December 15, 2008 Recent News





Peer Review


The Boston Globe reports that physicians are quitting giving vaccines due to losing money on each one given.  The Globe reports that one in ten physicians are refusing to give the costly injections.  This happened in the 1980s as well and led to an increase in measles with over 100 deaths.      

The New York Times had an article regarding physician "disruptive conduct" and the JC standard.  The JC stated that it was the medical equivalent of road rage.  It is hard to condone the behavior of some physicians and those deserve to be helped.  However, it is the use of the phrase "disruptive" by the JC that is so vague as to be useless.  It is imperative to place to JC standard as it applies to physicians in the medical staff bylaws and the same language as it applies to administrators and nursing in the hospital bylaws.  

The Washington Post had an article about how patients are starting to have a harder time finding a primary care physician to see them if they have Medicare and can not find one with Medicaid.  The proposed rate decrease of about 20% for physicians next year is not helping the problem.  It is easier not to take the patients then to tell them you are cutting back on Medicare and please find a new physician.  The statistics are that about 30% of patients are have difficulty finding new primary physicians taking Medicare. A study by the AMA states that 60% of primary physicians will stop taking Medicare if the proposed cuts in reimbursement go through.         Top


Newsweek has an article stating that the poor economy has the possibility due to less people working and paying into the system to have Medicare go broke during Obama's time in office.  This would take money from the general fund to pay for healthcare.  Of course, the politicians will not act early and we will pay the price later.  

Obama and the Democratic leaders are planning a new stimulus package for early in the new session.  The package is to include healthcare reform in the manner of increased Medicaid spending and increased medical IT.  Obama is looking to ex-Senator Daschle, the new nominee for the head of HHS and a new White House position of Health Reform to shepherd the bill. The new Board  would have members nominated by the president and be confirmed by the Senate.  The Republicans still have at least 40 Senate seats. Just think, Obama's Illinois could break a record having two governors in jail at the same time, one from each party.

UnitedHealth has a new insurance gimmick.  They are taking your premiums for a policy that will allow you to buy a health insurance policy from them at any time in the future while your initial policy is in force. This is aimed at people who are currently insured and are afraid they will lose their insurance. People who currently are ill are not eligible for the new insurance which costs about 20% monthly of the current premium.  

Bloomberg has hit the nail on the head.  EMR and on line prescribing is being pushed by insurers and those who profit monetarily from the switch.  To date about 25,000 of the 500,000 physicians in the country use electronic prescribing.  CMS is planning on paying a huge carrot of 2% increase in payments if a physician goes to the electronic format that will cost the physician over $10,000 and will not include triplicate prescriptions.  The stick is if a physician sees the folly in the deal, CMS will take away 2% in two years. Bloomberg reports that the reason more hospitals and physicians are not flocking to electronic records and prescriptions is that they never see the savings.  It is all kept by the insurance companies.  

AHRQ reported on an article in the Archives of Internal Medicine that discussed the amount of money insurers save with EMP.  Insurers can save almost $1 million if their physicians use electronic prescribing.  The prescribing is attached to a formulary that shows the beauty of generics.  (However, the physicians will lose time and money in using the electronic prescribing.)  

In Medical Tuesday there was an article talking about physicians in the old days coming out into the world and getting paid fee for service.  This made the patient in charge of his money spending.  The physicians donated their time to county hospitals and helped train other physicians.  Those patients who could not afford care went to these county hospitals and received excellent care.  Physicians also donated their time to take care of patients in their offices who could not afford care.  Then came Federal (socialized) medicine in the form of Medicare and later Medicaid.  These caused the largest inflation in healthcare costs in the world.  Hospital construction increased to care for all these new insured patients and of course the hospitals had to pay for the construction so they charged more.  With more for the hospital there was less left over for the physician and all charity care went out the window.  Now with the recent push for quality health more tests than ever are being ordered at an ever increasing rate and cost. Bureaucrats feel physicians are not doing quality procedures so there is now more cost added with little improvement in quality.  The new proposed HHS Secretary is considering lowering the age of Medicare to 55 therefore increasing the cost to society and giving more people incentive to quit work early, leaving less to pay for Social Security and Medicare.  This will cause the crash of both systems.  Something to think about.  

The dictator of Zimbabwe has ordered the physicians and nurses protesting the lack of healthcare in the country to be disbursed.  The police charged into the protest group and arrested several people.  Rogue elements in the country were blamed for the disturbances.  Be thankful you live here where peaceful protests and opinions are permitted.   Top


The Delaware Department of Insurance has mailed out personal medical information to the wrong people insured by Blue Cross.  They have apologized and asked the people who received the other person's information to please shred it.  No social security numbers were sent.        Top


The Advisory Board is warning hospitals that the largest competitive problem is in physician owned radiology units.  Radiology units grew in the hospital in the last eight years by one percent but by over 50% in the physician community.

One way to take care of the competitive problem is to buy the competitor.  Aurora Health in Wisconsin just bought a stake in the physician owned Surgical Medical Specialists, a n ambulatory surgical center.  The hospital system hopes to entice the physicians to utilize their hospital system and allows the private physicians access to referrals from the captive physician employees.

In an interesting turn in the People's Republic of Massachusetts, the mayor of Boston is forming a committee to get the non profits of the city to pay something in lieu of taxes.  I wonder what will happen when the Republic wakes up and thinks about how much charity care is now being done at the hospitals that are non profit.  All the patients are now insured. 

There are more hospitals in financial difficulty.  Boca Raton (Florida) Community Hospital is so far in debt in needed to borrow 73% of its Foundation money just to keep its doors open.  Most of the money was lost in its misplaced attempt to build a teaching hospital.  It's the Peter Principle.

Park Nicollet Heath Services in Minnesota is cutting 600 jobs due to failing business and rising bad debts.  This comes soon after rival Allina Hospitals had hundreds of layoffs. 

Beaumont Hospitals in Michigan is postponing a $60 million cancer center, asking execs to take a pay cut and freezing jobs.  The system is facing a $60 million shortfall.

Loyola University Medical Center in Maywood, Illinois is cutting 200 jobs.

Clarian Health in Indiana is also cutting jobs to get 5% less in operating expenses.

The only hospital in Clayton County, Georgia, is $40 million in debt and if it doesn't get a bond from the county by the end of the year will need to close.

The Wall Street Journal had an interesting story of Mt. Sinai Hospital in Chicago.  It has maintained its charitable mission that has been forgot by most non profits.  They have gone between a small profit and a $15 million loss in various years.  Only 10% of its population is insured and 72% has Medicaid.  The hospital was threatened by CMS to either upgrade its sprinkler system for $8 million or lose funding.  The state had to loan the hospital the money.  Advocate Health Care closed the only other hospital in the area which almost doubled the admissions to Mt. Sinai's ED.  Mt. Sinai spends about $16 million a year on charity and about the same amount to pay specialists to work at the hospital.  The hospital gets paid less than rich University of Chicago does to treat Medicaid patients.  How long before this hospital closes as well and leaves the area with no hospital.       Top

Peer Review

The same two attorneys who wrote about the peer review in the Recent Legal section of the last newsletter have another article.  This one is on "precautionary suspension".  It basically states that there is no such thing as precautionary suspension and it is the same as any other suspension with the same reporting requirements as summary suspension.  It warns hospitals that some states have strict reporting rules and if they do not follow through the non-reporters can be fined or more.


  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.