new applicants. To date about 12 states have the authority to conduct criminal background checks. Most physicians don't disapprove as it may increase patient safety. The problem happens at the hospital level where they do the checks every few years and charge the physician for the check. The main thing is the time involved for these checks and the costs for the hospital or state. Top
The State of California and the University of California Hospitals have worked out a Memorandum of Understanding to allow the state access to the hospital's cancer statistics. The MOU also stated that no one from the state would contact any person given to them for 60 days to allow the hospital to make sure the patient had learned of the cancer diagnosis. I am not sure that this MOU holds for the remaining hospitals in the state.
The University of California at Davis has screwed up big time. They gave out about 200 patients. They put out a email questionnaire but linked it to a page with the information of the other people being asked. The University had not done the survey but another subcontractor hired another subcontractor who did the screw up. Top
Those seniors that panicked when told their was a shortage of flu vaccine are now no where to be found. There is now additional doses and nobody to receive them. Top
Starting on the first of the year the US Immigration Service will remove a shortcut that has allowed foreign nurses to enter the US. This will greatly prolong admission into the country and increase the shortage of nurses. The present 60 day waiting period may turn into three or more years. 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.